{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T20:53:26Z","timestamp":1793307206958,"version":"4.5.0"},"reference-count":43,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Med Internet Res"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Patients inevitably incur some cost for accessing health care, even in universal systems such as Canada. The COVID-19 pandemic dramatically shifted health care delivery from in-person to telehealth services, also shifting the proportion of costs offset by patients and their families by reducing the need to travel to in-person appointments.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to develop a method for estimating the costs patients and their families incur and CO2 emissions attributed to travel needed for emergency department (ED) visits, hospitalizations, and physician appointments.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We present a method to evaluate the costs associated with in-person and telehealth care appointments from the perspective of patients, their families, and the environment. We used ED locations, road distances, and duration of appointment to account for costs paid by patients (ie, lost productivity, informal caregiving, and out-of-pocket expenses) attributed to travel to receive medical care. Costs to the environment were evaluated by calculating the amount of CO2 emitted per medical visit. Using our costs calculated per visit, we apply our method to calculate total patient costs for a simulated population over 1 year.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Our method estimates that patients in British Columbia pay up to $300 (2023 CAD, CAD $1=US $0.86) on average to attend an in-person ED visit, depending on where they live; $166 may be attributed to lost productivity, $83 to informal caregiving, and $50 to out-of-pocket expenses. These estimates are higher than most observed cost estimates. In addition, avoiding in-person care diverts up to 13 kg of CO2 per medical visit, depending on the distance and frequency of travel to appointments. This translates to up to $0.70 in carbon costs per visit, or cumulatively $44,120 per year in British Columbia, conventionally not included in patient cost estimates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>We present a novel method for estimating patient-incurred costs and CO2 emissions from accessing health care and apply it to estimate that every year, patients in British Columbia pay upwards of 30 million dollars to access health care services, primarily for medical travel. Our method adds to the economic evaluation literature by providing a more comprehensive and context-modifiable calculation of patient costs that will allow for more informed decision-making regarding health care services.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2196\/56766","type":"journal-article","created":{"date-parts":[[2024,12,9]],"date-time":"2024-12-09T16:33:51Z","timestamp":1733762031000},"page":"e56766","source":"Crossref","is-referenced-by-count":7,"title":["Estimating Patient and Family Costs and CO2 Emissions for Telehealth and In-Person Health Care Appointments in British Columbia, Canada: Geospatial Mixed Methods Study"],"prefix":"10.2196","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-0027-9340","authenticated-orcid":false,"given":"Graham","family":"Mainer-Pearson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3730-9733","authenticated-orcid":false,"given":"Kurtis","family":"Stewart","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7855-7939","authenticated-orcid":false,"given":"Kim","family":"Williams","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0378-0685","authenticated-orcid":false,"given":"John","family":"Pawlovich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-5883-7088","authenticated-orcid":false,"given":"Scott","family":"Graham","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-3247-1278","authenticated-orcid":false,"given":"Linda","family":"Riches","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4769-8082","authenticated-orcid":false,"given":"Sonya","family":"Cressman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4936-9031","authenticated-orcid":false,"given":"Kendall","family":"Ho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2025,2,19]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.9778\/cmajo.20220227"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.5489\/cuaj.8228"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000004392"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1017\/cjn.2020.162"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1089\/tmj.2018.0159"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0000000000000151"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1097\/JU.0000000000000750"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1136\/tsaco-2021-000763"},{"issue":"8","key":"ref9","first-page":"567","volume":"21","author":"Ray, KN","year":"2015","journal-title":"Am J Manag Care"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1093\/jbcr\/irab202"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0189174"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1093\/geronb\/51b.2.s82"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjoto.2023.103791"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.37545"},{"issue":"4","key":"ref15","first-page":"2723","volume":"13","author":"Ellis, I","year":"2013","journal-title":"Rural Remote Health"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.7861\/fhj.2020-0080"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1308\/rcsann.2018.0151"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1308\/rcsann.2021.0097"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1016\/j.avsg.2019.01.021"},{"key":"ref20","unstructured":"Households with out-of-pocket payments greater than 40% of capacity to pay for health care (food, housing and utilities approach - developed by WHO\/Europe)2023-10-03https:\/\/www.who.int\/data\/gho\/indicator-metadata-registry\/imr-details\/4989"},{"key":"ref21","unstructured":"Mainer-PearsonGGeospatial-Patient-Costing-Method-Companion2024-02-01https:\/\/github.com\/GrahamMP\/Geospatial-Patient-Costing-Method-Companion\/tree\/main"},{"key":"ref22","unstructured":"Community Health Service Areas Boundaries - B.C. 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