Developing Scenarios for the Iranian Health System Using System Dynamics Methodology

Background: Health systems (HSs) are complex adaptive entities, marked by dynamic interactions among their components. Understanding and predicting their behavior requires a systemic perspective and a comprehensive analysis of their interrelated dimensions. This study employed system dynamics modeling to examine key trends within Iran’s HS. Methods: A systems thinking approach was adopted, utilizing system dynamics methodology. The model was structured based on the Balanced Scorecard (BSC) framework, encompassing four dimensions: Population health, service delivery, financing, and development. Parameters affecting cost reduction were modified to assess policy implications across three scenarios from 2021 to 2031. Data were sourced from official Iranian statistics and relevant academic studies. Simulations were conducted using Vensim DSS 6.4E software. Results: By 2031, Iran’s population is projected to reach 90 million, with 35% exposed to risk factors, placing approximately 32 million individuals at risk. As a result, an estimated 9 million people will require inpatient services, 43 million will need outpatient care, and 52 million will require diagnostic and pharmaceutical services. Physician demand is projected to reach 135,500 by 2031, resulting in a shortage of 20,850 physicians. Financial projections estimate current healthcare costs at 17,000 trillion rials, while available resources will amount to only 7,807 trillion rials, indicating a substantial budget deficit. Conclusions: The demand for healthcare services will significantly increase in the coming decade. To meet this demand, two strategic actions are critical: (1) Strengthening preventive interventions to reduce population exposure to risk factors; and (2) expanding infrastructural resources, including human capital, hospital beds, and medical equipment. The developed model supports scenario analysis by enabling policymakers to assess the impact of changes in key parameters and plan effective responses.