The paradox of advanced healthcare: a qualitative study of accessibility barriers for wheelchair users in tertiary referral hospitals

Wheelchair users with physical disabilities frequently encounter barriers to healthcare access that contribute to poorer health outcomes compared with the general population. Although tertiary referral hospitals provide the highest level of specialized medical care, their complex organizational structures and standardized clinical processes may unintentionally create additional accessibility challenges. Despite increasing attention to healthcare access among people with disabilities, little is known about how wheelchair users experience barriers within tertiary referral hospitals. This study aimed to explore the experiences of wheelchair users with physical disabilities when accessing healthcare services at tertiary referral hospitals in South Korea. A descriptive qualitative design was employed. Semi-structured, in-depth interviews were conducted with 11 wheelchair users aged 19 years or older who had experience receiving outpatient care at tertiary referral hospitals in South Korea. Participants were recruited through purposive and snowball sampling. Interview data were analyzed using thematic analysis. Three main themes were identified: (1) structural barriers within tertiary referral hospitals, including transportation barriers, inaccessible diagnostic equipment, and limited access to rehabilitation services; (2) clinical encounters influenced by disability-centered assumptions, characterized by diminished autonomy, disability overshadowing, and limited attention to quality-of-life concerns; and (3) adaptation to inaccessible healthcare environments, including both coping strategies and gradual disengagement from healthcare services. The findings reveal a functional accessibility gap, where formal accessibility provisions do not necessarily translate into practically usable healthcare settings. Wheelchair users encounter persistent structural and relational barriers when accessing tertiary referral hospitals. The findings highlight an advanced-care paradox, in which highly specialized medical systems may unintentionally reproduce accessibility inequities. Improving healthcare access requires not only physical accessibility improvements but also disability-competent care practices, coordinated navigation support, and healthcare systems responsive to diverse physical needs.