  Motivated by reasons such as altruism, managers from different hospitals may
engage in cooperative behaviours, which shape the networked healthcare economy.
In this paper we study the determinants of hospital cooperation and its
association with the quality delivered by hospitals, using Italian
administrative data. We explore the impact on patient transfers between
hospitals (cooperation/network) of a set of demand-supply factors, as well as
distance-based centrality measures. We then use this framework to assess how
such cooperation is related to the overall quality for the hospital of origin
and of destination of the patient transfer. The over-dispersed Poisson mixed
model that we propose, inspired by the literature on social relations models,
is suitably defined to handle network data, which are rarely used in health
economics. The results show that distance plays an important role in hospital
cooperation, though there are other factors that matter such as geographical
centrality. Another empirical finding is the existence of a positive
relationship between hospital cooperation and the overall quality of the
connected hospitals. The absence of a source of information on the quality of
hospitals accessible to all providers, such as in the form of star ratings, may
prevent some hospitals to engage and cooperate with other hospitals of
potentially higher quality. This may result in a lower degree of cooperation
among hospitals and a reduction in quality overall.
