The impact of smart healthcare and eldercare on older adults' health and health inequality: Evidence from China.

OBJECTIVE

Digital health now serves as a central paradigm for modern health promotion, sparking growing concerns over whether it exacerbates health inequalities. Anchored in China's "Smart Healthcare and Eldercare" policy (SHE), this study investigates the policy's impact on older adults' health outcomes and inequality, offering empirical insights into this critical debate.

METHODS

Based on 32,634 micro-samples from five waves (2014-2023) of the China Longitudinal Aging Social Survey (CLASS), this study employs a multi-period difference-in-differences (DID) approach to identify the causal effects of the SHE pilot policy. Health is characterized by self-rated, mental, and functional health, with corresponding health inequality indices calculated based on the relative deprivation index.

RESULTS

The results show that SHE significantly improves self-rated health and mental health, with no significant effect on functional ability. The results provide evidence for three mechanisms: healthier behaviors, increased health-related expenditures, and enhanced utilization of community medical and other services. SHE also narrows inequalities in self-rated and mental health, but widens gaps in functional ability. Further analyses show that while the policy improves access to health resources in a broadly universal manner, disparities in older adults' digital usage capacity hinder the equal translation of technological interventions into functional ability gains. As a result, improvements in functional ability are more concentrated among socioeconomically advantaged groups, leading to widened inequality.

CONCLUSION

This study confirms that digital health interventions effectively improve older adults' health. However, to prevent widening health inequalities, targeted measures like digital literacy training must be implemented for digitally vulnerable groups.