Research on the Current Situation of Smart Services in Shanghai Internet Hospitals and User Behavior—An Integrated Analysis Based on Andersen Model and Technology Acceptance Model

Objectives: This study aims to assess the development of smart services in Shanghai's Internet hospitals and analyze the factors influencing user behavior by integrating the Andersen Health Service Model and the Technology Acceptance Model (TAM), with a focus on addressing service accessibility and health equity. Methods: A mixed-methods approach was employed, combining a cross-sectional survey of 1,028 valid questionnaires collected via multi-stage stratified sampling with service data analysis of 117 Internet hospitals in Shanghai. Statistical analyses, including chi-square tests, K-means cluster analysis, association rule mining (Apriori algorithm), and ordinal logistic regression, were conducted using SPSS 25.0 and Python. Results: Shanghai's Internet hospital system has achieved full coverage across 37 municipal-level hospitals, with 13.32 million registered users and 149 million cumulative service instances. However, significant usage disparities exist: the elderly population (over 61 years) exhibited significantly lower usage rates and satisfaction compared to younger groups (P<0.01). Cluster analysis identified three distinct user typologies: high-demand and high-adaptability (32.1%), passive usage (46.7%), and low-resource and high-barrier (21.2%). Association rule mining revealed that the service combination of "intelligent pre-consultation + electronic medical record card + online follow-up consultation" was the most preferred (confidence >85%). Key influencing factors included education level, income, chronic disease status, perceived usefulness (promoting factors), and advanced age, rural residence, and low perceived ease of use (hindering factors). Conclusion: While Shanghai has established a robust Internet hospital infrastructure, challenges related to the digital divide, particularly for elderly and low-resource groups, and a mismatch between service supply and demand persist. To potentially enhance health equity and service sustainability, targeted interventions such as aging-friendly technological transformations could be considered. This study provides evidence to inform policy innovation in online medical insurance payment, optimization of integrated service supply models, and strengthening of quality supervision frameworks.