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A case study integrating scenario thinking with dialysis policymaking in Thailand

Year: 2025

Type: article

Abstract: Healthcare policymaking often struggles to account for complex future uncertainties, particularly for policies affecting healthcare infrastructure or stakeholder behaviour. Scenario thinking is a structured approach for exploring multiple plausible futures. It has, however, been underutilised in healthcare policymaking. We applied scenario thinking to the 2024 dialysis policy in Thailand to guide policymaking under future uncertainty. Our study is composed of three parts: scenario development, policy analysis, and evaluation of scenario thinking in the policy process. We developed future scenarios using the intuitive logics method, which systematically identifies and explores key uncertainties, and the critical scenario method to evaluate stakeholder responses. Policy options were evaluated for their robustness across future scenarios. We assessed the overall approach according to fitness-for-purpose, influence, and efficiency indicators from established evaluation frameworks for health technology assessment. Four scenarios are presented along the dimensions of kidney transplant accessibility and skilled workforce availability. Approval of patients prior to dialysis initiation and a quality monitoring system can strengthen the dialysis programme’s adaptability to future change, while considerable uncertainty exists regarding performance of service provider payment mechanisms. Our evaluation suggests that scenario thinking is an efficient method to characterise future uncertainty within available resources for policymaking. This study demonstrates how scenario thinking can systematically evaluate healthcare policies under future uncertainty, providing a framework for more robust policies. Further research is needed to facilitate its use, building on the adaptations developed in this study to bridge scenario thinking with established processes and standards for healthcare policy. First author et al. apply scenario thinking to characterise uncertainty around the future impact of different dialysis policies in Thailand. Our findings highlight the benefit of scenario thinking for systematically evaluating policy robustness and understanding how the motivations of different actors may affect policy success. When healthcare policies are made, it is often under the assumption that present conditions will continue. This gives us a poor understanding of risk, particularly for policies that are difficult to change or that rely on people’s behaviour. We tested scenario thinking, a structured method commonly used in business, to evaluate policies for kidney failure treatment in Thailand. By exploring different possible futures, we found important risks and opportunities that traditional analysis missed, particularly around how healthcare providers might respond to policy changes. While adapting this method for healthcare required some adjustments, it proved to be a practical tool that required few extra resources. Our study shows how scenario thinking could help make healthcare policies more prepared for future challenges.

Source: Communications Medicine

DOI: 10.1038/s43856-025-01299-3