# Multilevel Privacy Assurance Evaluation of Healthcare Metadata
## 1 Introduction
### State of the Art  
Privacy as a fundamental human right: privacy is a fundamental human right and is legally protected at global [22], European [23], and national levels [7]. However, the idea of privacy is sometimes elusive and far reaching. From the individual's rights to be left alone and to control personal information share, to organizations' responsibilities concerning the collection, execution, disclosure, and retention of individuals' PII, all come under the umbrella term of 'privacy' [24]. In a nutshell, privacy is an individual's autonomous decision making and direct/indirect control over personal information share [5]. BDA for Better Data Utility and Ethical Concerns: With the growing dependency upon BDA, the individual's autonomy and decision making is now shifting from individuals to technology for better data utility [19]. Data utility directly depends upon the correct use of big data by implying apt data techniques to deliver efficient/effective services/goods [3]. Better data utility is also significant for financial stability as a majority of the western European and Scandinavian countries allocate a substantial share of approximately 10% of their GDP to healthcare [25]. However, there are also concerns regarding the fair use of data [2; 19]. For BDA, healthcare providers enumerated some generally prioritized values while dealing with healthcare data at the organizational level [26]. Among those ten enumerated values, four are directly related to patients' information security. In comparison, the rest of the six values regard the uninterrupted efficient healthcare data sharing for better data utility. Patients' information security values include personalized healthcare, patients' value care risks, privacy protection, and transparency, where privacy preservation is the least-valued organizational value for BDA. Patient-Centric, Value-Based Healthcare Model: Healthcare providers moved from a former, volume-based fee-reimbursement healthcare model to a value-based, patient-centric healthcare model [27]. In a value-based healthcare model, physical first-order value transactions between the value actors are the same as volume-based healthcare. However, the difference lies in qualitative intrinsic values, which prioritize patients' satisfaction along with patients' health improvement [17]. The shift marks the transformation from an exclusive monetary gain-oriented business model to a more intrinsic value-based (i.e., privacy and data security) value-modeling for consistent, trust-based future interactions [28]. Trust is an integral aspect of a value model, and it has to persist between the value actors throughout the healthcare service for healthy outcomes. The patient-centric value model also seeks shared decision making from patients' first meeting with the GP to the diagnosis, treatments, and better healthcare outcomes. In this wake, prioritized healthcare is mutually decided between the caregiver and the patient. Shared decision making is significant for patients' engagement, adherence, cost-effective decision making, and over  
Figure 1: Description of the Problem Area. all satisfaction [29]. Value-based healthcare is practiced mainly for more cost-effective, quality-assuring, and more patient-engaging health outcomes for the benefit of related stakeholders ranging from healthcare providers to the patient himself [30]. BDA and Informed Consent at the Expense of Privacy: Consumerism is defined as the \"advocacy of the rights and interests of the consumers\" [31]. Consumerism in healthcare advocates the patients' empowerment and their participation in decision-making regarding their healthcare. From a 'consumerism' perspective, privacy is protected personal information-use as per data subjects' expectations. This involves the idea of Informed Consent (IC) of the data subjects and the idea of patients' respective notice and choice according to the privacy by policy indicators in the healthcare domain [16].