<p>Policymakers have attempted to address the rising care demands of older adults by introducing marketization into community services. However, a thorny issue arises: for some older adults, service accessibility may not have improved and may even have worsened due to marketization. The theoretical relationship between marketization and service accessibility remains unclear. This article focuses on a market-oriented practice in China, venture philanthropy, which allows us to isolate the effects of marketization. Using a quasi-experimental approach, this study investigated the impact of venture philanthropy on the accessibility of community service for older adults. Our findings revealed that the effects of marketization are complex. While marketization generally increases accessibility, its effects are heterogeneous, with more significant benefits for high-income groups. Even with some support, the most disadvantaged groups may still struggle to benefit from marketization. This article provides direct evidence of marketization’s impact on the long-term care system and urges policymakers to address the inequalities that may arise from such market-driven approaches.</p>