The Distance Paradox: Spatial Agency, Patient Mobility, and Cancer Mortality in a Centralised Public Healthcare System

Supplementary Datasets for the Manuscript: The Distance Paradox: Spatial Agency, Patient Mobility, and Cancer Mortality in a Centralised Public Healthcare System Abstract Geographic accessibility to oncology care is traditionally modelled through the lens of distance decay, where greater travel burdens are assumed to systematically delay diagnosis, fragment treatment trajectories, and compromise survival outcomes. However, this “friction of distance” hypothesis remains contested in healthcare settings where patients possess substantial autonomy in provider selection and where the financial costs of care are publicly covered. This study investigates the complex relationship between patient mobility, travel burden, and cancer mortality in Hungary, a European nation with a single-payer, centralised healthcare system characterised by high patient choice. Analysing nationwide administrative healthcare and mortality data across 175 administrative districts, we quantified oncology care utilisation patterns, calculated population-weighted travel burdens, and evaluated correlations with standardised mortality ratios (SMR). Results are consistent with a “distance paradox”: at the national district level, higher population-weighted travel burden was not significantly associated with increased cancer mortality. Nearly one-third of clinical oncology treatment events involved care outside their home county or bypassed local regional centres in favour of distant academic or high-volume centres, indicating a mobility pattern consistent with access-seeking behaviour rather than simple distance avoidance. A critical regional exception was observed in the suburban region surrounding the capital (Pest County), where greater travel burden overlapped with socioeconomic disadvantage, suggesting that distance may become harmful when mobility reflects structural necessity rather than choice. These findings highlight the interplay between healthcare infrastructure and patient agency, suggesting that in publicly funded systems, the freedom to travel may mitigate the spatial disadvantages typically associated with remoteness, provided that travel is a choice rather than a structural necessity. Keywords: Health geography; Cancer outcomes; Distance paradox; Spatial accessibility; Patient agency; Single-payer system; Central Europe; Hungary.