Are the Portuguese public hospitals sustainable? A triple bottom line hybrid data envelopment analysis approach

The harmonious interaction between humans and the biosphere determines how sustainable existence and coexistence are. However, when social challenges appear, sustainability is heavily compromised. Health is one of the areas affected by such challenges, with the delivery of health services being ensured by health systems. Consequently, understanding how sustainable health services are, especially those that consume the majority of resources-hospitals-is indispensable for a sustainable future. For this reason, we propose using a hybrid data envelopment analysis (DEA) approach to study hospital sustainability in Portugal under environmental, social, and economic perspectives, in cooperation with the Portuguese Ministry of Health. In particular, the proposed methodology incorporates the preference information of decision makers (via the construction of utility scales and the determination of Mobius coefficients) and criteria interactivity, due to the integration of the Choquet multiple criteria preference aggregation model in the DEA approach. In the end, despite approximately 30% of the sampled 29 assessed hospitals were deemed as efficient across the three perspectives in 2018, only 1 was entirely sustainable.