Abstract This paper offers an empirical account of the engagement and success of nonprofits in contracting for elderly care in China and the Netherlands as two contrasting contexts. While contracting as an innovation demonstrates a state-centered approach in China, its Dutch counterpart has sought a balance between state and professional influences. The paper argues that public sector reforms, civil society development and social regulation support schemes contextualize the engagement and success of nonprofits in contracting for elderly care. Surveys among the managers of 176 elderly care organizations in Shanghai and 70 elderly care organizations in the Netherlands shows that the fundamental elements of nonprofit contracting in elderly care are strikingly similar between both contexts, although their manifestation is shaped by each specific institutional context.