Institutional Mechanisms Shaping the Digital Divide Among Older Patients in China’s Appointment-Based Outpatient System

Digital appointment systems have become the primary entry mechanism for outpatient care in China’s public hospitals. At the same time, rapid population aging has increased the proportion of older adults within the healthcare system. Although digital access among older adults has expanded, disparities remain in their ability to navigate complex procedural platforms. Existing discussions often interpret this situation as a problem of individual digital literacy. This paper adopts a different perspective and examines the digital divide as an institutional outcome. Through a structural analysis of policy rationality, organizational restructuring, and micro-level interaction processes, the study shows how digital competence becomes embedded as an implicit entry condition. Platform-centered allocation mechanisms link procedural performance to resource access, especially in high-demand specialist services. Repeated differences in appointment acquisition gradually translate into disparities in medical quality and health trajectories. Over time, these patterns stabilize and become normalized within routine hospital governance. The findings suggest that the digital divide in outpatient care is not merely a technological gap but a structured consequence of institutional design. Rebalancing efficiency and equity in aging societies requires adjustments in access pathways rather than sole reliance on individual adaptation.