Analysis of Travel Decision-Making for Urban Elderly Healthcare Activities under Temporal and Spatial Constraints

Xuefeng Li, Yong Zhang, Mingyang Du
2018 Sustainability  
This paper explores the travel decision-making process of healthcare behavior of urban elderly under different temporal and spatial constraints. Firstly, based on time geography, a two-dimensional space-time trip chain is applied and the concept of healthcare constraint degree (HCD) is proposed. Then, the elderly's medical treatment activities are divided into two categories: strong constraint activity and weak constraint activity, based on 625 samples in Kunming, China. Lastly, an improved
more » ... inomial logit model is adopted to determine the significant factors affecting the travel mode choice of these two types of activities. The results show that the travel mode choice of the elderly to healthcare facilities is not the same under different spatio-temporal constraints: strong constraint activity is mainly affected by external factors (such as travel time, travel distance, bus station distance and walking accessibility), whereas weak constraint activity is influenced by internal family factors (such as car pick-up, accompanied by family, and the number of family members with a driver's license). These findings present a new perspective for understanding the healthcare behavior of the elderly and provide a convincing support for the formulation of urban transportation planning policies. may allow policy makers to make better decisions on elderly healthcare policy and optimize medical and health service resources for the elderly. Many studies have examined the healthcare behavior of the elderly and they mainly focused on the attitudes toward the healthcare and the factors influencing the use of healthcare service [5, 6] . In the case of the attitudes toward healthcare, Fisher et al. and Fyffe et al. [7, 8] concluded that older respondents were less likely to seek the help of professional sources, including help from family or friends as well as services that require lots of physical effort. Diala et al. [9] found that individuals who endorsed negative attitudes toward the treatment were five times less likely to seek mental health services than those with more positive attitudes. As for the factors influencing the decision to seek the treatment, Bessho et al. [10] showed that the health status of the elderly was the main factor affecting medical behavior, and the more serious the elderly health situation was, the more active the elderly was. Borah [11] established a mixed multinomial logit model to explore the choice decision of the healthcare of the elderly by using the data from National Sample Survey Organization of India. The results suggested that price and distance were the greatest barriers in the choice decision of the healthcare. When the health status was poor, the distance played a less significant role, while price elasticity of demand for outpatient care varied with the income, and the low-income groups were more price-sensitive than the high-income ones. Samra et al. [12] applied a binomial logit model to analyze the influencing factors of healthcare for rural residents in India. The results showed that economic income and medical price were significant factors influencing the medical treatment of rural residents, and the distance to treatment was the greatest barrier. Fortney et al. [13] applied a joint choice model to analyze the decision of treatment based on 435 samples in Arkansans. The results showed that insurance coverage and availability significantly impact sector choice, subject-specific case mix factors (such as age, gender, employment status, depression severity, and psychiatric comorbidity) significantly affected the decision of seeking the treatment. In China, healthcare activities and travel behaviors of the urban elderly were examined in few studies. One study focused on demographic characteristics and social structure and selected indicators, designed questionnaires and analyzed the impact of medical insurance and family expenditure on medical demand [14] . Another study analyzed the impact of medical services for the elderly with regard to elderly individuals who were in poor health and need timely medical treatment at a hospital [15] . In addition, temporal and spatial constraints are important methods to study the patterns and decision-making mechanisms of the residents' daily behaviors [16, 17] . Kwan [18] explored gender differences in space-time constraints and their impacts on women's and men's activity-travel patterns from a time-geographic perspective. Based on travel data collected in Columbus, time-budget and fixity constraints of three population subgroups were examined, the results suggested that space-time constraints have a significant impact on individual travel choice. Based on the activity-travel diaries and seven-day GPS tracking data of 709 respondents in Beijing, temporal and spatial flexibilities were measured with the degree of variability in time and space of the respondents' self-reported activities, the spatial and temporal characteristics of residents' daily activities and their influencing factors were analyzed by Shen and Chai [19] . The results showed that temporal and spatial flexibility varied significantly among different activities, individuals and households; among the influencing factors, the type of activity was the most important factor. Chen and Chai [20] explored the relationship between the flexibility of the entire trip chains on the departure time of commuting trips and tried to verify that if flexible schedules contributed to the rush-hour avoidance. The results showed that flexible activity arrangement had a significant impact on early commuting time decision. In addition, temporal and spatial constraints have also been used in the analysis of resident activities, such as leisure, shopping, employment and commuting [21, 22] . As is evident from the above review, there are abundant research results regarding the healthcare of the elderly. However, these explorations focus more on the attitudes and preferences toward the healthcare and they do not reflect the demand for transportation. Besides, although temporal and spatial constraints were used to study the travel behavior in many studies, they neglect that Sustainability 2018, 10, 1560 3 of 15
doi:10.3390/su10051560 fatcat:vfcvcfqbjrhlbniyo7aooumkri