  The recent studies signify the growing concern of researchers towards
monitoring and measuring sustainability performance at various levels and in
many fields, including healthcare. However, there is no agreed approach to
assessing the sustainability of health systems. Moreover, social indicators are
less developed and less succinct. Therefore, the authors seek to map
sustainable reference values in healthcare and propose a conceptual and
structured framework that can guide the measurement of the social
sustainability-oriented health systems. Based on a new multi-criteria method
called Strong Sustainability Paradigm based Analytical Hierarchy Process,
(SSP-AHP), the presented approach opens the availability for systems'
comparison and benchmarking. The Strong Sustainability Paradigm incorporated
into the multi-criteria evaluation method prevents the exchangeability of
criteria by promoting alternatives that achieve good performance values on all
criteria, implying sustainability. The research results offer insights into the
core domains, sub-domains, and indicators supporting a more comprehensive
assessment of the social sustainability of health systems. The framework
constructed in this study consists of five major areas: equity, quality,
responsiveness, financial coverage, and adaptability. The proposed set of
indicators can also serve as a reference instrument, providing transparency
about core aspects of performance to be measured and reported, as well as
supporting policy-makers in decisions regarding sectoral strategies in
healthcare. Our findings suggest that the most socially sustainable systems are
Nordic countries. They offer a high level of social and financial protection,
achieving very good health outcomes. On the other hand, the most unsustainable
systems located in central and eastern European countries.
