Abstract: With the ongoing advancement and integration of digital technology in society, and improved medical experiences of patients, Internet hospitals, a novel healthcare model that amalgamates digital and information technologies, are promoting a significant transformation in the medical sector. Concurrently, the demand for such services is on the rise. The expansion of Internet hospitals represents a critical initiative aimed at promoting the integration of urban and rural healthcare systems in our country. However, the widespread adoption of digital technology poses substantial barriers to the elderly population in rural areas, which often lacks digital literacy. This digital divide significantly hampers its access to Internet-based medical services. Therefore, addressing the issue of making Internet hospitals more accessible and user-friendly for the elderly population in rural regions has become a pressing concern.
In response to these challenges, this paper investigates the roles of government and Internet hospitals in enhancing the demand for Internet medical services among the rural elderly. The study explores optimal cooperation models and the appropriate allocation of government subsidies, employing numerical simulations to derive optimal strategies. The research further provides policy recommendations based on these findings.
Firstly, the paper underscores the beneficial impact of government subsidies. It then develops three distinct decision-making models for expanding the demand for Internet hospitals among the rural elderly population: a decentralized model without government subsidies, a decentralized model with government subsidies, and a centralized model. Using differential game theory and Bellman’s continuous dynamic programming, the study derives equilibrium strategies for these scenarios. Numerical examples are used to examine variations in demand and benefits across the three models, as well as the influence of parameters such as costs on demand, using the decentralized and centralized models as reference points.
The findings reveal that, compared to the decentralized model without subsidies, the centralized model can significantly increase the demand for Internet hospitals and generate greater social benefits and profits for both the government and Internet hospitals. Under specific conditions, government subsidies can effectively guide Internet hospitals toward optimal decision-making, thereby mitigating the double marginalization effect inherent in decentralized models and resulting in enhanced demand expansion and benefits. Moreover, the analysis of demand parameter impacts indicates that the sensitivity of the rural elderly to age-friendly platform modifications has a more substantial effect on demand than digital technology training. When selecting Internet hospitals, rural elderly patients prioritize the age-friendliness of online platforms over their own digital proficiency. However, when the costs associated with adapting platforms for elderly use are prohibitively high, the efficacy of government subsidies in increasing demand will be limited.
The conclusions of this study are as follows: In the decentralized decision-making model without government subsidies, Internet hospitals usually have a low level of effort due to the lack of government subsidies. Hospitals will decide whether to carry out aging-friendly transformation based on their own cost-effectiveness ratio. The government’s effort level is also limited, mainly focusing on policy supervision and technical training. In the decentralized decision-making model with government subsidies, the government will provide a certain proportion of subsidies, so its effort level depends on its fiscal expenditure capacity and its guiding role in Internet hospitals. Government subsidies reduce the transformation costs of Internet hospitals and stimulate their enthusiasm for aging-friendly transformation, so their effort level will be higher than that of the non-subsidized decision-making model. In the centralized decision-making model, the government has high requirements for public health benefits and hopes to fully lead the aging-friendly transformation of Internet hospitals. When the demand for Internet medical care among the elderly in rural areas increases significantly and Internet hospitals face greater technical and financial challenges in the transformation process, the centralized decision-making model can maximize the government’s leading role and resource coordination effect. At this time, the effort level of the government and Internet hospitals reaches the highest level. The government leads the entire transformation process through policy enforcement, full subsidies or technical support, and Internet hospitals cooperate with the government’s centralized decision-making to implement relevant plans.

Key words: Internet hospital, digital divide, rural elderly people, differential game

摘要： 互联网医院的兴起和发展一方面拓宽了医疗服务形式,提供了更为便捷、高效和经济的就医服务;另一方面其诊疗模式阻碍了数字技术劣势群体尤其是老年群体的使用。鉴于单一依靠医院自身难以对互联网医院进行适老化改造,本文探讨了在政府补贴下,如何提高农村老年人对互联网医院的使用需求。本文选取数字技术薄弱且基数较大的农村老年群体为研究样本,构建政府和互联网医院在适老化改造过程中的三种决策模式,通过微分博弈方法分析政府和互联网医院分别在扩大农村老年人互联网医疗服务需求的作用程度,探讨其最佳的合作方式以及政府补贴的最佳比例,并通过数值算例加以模拟测算最优策略。研究发现:政府和互联网医院集中决策模式可以带来更多的社会效益和经济效益,政府补贴能正向引导互联网医院作出最优决策,在一定程度上可缓解分散式决策模式下双重边际效应,从而带来更好的扩需成效和收益。基于此,本文得出三种策略相对应的互联网医院适老化改造适用情形。

关键词: 互联网医院, 数字鸿沟, 农村老年人, 微分博弈