Tehran University of Medical Sciences Health Technology Assessment in Action 2645-3835 6 2 2023 02 25 132 132 Sahar Salehi Ph.D. Student of Futures Studies in Health, Department of Biostatistics and Epidemiology, Faculty of public Health, Kerman University of Medical Sciences, Kerman, Iran. Pejman Hamouzadeh Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Hamid Esmailzadeh Community Based Participatory Research Center, Tehran University of Medical Sciences, Tehran, Iran Mohammadreza Mobinizadeh National Institute for Health Research, Tehran University of Medical Sciences, Tehran, Iran. Fateme Yaftian Health Equity Research Center (HERC), Tehran University of Medical Sciences, Tehran, Iran Amirhossein Takian Health Equity Research Centre (HERC), Tehran University of Medical Sciences, Tehran, Iran Department of Global Health and Public Policy, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Department of Health Management, Policy & Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Alireza Olyaeemanesh Health Equity Research Center, Tehran University of Medical Sciences, Tehran, Iran National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran 2022 08 27 2022 11 29 Abstract Context: Health systems’ main mission is to improve society’s well-being and fulfill their health needs. Objectives: This study aimed to describe the intrinsic and extrinsic events that had influenced Iran’s health system over the previous decade, as well as to identify the possible factors influencing it until 2025 and investigate their positive/negative impacts. Methods: To determine previous driving forces, a systematic review of electronic databases was conducted up to December 2018. Then the most frequent contributing factors were extracted and discussed in expert panels, and finally, scenarios were composed. After identifying the internal and external driving forces as well as their effects, an input-output model was designed by using a sequence of events’ scenarios. Finally, findings were presented using a scenario-based expert system model. Results: The most important driving forces affecting health system’s policies included “demographic changes”, “economic changes”, “natural disasters”, “changes in population’s health status”, and “changes in the health system’s management.” Furthermore, other events such as “risks associated with emerging technologies”, “cold wars”, and “changes in personal vehicle utilization rates” may have, directly or indirectly, affected the benefits from health services, status, costs, and out-of-pocket payments. Conclusions: In sum, it was found possible to implement the most effective crisis management system, eliminate the negative effects of these uncertainties, and reap the most considerable benefits by identifying the factors influencing health system, determining their interrelationships and effects, as well as designing separate scenarios for all possible outcomes. https://htainaction.tums.ac.ir/index.php/hta/article/view/132 https://htainaction.tums.ac.ir/index.php/hta/article/download/132/102