Constructing Scenarios for the Iranian Health System Using Dynamic System Modeling

Abstract

Abstract Background Health systems (HSs) are recognized as complex adaptive systems, characterized by unforeseen interactions among their components. The prediction of such behaviors necessitates a systemic-perspective and a comprehensive identification of the dimensions and their interrelationships. In this study, dynamic system modeling was utilized to scrutinize the trends of critical components of Iran’s HS. Methods This study adopted a systems thinking and leveraging a system dynamics approach. The HS of Iran was modeled based on the balanced scorecard (BSC) framework, encompassing four dimensions: population health, service delivery, financing, and development. Subsequently, the parameters influencing cost reduction in the HS were modified to test policy implications over the forthcoming decade (2021–2031) under three scenarios: The data were derived from official Iranian statistics and information sources, as well as pertinent studies in the field. The modeling was executed using Vensim DSS6.4E software. Results By increasing the population, which is projected to reach 90 million by 2031, 35% of this population will be exposed to hazardous factors, putting approximately 32 million individuals at risk. Consequently, it is anticipated that 9 million people will require inpatient services, 43 million will necessitate outpatient services, and 52 million will need diagnostic and pharmaceutical services. In terms of human resources, the demand for physicians within the system by 2031 is projected to be 135,500, indicating a potential shortage of 20,850 physcians over the next decade. The current costs and expenses of the system are estimated at 17,000 trillion rials. Given the projected resource supply in the system in 2031 (7,807 trillion rials), the expenses are expected to exceed the supply, leading to a budget deficit. Conclusions As a result, the demand for medical services is expected to rise. To effectively address the escalating demands of society and improve the current situation, two primary steps must be undertaken. Firstly, strategic planning and interventions need to be enhanced to prevent and reduce the exposure of the population to risk factors. Secondly, infrastructural resources, including manpower, beds, and medical equipment, must be expanded. The model developed facilitates the consideration of changes in key-parameters and the evaluation of their impact on HS.