Abstract
As indicated by a worldwide common perspective about health and sustainable health systems, the health structure as a part of public health is a key theme of many societies. The future is shaped by probable future scenarios, for which dealing practically has many complications. This study is focused on the future scenarios for a comprehensive sustainable health financing model to support a superior structure for a decision and policy-making pilot for the society. This aim is followed based on multiple attribute decision making (MADM)-based scenarios using two MADM methods, step-wise weight assessment ratio analysis (SWARA) and weighted aggregated sum product assessment (WASPAS), as a hybrid model which is the first real case study of the approach. Four main probable future scenarios are identified and selected based on experts’ viewpoints about sustainable health financing models. These scenarios include membership in the World Trade Organization (WTO), dynamic basic insurance, international cooperation, and effective resources management. The process of evaluating based on the approach works as a wider picture, including all criteria and alternatives together. Sustainable medical services, empowering the private sector in both production and technology, and employing international managers took place as the top priority for considering the most applicable alternatives in the future. This structure is designed and developed in Iran’s context, and the Institute for Futures Studies in Health is the pilot of the research.
Highlights
The health system is supposed to function properly in four determined aspects to accomplish three fundamental objectives of health promotion, having reasonable financial contribution and responsiveness
Calculations were carried out separately based on a hybrid multiple attribute decision making (MADM) model (SWARA-weighted aggregated sum product assessment (WASPAS))
The first one is “Average based on priorities (Min)”, which is influential in evaluating momentous criteria, and the second one is “Estate of alternatives based on Average in state of max criteria (ASMAC) and Average state of “min” criteria (ASMIC)” which is utilized in the evaluation process of applicable alternatives
Summary
The health system is supposed to function properly in four determined aspects to accomplish three fundamental objectives of health promotion, having reasonable financial contribution and responsiveness. Concerning the growing challenges of health systems such as resources limitation and increased demand, neglecting variable circumstance and requirements would have detrimental consequences and lead to damaging failures (Coiera and Hovenga, 2007) [1]. These functions are stewardship, resource generation, financing, and services provision (WHO report, 2000) [2]. Financing is considered one of the most essential functions of health systems. Health system financing is the procedure by which revenues are collected from primary and secondary sources, which are accumulated in fund pools and allocated to specific activities of providers (1). The government, social insurance, and private health insurance payments constitute four main sources of out-of-pocket payments in health system financing (Markel, 2014) [3]
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