Objectives: Although people use health services throughout their lives, there are important differences in timing, location, and frequency of utilization. The aim of this article is to identify and explain these differences in terms of healthcare accessibility.Methods: Outpatient health services—diabetology, cardiology, and psychiatry—are analysed using anonymized data from the General Health Insurance Company (GHIC) in Czechia for 2019. Healthcare utilization is studied in relation to selected geodemographic characteristics—patient’s age, sex, place of permanent residence, and location of healthcare provision.Results: The analysis found significant differences in the utilization of the selected health services in terms of age, sex, and size of the patient’s municipality of residence. Generally, men tended to travel outside their municipality for healthcare more than women. Young patients were more likely (and also further) to travel outside their municipality for healthcare than older patients.Conclusion: The reasons for this were the location of the health service provider (mostly concentrated in local/regional centres), the patient’s ability and willingness to travel for healthcare, and differences in the patient’s permanent and ordinary place of residence.

In Czechia general practical medicine represents the bulk of basic primary healthcare both in terms of the number of doctors and the range of services provided. For the healthcare system to function effectively as a whole requires sufficient capacity and the even distribution of providers across the country. As observed throughout Europe, a key risk is the age structure of the general practitioner population, with most of the capacity being provided by older practitioners, which could affect overall primary care access in the future. In Czechia, the general practitioner age structure is skewed, with the proportion of older age groups continually increasing. This article analyses changes in selected indicators of the number, capacity and age structure of general practitioners at the regional level in 2010–2019 and identifies regions where general healthcare access may be at risk. These areas are often rural and, as the specially created municipality typology shows, the pace of change differs along an urban vs rural line.

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.

Background Diabetologists, as other specialists, are more likely concentrated in towns and cities rather than in the countryside so the people who live in these municipalities have a wider supply of health services. Our aim is to determine whether there are significant differences in the use of diabetology services between patients who live in the municipality with these services or not in Czechia. Methods The sorted anonymized data obtained from the General Health Insurance Company of the Czech Republic (GHIC CR) were used. The studied patients were people with a diagnosis of type 2 diabetes mellitus (E11) who were insured by GHIC CR and used health services in 2019 in Czechia. Results The distribution of providers of diabetology services (PDS) is relatively even throughout the country, and PDS are mainly concentrated in the municipality with a large population. In total, 52% of patients have the diabetologist in their municipality of residence. Patients living in the municipality with PDS have greater odds of using their services (OR 1.63, Cl 1.61-1.65). Specifically, 67% of the patients who have the diabetologist in their municipality of residence use diabetology services compared to 55% of the patients living in the municipality without PDS commute for diabetology services to the other municipality. Conclusions The results show that diabetology services are concentrated mainly in towns and cities and patients living in the municipality with the diabetologist use more diabetology services compared to patients living in the municipality without them. At the same time, it seems that more than half of the patients in the municipality where is not PDS are willing and able to commute for diabetology services. Key messages • Although patients living in the municipality without the diabetologist use diabetology services less often than with them, due to the commuting for healthcare, the differences are blurred.

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