Drivers, uncertainties, and future scenarios of the Iranian health system

Mozhgan Emami; Ali Akbar Haghdoost; Vahid Yazdi-Feyzabadi; Mohammad Hossein Mehrolhassani

doi:10.1186/s12913-022-08774-w

Drivers, uncertainties, and future scenarios of the Iranian health system

BMC Health Serv Res. 2022 Nov 23;22(1):1402. doi: 10.1186/s12913-022-08774-w.

Authors

Mozhgan Emami¹, Ali Akbar Haghdoost², Vahid Yazdi-Feyzabadi^{3

4}, Mohammad Hossein Mehrolhassani^{5

6}

Affiliations

¹ PhD by Research Student in Management Sciences (Health Policy), Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
² Epidemiology, Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
³ Health Policy, Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
⁴ Department of Health Management, Policy and Economics, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran.
⁵ Department of Health Management, Policy and Economics, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran. mhmhealth@kmu.ac.ir.
⁶ Health Services Management, Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Haftbagh Highway, Kerman, Iran. mhmhealth@kmu.ac.ir.

Abstract

Background: Health promotion is an essential dimension of sustainable development in any country. It has a high degree of complexity, with numerous components interacting both inside and outside of the system, so having a systemic and forward-looking approach is essential to planning for the future.

Methods: The research has been designed based on scenario-based planning in three main stages. The data gathering was qualitative by working group meetings and compiling an importance-uncertainty questionnaire to complete the cross-impact analysis matrix. The MicMac and scenario Wizard has been used for data analysis.

Results: The scoping review and upstream document evaluation lead to 54 key variables for analyzing the Iranian health system (HS). The MicMac analysis ends by determining seven key variables: power, politics, and communication network; lifestyle and behavioral factors; quality of human resources training and education; environmental and occupational risk factors, payment and tariff system, and allocation pattern; support society / individuals health; and services effectiveness, especially para-clinical and outpatient ones. Finally, six main scenario spaces are depicted using Scenario Wizard. collective equity was the priority of the HS vision in the desirable scenario, consisting of the most favorable state of the uncertainties. The second, third, and fourth scenarios are also considered desirable. In the disaster scenario, which is the most pessimistic type of consistent scenario in this study, health and equity are not significant either in the social or individual dimensions. In the sixth scenario, the individual dimension of health and equity is the most critical perspective of the HS.

Conclusions: Due to the unsustainability and high complexity of the Iran's HS, the development and excellence of the HS governance based on the Iran context and health advocacy improvement (applying good governance); creating sustainable financial resources and rational consumption; and human resources training and education are three main principles leading the HS to the images of the desired scenarios.

Keywords: Drivers; Health system; Scenario planning; Systems analysis; Uncertainty.

MeSH terms

Forecasting
Government Programs*
Humans
Iran
Medical Assistance*
Uncertainty