Mitigating Systemic Risks in Aging Services: An Evolutionary Game Analysis of Fiscal Policy, Service Quality, and Workforce Supply

Introduction: Rapid population aging imposes escalating fiscal and operational pressures on public health and long-term care systems, increasing the likelihood of supply-demand imbalances and workforce shortages. Understanding how government agencies, aging service institutions, and the professional education system interact is essential for mitigating systemic risks and ensuring sustainable service provision. Methods: This study develops a tripartite evolutionary game model that integrates talent supply dynamics into a comprehensive risk-governance framework. The model links workforce development with institutional performance and fiscal sustainability. System stability and evolutionary trajectories were examined through MATLAB simulations under multiple policy scenarios involving subsidies, incentives, and professional education reform. Results: Simulation results reveal that exclusive reliance on government subsidies may heighten long-term fiscal pressures and weaken systemic resilience. In contrast, a market-oriented self-organizing mechanism helps maintain service quality while reducing dependence on public funding. The analysis also identifies a bidirectional feedback loop: institutional demand can stimulate educational reform, while an adequately trained workforce lowers marginal service costs. Nevertheless, insufficient practice-oriented education may create a talent bottleneck that destabilizes the system even when financial support is present. Discussion: The findings indicate that the sustainability of aging care systems depends more on dynamic incentive structures that align workforce development with service quality evaluation than on static fiscal expansion. Strengthening the coordination of education, institutional performance incentives, and government regulation can mitigate market failure risks and foster more equitable resource allocation. Keywords: healthcare risk management, policy optimization, fiscal sustainability, evolutionary game theory, workforce supply chain, long-term care governance