A Sustainable Health System Financing Model: An Approach Based on Sustainable Supply Chain Performance and Artificial Intelligence

Zahra Zabihi; Mohsen Amini Khouzani; Mohsen Hashemigohar; Artin Beytari; Maryam Atarasadi

Authors

Zahra Zabihi Department of Accounting, ShQ.C., Islamic Azad University, Shahr-e Qods, Iran Author https://orcid.org/0009-0003-0480-6984
Mohsen Amini Khouzani Department of Financial Engineering, ShQ.C., Islamic Azad University, Shahr-e Qods, Iran https://orcid.org/0009-0001-4063-1056
Mohsen Hashemigohar Department of Accounting, ShQ.C., Islamic Azad University, Shahr-e Qods, Iran Author https://orcid.org/0000-0003-1058-1606
Artin Beytari Department of Accounting, ShQ.C., Islamic Azad University, Shahr-e Qods, Iran Author https://orcid.org/0009-0006-8609-0482
Maryam Atarasadi Department of Accounting, Qa.C., Islamic Azad University, Qazvin, Iran Author https://orcid.org/0009-0009-5014-8795

Keywords:

sustainable financing, health system, innovative financing methods, artificial intelligence, sustainable supply chain performance, financing portfolio, structural equation modeling

Abstract

Financing is one of the most important functions of a health system and plays a critical role in achieving universal health coverage and promoting societal well-being. Countries increasingly seek to protect their populations from excessive healthcare expenditures while ensuring equitable access to healthcare services. This study aimed to validate and assess the fit of a sustainable health system financing model, with particular emphasis on the roles of sustainable supply chain performance and artificial intelligence (AI). The proposed model examined the relationships among sustainable health system resources, AI, sustainable supply chain performance, innovative financing methods, and the optimal financing portfolio. The study was applied in terms of purpose and employed a quantitative, descriptive-survey design. Structural equation modeling (SEM) was used to examine the proposed relationships. The study population consisted of experts and specialists familiar with sustainable health system financing. Based on Cohen’s formula, a sample of 350 experts was selected at a 95% confidence level. Data were analyzed using SmartPLS. Assessment of the measurement model using Cronbach’s alpha, composite reliability, and convergent validity indicators generally supported the reliability and validity of the study constructs. In addition, the overall model fit index indicated a strong fit for the proposed model according to the criterion adopted in the study. The findings suggest that innovative financing methods, together with AI technologies and sustainable supply chain management, can contribute to improving the effectiveness and sustainability of health system financing. The integrated application of these approaches may facilitate more effective resource allocation, improved financial risk management, and the development of a more resilient health system.

References

[1] O. World Health, "A WHO framework for health system performance assessment," World Health Organization, Geneva, 2021. Accessed: 2021/04/12. [Online]. Available: https://apps.who.int/iris/bitstream/handle/10665/66267/a68870.pdf?sequence=1&isAllowed=y

[2] A. Aryankhesal, M. Etemadi, M. Mohseni, S. Azami-Aghdash, and M. Nakhaei, "Catastrophic health expenditure in Iran: A review article," Iranian Journal of Public Health, vol. 47, no. 2, pp. 166-177, 2018.

[3] R. Negarandeh, A. Kamran, and H. Heydari, "Iran's health system performance in achieving goals based on the World Health Organization's framework: A scoping review," Journal of Research & Health, vol. 12, no. 2, pp. 65-74, 2022, doi: 10.32598/JRH.12.2.1932.1.

[4] F. Farzadfar, M. Naghavi, S. G. Sepanlou, S. S. Moghaddam, W. J. Dangel, and N. D. Weaver, "Health system performance in Iran: A systematic analysis for the Global Burden of Disease Study 2019," The Lancet, vol. 399, no. 10335, pp. 1625-1645, 2022, doi: 10.1016/S0140-6736(21)02751-3.

[5] A. Sisodia and G. C. Maheshwari, "Exploring sustainable finance: A review and future research agenda," Vision, 2023, doi: 10.1177/09722629231209177.

[6] M. Amini Khouzani, S. Shahidi, A. Sarvari, M. Arabzadeh, and M. Attarasadi, "Loose coupling theory, revenue diversification, and financial sustainability in higher education," ed, 2024.

