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.论文补充数据集： 《距离悖论：集中化公共医疗体系中的空间能动性（Spatial Agency）、患者流动性（Patient Mobility）与癌症死亡率》 摘要 传统上，肿瘤医疗服务的地理可及性（Geographic Accessibility）以距离衰减效应（distance decay）为建模框架，该框架假设更重的出行负担会系统性延误诊断、割裂治疗路径并损害生存结局。然而，这一“距离摩擦（friction of distance）”假说仍存在争议，尤其在患者拥有充分医疗机构选择权且医疗费用由公共财政覆盖的医疗环境中。本研究以匈牙利——一个患者选择权较高的欧洲单一付款人集中化医疗体系国家——为研究对象，探讨患者流动性、出行负担与癌症死亡率之间的复杂关联。 本研究分析了匈牙利175个行政区的全国行政医疗与死亡率数据，量化了肿瘤医疗服务利用模式，计算了人口加权出行负担，并评估了其与标准化死亡率比（Standardized Mortality Ratio, SMR）的相关性。 研究结果与“距离悖论”相符：在全国行政区层面，更高的人口加权出行负担与癌症死亡率升高并无显著关联。近三分之一的临床肿瘤治疗事件涉及跨原籍县就医，或绕过本地区域医疗中心选择前往远端学术型或高诊疗量医疗中心，这表明患者的流动性模式符合就医寻优行为，而非单纯规避距离。在首都周边郊区（佩斯县，Pest County）观察到一个关键的区域例外：该区域内更重的出行负担与社会经济弱势状态叠加，这表明当流动性源于结构性必需而非自主选择时，距离可能会产生不利影响。这些研究结果凸显了医疗基础设施与患者能动性之间的相互作用，表明在公共资助的医疗体系中，只要出行是自主选择而非结构性必需，患者的出行自由可缓解通常与地理位置偏远相关的空间劣势。 关键词：健康地理学（Health Geography）；癌症结局（Cancer Outcomes）；距离悖论（Distance Paradox）；空间可及性（Spatial Accessibility）；患者能动性（Patient Agency）；单一付款人体系（Single-payer System）；中欧（Central Europe）；匈牙利（Hungary）