Technology Empowerment or Reinventing Barriers?—A Study on the Impact of Digital Health Literacy on Access to Basic Public Health Services among Elderly

Digital health tools are reshaping primary care around the world. But these tools—designed to make healthcare access easier—can create new barriers for people who lack digital skills. They face a rapidly digitalising healthcare system yet have only 5.8 years of formal schooling on average. Digital health literacy has been discussed in urban populations and grassroots settings; however, the two fields hardly overlap. The elderly population remains largely invisible in research on DHL and healthcare access, and studies on policy implementation have focused on counting inputs rather than on asking what actually happens when older patients try to use digital systems. This study adopts a mixed-methods approach, drawing on administrative data from the Chinese health insurance system and survey data from CHARLS 2023. This study finds that older adults use digital channels at only 7.8%, compared to 27.9% for the general population. We argue that performance targets push frontline staff to complete digital tasks on behalf of elderly patients, inflating statistics while leaving patients' actual capabilities unaddressed. This study contributes Chinese evidence to the wider discussion on digital health equity, and calls for a shift from technology-focused to capability-focused policies.