Is sunshine regulation the new prescription to brighten up public hospitals in Portugal?

Health systems are complex organisations that attempt to deliver health services to meet the needs of the population. Regardless of the degree of access to and quality of those health services, the systems' sustainability has been the object of special attention by governments worldwide. To ensure their adequate functioning in light of the accountable and transparent facets of New Public Governance, one must resort to regulatory mechanisms, such as sunshine regulation. By publicly displaying the results of benchmarking assessments, sunshine regulation “embarrasses” operators with poor performances in an effort to force them to correct such divergences. Thus, in this paper, we propose a sunshine regulatory model to the public hospitals in Portugal using multi-criteria decision analysis. In particular, we created a five-star rating that categorises those operators according to their performances, by means of the outranking method electre tri-nc. As a result, we provide evidence of the existence of a majority of providers assigned to the ‘Average’ category of “Three stars” and the nonexistence of providers with unique extreme category assignments (“One star” or “Five stars”), both of which are supported by extensive stability and robustness analyses, and discussed in terms of policy implications for relevant stakeholders.