An Evolutionary Game-Based Governance Mechanism for Sustainable Medical and Elderly Care Building Retrofits in Urban Renewal

The retrofit of vacant buildings into sustainable integrated medical and elderly care facilities represents an important pathway for promoting urban regeneration and addressing population aging challenges. However, conflicts of interest among key stakeholders frequently compromise the quality of retrofit and long-term operational sustainability. To address this issue, this study develops a tripartite evolutionary game model comprising investors, builders, and operators to examine the behavioral evolution and cooperative mechanisms of these stakeholders across the investment, construction, and operation phases. Simulations were conducted based on a real-world retrofit project in Lanzhou, China, and the results suggest that: (1) Policy preference or reputational incentives alone appear insufficient to maintain cooperation, whereas their integration with economic incentives can effectively enhance the stability of cooperation among the three parties. (2) Builders exhibit higher sensitivity to penalties than operators, underscoring the pivotal role of the construction phase in ensuring retrofit quality. (3) When investors shift their role from short-term compliance regulation to long-term governance, it is more conducive to promoting operators to provide high-quality services in the long run. This paper proposes several suggestions and countermeasures, to provide practical guidance for the multi-party collaborative governance and sustainable operation of integrated medical and elderly care retrofit projects in China under the background of urban renewal.