Multiple Criteria Sorting Model with MEREC and VIKOR-Sort for Evaluating European Union Countries Through Health Indicators

Evaluating national healthcare performance is a complex and multidimensional problem that requires balancing system resources against health outcomes and financial equity. This study introduces an integrated Multi-Criteria Decision Making (MCDM) framework combining the MEREC (Method based on the Removal Effects of Criteria) and VIKOR-Sort methods to classify the 27 European Union (EU) member states into ordered health-performance categories. The analysis uses a set of health indicators that reflect key dimensions of risk and system performance, including preventable mortality burdens, health-system capacity, financing effort and outcome vulnerability. The proposed methodology is based on a data-driven model designed to reduce decision-maker subjectivity. In the first stage, the MEREC approach is employed to determine objective indicator weights by evaluating how the overall assessment changes when each indicator is removed. In the second stage, using the weights, the VIKOR-Sort method is utilized to classify countries into ordered performance classes based on boundary profiles. The results identify three performance groups: higher-performing countries, a broad middle group with mixed results, and a lower-performing group facing multiple challenges. The ordered class structure is intended to provide a basis for benchmarking and policy interpretation and to help identify priority areas for improvement across countries’ health systems.