嵌入与边界：老年健康服务体系中AI问诊的使用逻辑与风险规避研究

Embedding and Boundaries: The Usage Logic and Risk Mitigation of AI Consultation in the Elderly Health Service System

摘要: 随着人工智能技术在健康服务领域的快速渗透，AI问诊正成为老年健康服务体系中的新兴服务形式。然而，AI系统固有的“幻觉”现象使得这一新型健康服务潜藏着不容忽视的风险。本研究基于对10位有AI问诊经验的老年人的深度访谈，运用质性研究方法，探讨老年人在健康服务实践中如何使用AI问诊工具，如何将其嵌入既有的健康服务网络，以及如何通过风险规避实践管理这一新型服务形式带来的不确定性。研究发现，老年人对AI问诊的定位呈现出“补充性服务”“应急性服务”和“替代性服务”三种类型；在健康服务体系中，AI问诊与线下医疗服务、家庭照护服务形成互补、替代、冲突和衔接四种关系；风险规避实践体现为服务前的边界筛选、服务中的交叉验证、服务后的责任追究。研究揭示了老年人在健康服务数字化转型中的主体性与能动性，为构建“人机协同”的老年健康服务体系提供了实证依据。

Abstract: With the rapid penetration of artificial intelligence technologies into health services, AI consultation has emerged as a new form of service within the elderly health service system. However, the inherent “hallucination” phenomenon of AI systems poses risks that cannot be ignored. Based on in-depth interviews with ten elderly individuals who have experience using AI consultation, this qualitative study explores how older adults utilize AI consultation tools in health service practices, how they embed these tools into their existing health service networks, and how they manage the uncertainties brought by this new service form through risk mitigation practices. The findings reveal three types of positioning of AI consultation by older adults: supplementary service, emergency service, and substitutive service. Within the health service system, AI consultation forms four types of relationships with offline medical services and home care services: complementarity, substitution, conflict, and articulation. Risk mitigation practices are manifested as boundary screening before service, cross‑validation during service, and accountability after service. This study reveals the agency and initiative of older adults in the digital transformation of health services, providing empirical evidence for building a “human‑AI collaborative” elderly health service system.