Pathways to Enhance the Sustainability of Integrated Medical and Endowment Service in  Community in China ——A Fuzzy-Set Qualitative Comparative Analysis Based on 96 Cases

China is facing a severe challenge of population aging. Although the Integrated Medical and Aged Care Services has been vigorously promoted through national policies, key drivers and pathways for achieving its sustainable development remained unclear. This study was aimed to explore multi-level mechanisms for enhancing the sustainability of these services from macro, meso, and micro perspectives and to identify differentiated condition configurations and viable pathways. The fuzzy-set Qualitative Comparative Analysis method was employed to examine 96 typical cases across diverse regions in China. The results showed that no single factor was sufficient. Rather, synergy among conditions such as funding from Long-Term Care Insurance, robust policy regulation, and context-specific capacity building are critical. The findings highlighted three primary sustainable pathways: the Long-Term Care Insurance-Led path, the Basic Medical Insurance-Led path, and the Supply-Demand Matching path. These configurational pathways addressed the potential importance of tailored financing mechanisms, optimized human resources, and precise needs assessment systems in their respective contexts.