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ORIGINAL RESEARCH article

Front. Public Health
Sec. Aging and Public Health
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1467745
This article is part of the Research Topic The Formal and Informal Workforce for a Global Aging Population View all 4 articles

The 4E theory-based Performance Benchmarking of Aged Care Service Provision in Community Care Facilities: A case study of Nanjing, China

Provisionally accepted
Wei Huang Wei Huang 1,2Ying Hu Ying Hu 1Lingzhi Li Lingzhi Li 1*Chendi Wang Chendi Wang 1Luyao Liu Luyao Liu 1
  • 1 School of Architecture, Nanjing Tech University, Nanjing, China
  • 2 Sanjiang University, Nanjing, Jiangsu Province, China

The final, formatted version of the article will be published soon.

    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 inputoutput 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 professional, and insufficient older people 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 participation.

    Keywords: community-care1, care service provision2, performance benchmarking3, DEA4, social performance5, economic performance6

    Received: 20 Jul 2024; Accepted: 20 Jan 2025.

    Copyright: © 2025 Huang, Hu, Li, Wang and Liu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Lingzhi Li, School of Architecture, Nanjing Tech University, Nanjing, China

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