Spatial Healthcare Accessibility: A District-Level Analysis of Travel for Outpatient Diabetology in Czechia.

Assessments of regional differences in the accessibility and capacity of health services often rely on indicators based on data from the permanent residents of a given region. However, a patient does not always use health services in their place of residence. The objective of this article is to evaluate the influence of spatial healthcare accessibility on regional differences in the provision and take-up of health services, using outpatient diabetology in Czechia as a case study. The analysis is grounded in monitoring the differences in the patient's place of residence and the location of the healthcare provided. Anonymized individual data of the largest Czech health insurance company for 2019 are used (366,537 patients, 2,481,129 medical procedures). The data are aggregated at the district level (LAU 1). It has been identified that regions where patients travel outside their area of residence to access more than half of their healthcare needs are mostly in local/regional centres. Moreover, these patients increase the number of medical services provided in local/regional centres, often by more than 20%, which has been reflected in greater healthcare capacity in these centres. To assess regional differences, it is important to take the spatial healthcare accessibility into account and also consider why patients travel for healthcare. Reasons could be the insufficient local capacity, varied quality of health services or individual factors. In such cases, healthcare actors (health insurance companies, local government etc.) should respond to the situation and take appropriate action to reduce these dissimilarities.