Abstract
This study constructs a fuzzy-set Qualitative Comparative Analysis (fsQCA) framework based on seven supply-demand variables in the senior-health sector of Japan and South Korea (2014-2023) and the medical-industry's investment ratio in senior health, to systematically explore the multiple configurational pathways that enhance investment ratios. Four typical pathways were identified: P1 (high Government Fiscal Investment + Enterprise Technology Innovation Index + Older Adult Service Institution Capacity), P2 (Government Fiscal Investment + Social Capital Participation + high Health Insurance Reimbursement Rate + Older Adult Service Institution Capacity), P3 (Government Fiscal Investment + Enterprise Technology Innovation Index + Smart Service Platform Construction) and P4 (Social Capital Participation + Enterprise Technology Innovation Index + Smart Service Platform Construction + Older Adult Service Institution Capacity + high Health Insurance Reimbursement Rate). All paths demonstrate that "fiscal leverage + market incentives + digital empowerment + institutional safeguards" in four-dimensional linkage are pivotal to improving resource-allocation efficiency. Robustness tests confirm the stability of each pathway after threshold adjustments and outlier exclusions, bolstering the external validity of the findings. A Japan-Korea comparison reveals higher coverage in government-led and market-reform pathways in Korea, whereas Japan leads in the intelligent-care and telemedicine pilot pathway. Policy recommendations emphasize context-sensitive, flexible configuration of fiscal, market, technological and institutional elements, with priority support for Smart Service Platform Construction and public-private partnership models to meet differentiated needs under varying fiscal capacities and aging pressures. This study applies the dynamic fsQCA method to the integrated medical-older adult care domain, enriching the theoretical paradigm of strategic investment in the senior-health industry and offering transferable policy-configuration pathways for other aging societies.