Equity and efficiency of traditional Chinese medicine healthcare resource allocation in Jiangsu province in the context of population aging

Purpose Rapid population aging presents a profound governance challenge for healthcare alignment. While Traditional Chinese Medicine (TCM) is critical for geriatric care in Jiangsu Province, the equity and efficiency of its resource allocation remain unexamined, hindering systemic reform. Design/methodology/approach A multi-method approach analyzed 2023 municipal data. Equity (institutions, beds and personnel) was quantified using the Gini coefficient, Theil index and Health Resource Density Index (HRDI). Efficiency was evaluated via a three-stage DEA model incorporating aging-related environmental factors. Findings The study identified clear governance-related disparities, including a north-south divide and a paradox of inefficiency amid resource abundance. Severe geographic-based inequities, particularly in personnel distribution, coexisted with significant operational inefficiencies in six municipalities. Intra-regional disparities, especially within the affluent South, were the primary source of inequality. Originality/value This study separates structural access constraints from performance after environmental adjustment in TCM resource allocation. It shows how per-capita equity can mask geographic inequity and how resource abundance can coexist with inefficiency. These insights offer a governance diagnostic for aging-equity-efficiency contexts.