Has smart healthcare improved older adults’ health? Evidence from China’s smart city pilot program— a quasi-natural experiment

Background While integrating digital technology into healthcare is a key strategy to address population aging, robust evidence on the causal impact of large-scale policies is scarce. This study aims to quantify the health effects of China’s smart city policy on older adults and identify the mechanisms driving these outcomes. Methods This study employed a multi-period difference-in-differences (DID) model, leveraging China’s national smart city pilot policy as a quasi-natural experiment. The analysis utilized balanced panel data from the China Family Panel Studies (CFPS) for the period 2010–2020. The primary outcomes were self-rated health and mental health among adults aged 60 and over. Results Smart healthcare significantly improved older adults’ self-rated health ( β = 0.093, p < 0.10) and mental health ( β = 0.088, p < 0.10). The policy effect followed an inverted-U shape, peaking at four years post-implementation. Benefits were stronger for rural, younger-old (60-74), and unmarried individuals, suggesting a compensatory effect for underserved groups. These improvements were driven by three mechanisms: increased healthcare utilization, healthier behaviors, and greater health-related investments. Conclusion Smart healthcare is an effective tool for improving older adults’ health, but its dynamic and heterogeneous effects highlight the need for adaptive and targeted policies to sustain long-term benefits and ensure equity.