# Multilevel Privacy Assurance Evaluation of Healthcare Metadata
## 3 Multilevel Privacy Assurance Evaluation: Results and Evaluation
### At Inter- and Intra-Organizational Level
#### 3.2.3 Conceptual Modeling Framework Using REA Ontology  
Results: Dutch caregivers are privately run and partially publicly funded enterprises. Our goal behind using REA ontology was to discover the underlying financial priorities of care enterprises for patients' un-anonymized metadata share [66]. REA's Insurance Model (IM) is an extended application model because it includes contract and commitment levels to the increment and decrement events between economic agents for mutual value gain or loss. Before conceptualization fundamentals, it is vital to emphasize that the PM experiments in Figures 5 and 6 verified our assumptions regarding patients' un-anonymized metadata share amongst Dutch caregivers. Whereas Figure 7 is about the proposed REA model, which relates to real-life events where privacy is used as a Materialized Claim against caregivers/health insurers in the Netherlands. Figure 7 is explained from top to bottom, describing the concepts and relations of the model below:  
The economic agents' are legal entities who lose or gain control over the economic resources through economic events/interactions. An economic resource is a thing or service to be planned, monitored, and controlled by the concerned authorities (economic agents). Here, resources such as cash, metadata, and care services are exchanged as increment or decrement events. The increment is the inflow of resources, while the decrement is the outflow of resources from a patient's perspective. Contracts are legal commitments that involve each agent as a party. Initially, the contract is signed between two active  
Figure 7: REA using Insurance Model and explicating privacy as a materialized claim. 'party' agents. The passive 'party' agents activate their value transactions later with future increments/decrements events. For example, the passive agents include the caregivers who are absent at signing the insurance contract but later become active at their service delivery. Initially, the patients and health insurers perform increment and decrement events by exchanging cash with and for one another. With an insurance contract, the PII of the insured is also stored in insurer IS. This information intake (economic resource) leaves the insured with less control over his or her PII (for physical, decisional, and informational security). The insurance contract clauses commit the (party) agents for future increment and decrement events (including the privacy preservation of the insured). From the patient's perspective, the increments include the timely cash payments from the insurer to caregivers, clinical care to the patient, and the patient's PII security assurance from insurer and caregivers alike. The decrement events are monthly insurance payments from the patient to the insurer and the outflow of patients' PII (as an input to metadata) to the insurer and caregivers. After the increment and decrement events' execution, the involved agents evaluate any imbalances between the materialization and the settlements of the patient's resources. Patients usually evaluate their physical security/recovery in comparison to their cash payments to the insurer. Materialized Privacy Claim (MPC) surfaces only when either the patient or any other involved potent authority (such as Data Protection Officer) claims to assure the patient's informational and decisional security in addition to his/her physical security/recovery. For instance, recently, the Dutch Data Protection Officer (DPO) fined Haga hospital 460,000 euros for a Dutch celebrity's privacy breach [80] and charged Menzis (health insurer) euros 50K for care data mishandling [81]. Evaluation: Privacy and metadata in REA Ontology: In REA ontology, the metadata, the formation, maintenance, and interoperability is part of an organization's 'posting and dimension aspect of financial disbursement' instead of its application model [66]. Earlier (in 2006), metadata handling was considered dependent upon the behavioral pattern of the respective organization [66].