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 Möbius 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.

中文翻译：

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葡萄牙公立医院是否可持续？三重底线混合数据包络分析方法

人类与生物圈的和谐互动决定了存在与共存的可持续性。然而，当出现社会挑战时，可持续性会受到严重影响。卫生是受此类挑战影响的领域之一，卫生系统确保提供卫生服务。因此，了解可持续的卫生服务，尤其是那些消耗大部分资源的卫生服务——医院——对于可持续的未来是必不可少的。出于这个原因，我们建议与葡萄牙卫生部合作，使用混合数据包络分析 (DEA) 方法从环境、社会和经济角度研究葡萄牙的医院可持续性。尤其是，由于在 DEA 方法中集成了 Choquet 多标准偏好聚合模型，所提出的方法结合了决策者的偏好信息（通过效用尺度的构建和莫比乌斯系数的确定）和标准交互性。最后，尽管在 2018 年抽样的 29 家评估医院中，约有 30% 的医院在三个方面被认为是高效的，但只有 1 家是完全可持续的。