Contractual cooperation between public medical institutions and elderly care institutions is one of the core practical forms of integrating medical and elderly care services. As a mountainous city, Chongqing exhibits distinctive characteristics in such cooperation due to its urban-rural dual structure, topographical features, and regional development disparities. Based on the theories of collaborative governance and resource dependence, this study employs research methods including surveys (covering 9 central urban districts of Chongqing and 6 counties in southeastern and northeastern Chongqing) and case studies. It systematically sorts out the policy implementation, types of cooperation models, and phased achievements of medical-elderly care contractual cooperation in Chongqing from a practical perspective, while in-depth analyzing the existing practical obstacles such as insufficient subject collaboration, ineffective mechanism operation, weak resource guarantees, and inadequate regional adaptability. Combined with Chongqing’s local practical scenarios, targeted optimization paths are proposed to provide feasible practical references for improving the quality and efficiency of medical-elderly care contractual cooperation in mountainous cities.