Using Deep Learning and Explainable Artificial Intelligence in Patients' Choices of Hospital Levels

In countries that enabled patients to choose their own providers, a common problem is that the patients did not make rational decisions, and hence, fail to use healthcare resources efficiently. This might cause problems such as overwhelming tertiary facilities with mild condition patients, thus limiting their capacity of treating acute and critical patients. To address such maldistributed patient volume, it is essential to oversee patients choices before further evaluation of a policy or resource allocation. This study used nationwide insurance data, accumulated possible features discussed in existing literature, and used a deep neural network to predict the patients choices of hospital levels. This study also used explainable artificial intelligence methods to interpret the contribution of features for the general public and individuals. In addition, we explored the effectiveness of changing data representations. The results showed that the model was able to predict with high area under the receiver operating characteristics curve (AUC) (0.90), accuracy (0.90), sensitivity (0.94), and specificity (0.97) with highly imbalanced label. Generally, social approval of the provider by the general public (positive or negative) and the number of practicing physicians serving per ten thousand people of the located area are listed as the top effecting features. The changing data representation had a positive effect on the prediction improvement. Deep learning methods can process highly imbalanced data and achieve high accuracy. The effecting features affect the general public and individuals differently. Addressing the sparsity and discrete nature of insurance data leads to better prediction. Applications using deep learning technology are promising in health policy making. More work is required to interpret models and practice implementation.