{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T06:28:02Z","timestamp":1786343282890,"version":"build-2736575974"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T00:00:00Z","timestamp":1786320000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:p>How do institutional constraints, technological embeddedness, and platform governance co-evolve to reconfigure the public health governance of regulated digital service industries? This article develops a triadic co-evolutionary framework\u2014the ITP model\u2014that integrates institutional theory, technological evolution theory, and platform ecosystem theory to address this question. The study is positioned as a theory-building, qualitatively oriented single-case analysis supported by secondary documentary evidence and extended through structured cross-national comparison; it does not report primary empirical data. Drawing on China\u2019s medical esthetics social commerce sector as a \u201ctheory-laden\u201d extreme case\u2014in which multi-agency public health and consumer-protection regulatory pressure, deep generative-AI (AIGC) penetration, and platforms occupying dual commercial\u2013regulatory roles are simultaneously present\u2014we trace the mechanisms through which the three elements interact via a \u201cconstraint\u2013enablement\u2013transmission\u201d channel across three co-evolutionary phases, with explicit attention to the public-health implications of governance dynamics. Cross-national comparative evidence from Republic of Korea and the European Union is incorporated to assess the framework\u2019s conditional generalizability for health-systems governance. The analysis identifies three structurally embedded tensions that the co-evolutionary process appears to generate: a temporal disjuncture between regulatory rigidity and technological elasticity that may compromise public-health responsiveness; a structural contradiction between platform growth imperatives and public-health compliance mandates, expressed as legitimacy deficits; and a compliance-cost escalation dynamic that is consistent with a self-reinforcing feedback loop of concentrated enforcement and market fragmentation, with downstream consequences for the safety, quality, and equitable accessibility of health-related services. We translate these mechanisms into explicit public-health propositions concerning patient safety, health equity, quality of care, health misinformation, and health-system resilience, and we situate the framework against the rapidly expanding 2024\u20132026 literatures on trustworthy AI, AI governance, algorithmic accountability, and digital-health governance. The ITP framework advances the public-health governance literature by suggesting that these tensions are emergent properties of triadic co-evolutionary interaction\u2014not reducible to any single element\u2019s excess\u2014and by specifying the boundary conditions under which the framework may generalize to other public-health-relevant regulated service industries, including telemedicine, online pharmacy, digital mental health, and platform-based care delivery.<\/jats:p>","DOI":"10.3389\/fpubh.2026.1915580","type":"journal-article","created":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T05:31:28Z","timestamp":1786339888000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["When institutions, technologies, and platforms co-evolve: a triadic co-evolutionary framework for public health governance in regulated digital service industries"],"prefix":"10.3389","volume":"14","author":[{"given":"Yiding","family":"Xiao","sequence":"first","affiliation":[{"name":"Department of Plastic and Aesthetic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zirui","family":"Liao","sequence":"additional","affiliation":[{"name":"Department of Science and Education, Shenzhen Stomatological Hospital","place":["Shenzhen, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hailin","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Plastic and Aesthetic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,10]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","DOI":"10.1017\/CBO9780511808678","volume-title":"Institutions, Institutional Change and Economic Performance","author":"North","year":"1990"},{"key":"ref2","volume-title":"Institutions and Organizations: Ideas, Interests, and Identities","author":"Scott","year":"2013"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"117","DOI":"10.18261\/ISSN1504-2928-2004-02-02","article-title":"Five misunderstandings about case-study research","volume":"12","author":"Flyvbjerg","year":"2004","journal-title":"Sosiol Tidsskr"},{"key":"ref4","article-title":"Regulation (EU) 2022\/2065 of the European Parliament and of the council of 19 October 2022 on a single market for digital services (digital services act)","year":"2022","journal-title":"Off J Eur Union"},{"key":"ref5","article-title":"Regulation (EU) 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