{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T14:50:06Z","timestamp":1782917406801,"version":"3.54.5"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"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>Rapid population aging has heightened the need for efficient integrated medical and older adult care services in China. Despite policy-driven expansion since 2013, the static efficiency and dynamic productivity performance of integrated medical and older adult care institutions have not been well characterized. This study adopts the Malmquist production index method under the data envelopment analysis (DEA) approach to dynamically assess the total factor productivity (TFP) of 54 integrated medical and older adult care institutions in six provinces (Hebei, Inner Mongolia, Jilin, Shandong, Hubei, and Sichuan) across the eastern, central, and western regions of China from 2020 to 2022 and to analyze the current status and development trends of their productivity. The Malmquist index results showed that total factor productivity increased from 2020 to 2021, with a TFP index of 1.118, but declined from 2021 to 2022, with a TFP index of 0.956, indicating short-term fluctuations in dynamic productivity. These results suggest that the productivity changes of integrated medical and older adult care institutions were not stable across the study period. In terms of regional differences, the comprehensive efficiency and pure technical efficiency in the eastern region are greater than those in the central and western regions. This result may be closely related to differences in economic development, policy support, and the distribution of health care resources. In addition, although some institutions show higher efficiency at the technical level, their comprehensive efficiency fails to reach the optimal level because of irrational scale allocation. Improving the total factor productivity of integrated medical and older adult care institutions is a complex systematic task that not only relies on technological progress but also requires the optimization of resource allocation and scale management.<\/jats:p>","DOI":"10.3389\/fpubh.2026.1852119","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T14:02:31Z","timestamp":1782914551000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Research on the allocation efficiency of integrated medical and older adult care institutions using the Malmquist productivity index"],"prefix":"10.3389","volume":"14","author":[{"given":"Lijuan","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Social Medicine and Health Management, School of Public Health, Jilin University","place":["Changchun, Jilin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiangchen","family":"Kong","sequence":"additional","affiliation":[{"name":"Department of Social Medicine and Health Management, School of Public Health, Jilin University","place":["Changchun, Jilin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongxia","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Social Medicine and Health Management, School of Public Health, Jilin University","place":["Changchun, Jilin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haozhen","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Social Medicine and Health Management, School of Public Health, Jilin University","place":["Changchun, Jilin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xihe","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Social Medicine and Health Management, 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