Using multi-criteria decision analysis to rank European health systems: The Beveridgian financing case

Health is one of the most fundamental human rights. In that sense, the creation of health systems attempted to provide the population with organisations, institutions, and resources to meet their needs. However, health inequalities are prevalent in all countries. Thus, evaluating health systems is vital to understand this issue. Accordingly, the aim of this work is to develop a multi-criteria decision analysis (MCDA) approach to innovatively rank nine of the European health systems with Beveridgian financing that would help determine the shortcomings of the Portuguese National Health Service and discern the operating "best practices", in a close interaction with the Portuguese Ministry of Health. First, the panel of decision-making actors was guided through the design of a cognitive map to promote their learning process and help them identify eleven fundamental points of view. Second, their operationalisation was facilitated by selecting acceptable descriptors of performance. Finally, an MCDA approach was proposed to evaluate the chosen health systems using an additive model, which included a sensitivity and a robustness analysis. In the end, the model was perceived by the panel as being trustworthy and reliable. This framework can be used for further MCDA modelling in similar applications based on participatory procedures.