The 4E theory-based performance benchmarking of aged care service provision in community care facilities: a case study of Nanjing, China

The global aging population is growing rapidly, and due to its large population, China is expected to become a ‘super-aged society’ within the next decade. Therefore, ensuring that older people can ‘age in place’ has become a major national priority. Community-care facilities (CCFs) play a key role...

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Main Authors: Wei Huang, Ying Hu, Lingzhi Li, Chendi Wang, Luyao Liu
Format: Article
Language:English
Published: Frontiers Media S.A. 2025-02-01
Series:Frontiers in Public Health
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Online Access:https://www.frontiersin.org/articles/10.3389/fpubh.2025.1467745/full
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author Wei Huang
Wei Huang
Ying Hu
Lingzhi Li
Chendi Wang
Luyao Liu
author_facet Wei Huang
Wei Huang
Ying Hu
Lingzhi Li
Chendi Wang
Luyao Liu
author_sort Wei Huang
collection DOAJ
description The global aging population is growing rapidly, and due to its large population, China is expected to become a ‘super-aged society’ within the next decade. Therefore, ensuring that older people can ‘age in place’ has become a major national priority. Community-care facilities (CCFs) play a key role in this process, but their service performance often faces challenges, with high input costs and limited output benefits. This paper aims to evaluate and improve the social and economic performance of CCFs by proposing a comprehensive framework based on the 4E (Economy, Efficiency, Effectiveness, Equity) theory. Specifically, based on the 4E theory, a literature review and correlation analysis are conducted to select performance indicators. The input–output relationships are then established according to the four dimensions of the 4E theory. These indicators and input–output relationships form the foundation for applying the δ-SBM DEA model, which is used to assess the performance of 75 CCFs in Nanjing. The study finds that the economic performance of CCFs generally lags behind their social performance, with many facilities showing inefficiency in economic indicators, characterized by high operational costs and limited profitability. Projection analysis reveals major issues in low-performing CCFs, including uneven regional distribution of facility performance, poor profitability, a shortage of skilled older people care professionals, and insufficient older people’s participation. Based on these findings, the paper provides specific policy recommendations for government authorities, industry associations, and CCFs, focusing on improving cost-effectiveness, increasing the number of professionals, and enhancing older people’s participation.
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spelling doaj-art-8dba9dfae84441a989edc87ae0ab9a5e2025-02-04T15:12:21ZengFrontiers Media S.A.Frontiers in Public Health2296-25652025-02-011310.3389/fpubh.2025.14677451467745The 4E theory-based performance benchmarking of aged care service provision in community care facilities: a case study of Nanjing, ChinaWei Huang0Wei Huang1Ying Hu2Lingzhi Li3Chendi Wang4Luyao Liu5Research Center of Smart City, Nanjing Tech University, Nanjing, ChinaSchool of Civil Engineering, Sanjiang University, Nanjing, ChinaResearch Center of Smart City, Nanjing Tech University, Nanjing, ChinaResearch Center of Smart City, Nanjing Tech University, Nanjing, ChinaResearch Center of Smart City, Nanjing Tech University, Nanjing, ChinaResearch Center of Smart City, Nanjing Tech University, Nanjing, ChinaThe global aging population is growing rapidly, and due to its large population, China is expected to become a ‘super-aged society’ within the next decade. Therefore, ensuring that older people can ‘age in place’ has become a major national priority. Community-care facilities (CCFs) play a key role in this process, but their service performance often faces challenges, with high input costs and limited output benefits. This paper aims to evaluate and improve the social and economic performance of CCFs by proposing a comprehensive framework based on the 4E (Economy, Efficiency, Effectiveness, Equity) theory. Specifically, based on the 4E theory, a literature review and correlation analysis are conducted to select performance indicators. The input–output relationships are then established according to the four dimensions of the 4E theory. These indicators and input–output relationships form the foundation for applying the δ-SBM DEA model, which is used to assess the performance of 75 CCFs in Nanjing. The study finds that the economic performance of CCFs generally lags behind their social performance, with many facilities showing inefficiency in economic indicators, characterized by high operational costs and limited profitability. Projection analysis reveals major issues in low-performing CCFs, including uneven regional distribution of facility performance, poor profitability, a shortage of skilled older people care professionals, and insufficient older people’s participation. Based on these findings, the paper provides specific policy recommendations for government authorities, industry associations, and CCFs, focusing on improving cost-effectiveness, increasing the number of professionals, and enhancing older people’s participation.https://www.frontiersin.org/articles/10.3389/fpubh.2025.1467745/fullcommunity-carecare service provisionperformance benchmarkingDEAsocial performanceeconomic performance
spellingShingle Wei Huang
Wei Huang
Ying Hu
Lingzhi Li
Chendi Wang
Luyao Liu
The 4E theory-based performance benchmarking of aged care service provision in community care facilities: a case study of Nanjing, China
Frontiers in Public Health
community-care
care service provision
performance benchmarking
DEA
social performance
economic performance
title The 4E theory-based performance benchmarking of aged care service provision in community care facilities: a case study of Nanjing, China
title_full The 4E theory-based performance benchmarking of aged care service provision in community care facilities: a case study of Nanjing, China
title_fullStr The 4E theory-based performance benchmarking of aged care service provision in community care facilities: a case study of Nanjing, China
title_full_unstemmed The 4E theory-based performance benchmarking of aged care service provision in community care facilities: a case study of Nanjing, China
title_short The 4E theory-based performance benchmarking of aged care service provision in community care facilities: a case study of Nanjing, China
title_sort 4e theory based performance benchmarking of aged care service provision in community care facilities a case study of nanjing china
topic community-care
care service provision
performance benchmarking
DEA
social performance
economic performance
url https://www.frontiersin.org/articles/10.3389/fpubh.2025.1467745/full
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