关键词: 数字资本, 老年人, 医疗服务可及性, 数字化转型, 数字鸿沟, 包容性治理

Abstract:

[Purpose/Significance] The aging population and the digital transformation of health services are profoundly altering the conditions under which older adults access healthcare. Although online appointment systems, electronic credentials, mobile payment, and internet-based consultations may increase overall efficiency, they can also make access to devices, accounts, operational skills, and assistance implicit prerequisites for care. This study examines how such prerequisites impair older adults' access to medical services. It clarifies why the issue should be understood as a question of inclusive digital governance and health equity rather than as an individual deficit alone. [Method/Process] This study is a theory-driven conceptual inquiry based on a structured literature review. It first synthesizes scholarship on digital capital, the digital divide, and health-service accessibility. Then, it conducts a structured reading of national policy documents, official health statistics, and publicly available measures designed to facilitate medical treatment for older persons. The analysis proceeds in four steps: defining the outcome as a continuous process of entry, use, and outcome attainment; identifying the resource, competence, and relational components of digital capital; translating these components into the institutional setting of digital health services; and examining whether policy and practice materials are consistent with the proposed mechanisms. The materials are used for cross-source comparison and contextual corroboration rather than causal estimation or claims of statistical generalizability. [Results/Conclusions] The analysis identifies three interrelated components of digital capital: digital access resources, digital-use capability, and support networks. Their unequal distribution impairs accessibility through four pathways: technological access, procedural operation, information recognition, and support mobilization. These pathways jointly affect the ability to enter a service system, complete a service process, and secure a meaningful and continuous service outcome. More specifically, impaired entry accessibility occurs when older adults lack the necessary devices, network connections, and registered accounts for digital medical platforms. Impaired use accessibility occurs when multi-step processes and information-dense interfaces exceed their operational and cognitive capacities. Impaired outcome accessibility occurs when intermittent or absent support networks prevent them from sustaining engagement over time. These three layers are nested and cumulative: failure at the entry level forecloses subsequent use, and fragile use undermines stable outcomes, so that initial resource gaps may compound into structural exclusion through repeated cycles of frustration, avoidance, and skill stagnation. Institutional conditions, including the digitization of service entrances, complex procedural rules, and inadequate offline fallback arrangements, filter and amplify these differences. Official requirements for parallel traditional and intelligent services, multi-channel appointment, family-assisted registration, and age-friendly healthcare arrangements provide practical support for treating the identified barriers as institutionally mediated. The governance implication is, therefore, not to require every older adult to adapt fully to a digital system. Instead, policy should preserve accessible non-digital channels, simplify and clarify digital interfaces, and institutionalize coordinated support from families, communities, and medical institutions. The study contributes an integrated framework that connects resources, conversion pathways, institutional filtering, and differentiated outcomes. Its limitation is that the framework has not been tested with individual-level survey data or longitudinal evidence. Future research should assess pathway strength, interaction effects, and variation across regions and medical institutions.

Key words: digital capital, older adults, access to medical services, digital transformation, digital divide, inclusive governance