Estimation method for distance cost to access medical services: Policy and patient privacy implications in Taiwan

Indicators of healthcare access with high reliability, validity, timeliness, and easy application can aid in an understanding of the supply and demand of a region's medical resources and assist governments in allocating resources more effectively. However, a key concern when developing indicators is the protection of private information, such as patients' residential addresses.

We develop an estimation method for distance cost using official public information, including a region's disease prevalence rates and population.

The method accounts for patients' privacy and addresses limitations associated with using the National Health Insurance Database. This cross-sectional study conducts a secondary data analysis using SPSS and QGIS. The data were divided into a validation group and an index development group with the medical distance calculated for each group. Data for the validation group were sourced from the medical records of patients with diabetes (n = 108-164) and hypertension (n = 243-348) in Yuli documented by a medical center in 2017-2019, and the data for the novel index development group included diabetes and hypertension prevalence sourced from national official public data. The study compared the consistency of the two groups' medical treatment distances to verify the accuracy of the estimation method.

The estimated distances for the index development group showed a high consistency (ICC > 0.9). Further, the index development group had an excellent R-square after adjusting for age (98.1%) and gender (92.7%).

The proposed method to estimate healthcare on the basis of disease prevalence and population protects patient privacy and can be implemented by local governments.

This study was approved by the Research Ethics Committee of the Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation (IRB109-239-B).