Migration and Health Care Utilization: An Empirical Analysis of the Impact of Migrants on Hospital Congestion in Italy.

Abstract: The effect of migrants on public health care in the host country is an important component of the economic and political discourse about immigration. Lack of familiarity with the healthcare system and systematically different health status may drive patients of foreign origins to crowd medical facilities, affecting the quality of service provision. Using a Difference-in-Differences fixed effect model, this paper investigates whether province-level migration in Italy creates congestion in the treatment delivery, measured by the number of visits to emergency rooms, hospitalizations and utilization of hospital beds. To alleviate the concerns of omitted variable bias, the paper further adopts an IV strategy based on a spatial allocation model of migrants' penetration. After assessing the robustness of the results, the paper concludes that, ceteris paribus, migration has a negligible impact on overcrowding in health care. No effect on emergency departments and beds' utilization is detected, while a slight increase in hospitalizations cannot be excluded. Based on the empirical evidence, policies aimed to strengthen migrants' knowledge of the healthcare system, while possibly enhancing the wellbeing of this category of users, would have limited impact on overall resource utilization.