A case study integrating scenario thinking with dialysis policymaking in Thailand

Background: 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. Methods: 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. Results: 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. Conclusions: 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.