北京市下肢障碍群体就医出行行为与影响因素研究OA

Healthcare-related travel represents a highly rigid and indispensable form of mobility for people with disabilities.For individuals with lower limb disabilities in particular,inadequate barrier-free environments not only constrain their physical mobility but also systematically restrict their ability to access essential medical services,thereby intensifying health vulnerability and reinforcing spatially embedded social inequality.In rapidly urbanizing megacities such as Beijing,where medical resources and accessible infrastructure remain unevenly distributed,healthcare travel provides a critical lens through which to examine the interaction between individual mobility capacity and the spatial organization of public services.This study investigates the healthcare travel behavior of people with lower limb disabilities in Beijing and examines the mechanisms through which individual characteristics and the built environment jointly shape travel frequency and spatial reach.Drawing on a dataset of 2 601 valid questionnaires collected across all 16 administrative districts of Beijing,combined with spatial data on barrier-free public medical facilities and accessible bus stops,the study develops an integrated analytical framework of"travel behavior identification-spatial coverage assessment-impact mechanism analysis".Grounded in spatial behavior theory,this framework conceptualizes healthcare travel as a demand-driven yet constraint-sensitive activity influenced by both personal attributes and environmental conditions.At the behavioral level,descriptive and comparative analyses reveal that healthcare travel among people with lower limb disabilities exhibits pronounced rigidity and a predominance of medium-to-long-distance trips,frequently exceeding the conventional service radius of the"15-minute city".Travel frequency and distance do not follow a simple linear relationship,indicating that healthcare travel cannot be adequately explained by proximity alone.Individual characteristics exert differentiated and non-linear effects.Age is positively associated with healthcare travel frequency,reflecting increasing health needs over the life course.Disability severity demonstrates a dual mechanism:while more severe impairments generate greater medical demand,they simultaneously impose stronger mobility constraints,resulting in heterogeneous behavioral outcomes rather than a monotonic decline in travel activity.Travel mode choice further mediates healthcare travel behavior.Public transport,particularly buses,constitutes the primary mode for low-and medium-frequency healthcare trips,while high-frequency travelers tend to rely more on walking or disability-specific mobility devices to ensure reliability.Survey responses also reveal persistent dissatisfaction with bus stop accessibility,particularly regarding distance from both residences and medical destinations,suggesting latent spatial barriers even where public transport infrastructure formally exists.Spatial analysis of barrier-free public medical facilities demonstrates a clear"center-periphery"pattern.High-density,well-distributed facilities are concentrated within the central urban area,while suburban and peripheral districts remain comparatively underserved,with facilities clustered around administrative centers and large population nodes.Accessible bus stops exhibit a contrasting pattern of"networked cores and isolated peripheries":while inner-city areas benefit from continuous coverage,suburban districts often display fragmented or island-like distributions with weak interconnectivity.Overlay analysis further reveals insufficient spatial integration between medical facilities and accessible bus stops beyond the Fourth Ring Road,significantly undermining effective accessibility for suburban residents.To examine the combined effects of individual and spatial factors,the study employs a generalized ordered logistic regression model with healthcare travel frequency as the dependent variable.The results confirm that healthcare travel behavior is shaped by the joint influence of personal attributes and environmental conditions.Age and disability severity remain significant predictors,but their effects vary across frequency thresholds,underscoring the importance of accounting for behavioral heterogeneity.Contrary to expectations,the overall coverage rate of barrier-free medical facilities does not exert a statistically significant effect,suggesting that once a basic supply threshold is reached,the quantity of facilities alone is insufficient to promote healthcare travel.In contrast,the coverage of accessible bus stops significantly increases the likelihood of transitioning from low-frequency to medium-or high-frequency healthcare travel,highlighting the critical role of public transport connectivity in enabling mobility.Residential location emerges as a key structural constraint.Living in suburban districts significantly reduces the probability of high-frequency healthcare travel,even after controlling for individual characteristics and facility coverage.This finding indicates that urban-suburban disparities in accessibility operate through spatial mismatches between healthcare resources and transport infrastructure,systematically suppressing healthcare mobility among suburban residents with lower limb disabilities.Based on these findings,the study argues that policy priorities should shift from expanding the number of barrier-free facilities to optimizing their spatial configuration and functional integration.Recommendations include strengthening the service capacity and accessibility of primary medical facilities in areas with high concentrations of elderly and disabled populations;improving the physical and functional integration between public transport systems and medical institutions,particularly in suburban areas;and reducing urban-suburban disparities in healthcare accessibility through coordinated transport and facility planning.By linking individual healthcare travel behavior with spatial accessibility at the metropolitan scale,this study contributes to disability-inclusive mobility research and provides empirical evidence to support more equitable healthcare and transport governance in megacities.