Hospitals consume most of the health systems' financial resources. In Portugal, for instance, public hospitals represent more than half of the National Health Service debt and are decisive in their financial insufficiency. Although profit is not the primary goal of hospitals, it is essential to guarantee their financial sustainability to ensure users' health care and the necessary resources. An analysis of the existing literature shows that researches focus mainly on the hospital's technical efficiency. The literature has paid little or even no attention to the use of composite indicators in hospital benchmarking studies. This study uses the Benefit of Doubt methodology alongside recent data about Portuguese public hospitals (2013–2017) to understand the factors that contribute to low performance and high indebtedness levels. Our results suggest that hospitals perform better in terms of access (average score: 0.982). The group of criteria with the lowest performance was efficiency and productivity (average score: 0.919), suggesting resources waste. Financial performance is, in general, higher than quality, raising social concerns about the way that public hospitals have been managed. Findings bring relevant implications. For example, the way hospitals are currently financed should consider efficiency, productivity, quality, and access. Regulators should ensure that minimum performance levels are fulfilled, applying preventive and corrective measures to avoid future low-performance levels. We suggest that hospital managers introduce satisfaction inquiries to improve quality. These improvements can attract more patients in the medium- or long-term; thus, our results are useful to citizens to make a better choice.

医院消耗了卫生系统的大部分财政资源。例如，在葡萄牙，公立医院占国家卫生服务债务的一半以上，是其财政不足的决定性因素。虽然盈利不是医院的主要目标，但必须保证其财务可持续性，以确保用户的医疗保健和必要的资源。对现有文献的分析表明，研究主要集中在医院的技术效率上。文献很少甚至没有关注综合指标在医院基准研究中的使用。本研究使用怀疑收益法以及有关葡萄牙公立医院（2013-2017 年）的最新数据来了解导致低绩效和高负债水平的因素。我们的结果表明，医院在访问方面表现更好（平均得分：0.982）。表现最低的一组标准是效率和生产力（平均得分：0.919），表明资源浪费。总体而言，财务绩效高于质量，这引起了社会对公立医院管理方式的担忧。研究结果带来了相关的影响。例如，目前医院的融资方式应考虑效率、生产力、质量和可及性。监管机构应确保达到最低绩效水平，并采取预防和纠正措施以避免未来的低绩效水平。我们建议医院管理者引入满意度调查以提高质量。这些改进可以在中长期吸引更多患者；因此，