Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of medical sciences, Kerman, Iran.
Arch Iran Med. 2022 Feb 1;25(2):85-90. doi: 10.34172/aim.2022.14.
The financing function within a health system is considered inherently complex, so it is of utmost importance to design a suitable future for this system given uncertainties and complexities of the environment. With regard to the current and future complicated conditions, health system financing is also likely to succeed if it can anticipate the impacts of effective factors in the future and further plan appropriate interventions ahead of time. Thus, the purpose of this study was to develop scenarios for the health system financing in Iran.
This mixed-design research of exploratory future studies type was conducted using the scenario method. In this respect, the key variables were evaluated using a questionnaire from two aspects of importance and uncertainty as well as formation of a future studies group (focus group). Finally, sensitivity analysis was carried out through cross-impact balance (CIB) analysis using the Scenario Wizard (Version 4.31) software.
A total of 25 factors were selected based on the type and the position of the variables (driving force, bi-dimensional, risk, secondary leverage or modifiable-to-secondary leverage) over the diameter of the MICMAC chart. Considering the degree of significance and uncertainty, eight variables including all four driving force variables (oil sales and economic blockade, leadership and advocacy, bureaucracy and corruption, and possibility of using information technology in providing services), as well as the variables of resource sustainability, natural disasters, regional security, and specialization culture were chosen. Then, five variables were finalized as the key changes that would create the scenario based on sensitivity analysis and final expert opinions. According to the defined conditions, 270 scenarios were developed, of which fourteen scenarios were identified as poorly adaptable and five cases as highly adaptable.
The best scenario identified in this study based on the degree of adaptation included the use of massive technology and oil sales, mediocre economic conditions with high probability of occurrence, strong leadership and advocacy, high regional security, as well as bureaucracy and low corruption with medium probability of occurrence.
卫生系统的融资功能被认为具有内在的复杂性，因此，鉴于环境的不确定性和复杂性，为该系统设计一个合适的未来是至关重要的。考虑到当前和未来的复杂情况，如果卫生系统融资能够预测未来有效因素的影响，并提前计划适当的干预措施，那么它也有可能取得成功。因此，本研究的目的是为伊朗卫生系统的融资制定方案。
本研究采用情景方法进行了探索性未来研究类型的混合设计研究。在这方面，使用问卷调查从重要性和不确定性两个方面评估了关键变量，并组建了一个未来研究小组（焦点小组）。最后，通过使用Scenario Wizard（Version 4.31）软件进行交叉影响平衡（CIB）分析，进行了敏感性分析。
总共根据变量的类型和位置（驱动力、二维、风险、次要杠杆或可转化为次要杠杆）选择了 25 个因素，这些因素跨越了 MICMAC 图表的直径。考虑到显著性和不确定性程度，选择了包括所有四个驱动力变量（石油销售和经济封锁、领导力和倡导、官僚主义和腐败以及在提供服务中使用信息技术的可能性）在内的八个变量，以及资源可持续性、自然灾害、区域安全和专业化文化等变量。然后，根据敏感性分析和最终专家意见，选择了五个变量作为产生方案的关键变化。根据定义的条件，制定了 270 个方案，其中 14 个方案被认为适应性差，5 个方案适应性强。
根据适应程度，本研究确定的最佳方案包括大规模使用技术和石油销售、经济条件中等但发生概率高、领导力和倡导强、区域安全高、官僚主义低且腐败程度低，但发生概率中等。
