Balancing patient choice and health system capacity: a system dynamics model of dialysis in Thailand
Regulating financial incentives in the Thai health system offered the greatest potential to reduce inappropriate dialysis initiation and increase peritoneal dialysis uptake. The system dynamics model showed that coupling policies with complementary mechanisms could address key uncertainties and amplify their impact. We suggest that policymakers incorporate quality of care and time-dependent performance into policy goals to achieve sustainable improvements. Our findings highlight the value of a systems approach to account for unintended consequences of well-intended policy interventions, resulting from delayed responses across organisational boundaries.
Authors
- Jeerath Phannajit (ORCID: https://orcid.org/0000-0002-3524-6292)
- Kinanti Khansa Chavarina (ORCID: https://orcid.org/0009-0002-3274-0591)
- Itamar Megiddo (ORCID: https://orcid.org/0000-0001-8391-6660)
- John Quigley (ORCID: https://orcid.org/0000-0002-7253-8470)
- Siobhan Botwright (ORCID: https://orcid.org/0000-0002-8204-2065)
- Yot Teerawattananon (ORCID: https://orcid.org/0000-0003-2217-2930)
- Jiratorn Sutawong (ORCID: https://orcid.org/0000-0002-3385-6919)
- Le Khanh Ngan Nguyen (ORCID: https://orcid.org/0000-0002-6742-6896)
- Natcha Yongphiphatwong (ORCID: https://orcid.org/0009-0004-9283-8819)
Institutions
- Chulalongkorn University (TH)
- National University of Singapore (SG)
- University of Strathclyde (GB)
- Health Intervention and Technology Assessment Program (TH)
- King Chulalongkorn Memorial Hospital (TH)
- National University Health System (SG)
- University of York (GB)
Publication Details
- Journal
- BMC Medicine
- Published
- 2025-11-20
- DOI
- https://doi.org/10.1186/s12916-025-04522-z
- Citations
- 5
- Primary Topic
- Healthcare Systems and Reforms
- Type
- article
- Field-Weighted Citation Impact
- 11.04
Funders
- Health Systems Research Institute