[7] F. Almodhen and W. M. Moneir, "Toward a financially sustainable healthcare system in Saudi Arabia," Cureus, vol. 15, no. 10, p. e46781, 2023, doi: 10.7759/cureus.46781.

[8] V. J. Dzau and C. Balatbat, "Strategy, coordinated implementation, and sustainable financing needed for COVID-19 innovations," The Lancet, vol. 396, no. 10261, pp. 1469-1471, 2020, doi: 10.1016/S0140-6736(20)32289-3.

[9] N. Akca, S. Sonmez, and A. Yilmaz, "Determinants of health expenditure in OECD countries: A decision tree model," Pakistan Journal of Medical Sciences, vol. 33, no. 6, p. 1490, 2017.

[10] R. Muremyi, D. Haughton, I. Kabano, and F. Niragire, "Prediction of out-of-pocket health expenditures in Rwanda using machine learning techniques," Pan African Medical Journal, vol. 37, no. 1, 2020.

[11] Z. Lan, G. Zhou, Y. Zhang, Y. Duan, W. Yan, and C. Chi, "Healthcare expenditure prediction for crowd with co-existing medical conditions," 2019. [Online]. Available: https://doi.org/10.1109/BIGCOM.2019.00052.

[12] A. Beytari, R. Zarehzadeh, M. R. Ghorbanian, and H. Badiei, "Modeling the total stock index using the Brownian droplet-motion model and comparing it with online machine-learning methods," ed, 2025.

[13] A. Jabbari, A. Zakeri, F. Saghafi, and M. Hadian, "Iranian health financing system challenges to promote health outcomes: Qualitative study," Journal of Education and Health Promotion, vol. 12, p. 149, 2023, doi: 10.4103/jehp.jehp_507_22.

[14] A. M. Mosadeghrad, S. Tolouie Rakhshan, M. Afshari, and P. Isfahani, "Health financing system indicators: A scoping review," Hakim, vol. 23, no. 3, pp. 353-366, 2020.

[15] H. C. Karamagi et al., "Financing health system elements in Africa: A scoping review," PLOS ONE, vol. 18, no. 9, p. e0291371, 2023, doi: 10.1371/journal.pone.0291371.

[16] F. Kitsios, M. Kamariotou, A. I. Syngelakis, and M. A. Talias, "Recent advances of artificial intelligence in healthcare: A systematic literature review," Applied Sciences, vol. 13, p. 7479, 2023, doi: 10.3390/app13137479.

[17] P. Nallamothu and K. M. Cuthrell, "Artificial intelligence in health sector: Current status and future perspectives," Asian Journal of Research in Computer Science, vol. 15, pp. 1-14, 2023, doi: 10.9734/AJRCOS/2023/v15i4325.

[18] G. Krishnan et al., "Artificial intelligence in clinical medicine: Catalyzing a sustainable global healthcare paradigm," Frontiers in Artificial Intelligence, vol. 6, p. 1227091, 2023, doi: 10.3389/frai.2023.1227091.

[19] J. C. Okeibunor et al., "The use of artificial intelligence for delivery of essential health services across WHO regions: A scoping review," Frontiers in Public Health, vol. 11, p. 1102185, 2023, doi: 10.3389/fpubh.2023.1102185.

[20] I. Kulkov, J. Kulkova, R. Rohrbeck, L. Menvielle, V. Kaartemo, and H. Makkonen, "Artificial intelligence-driven sustainable development: Examining organizational, technical, and processing approaches to achieving global goals," Sustainable Development, 2023, doi: 10.1002/sd.2773.

[21] M. Ramezani, A. Takian, and A. Bakhtiari, "Research agenda for using artificial intelligence in health governance: Interpretive scoping review and framework," BioData Mining, vol. 16, p. 31, 2023, doi: 10.1186/s13040-023-00346-w.

[22] M. Ramezani, A. Takian, A. Bakhtiari, H. R. Rabiee, A. A. Fazaeli, and S. Sazgarnejad, "The application of artificial intelligence in health financing: A scoping review," Cost Effectiveness and Resource Allocation, vol. 21, no. 1, p. 83, 2023, doi: 10.1186/s12962-023-00492-2.

[23] Y. Azar-Saeed and S. Rostami, "Artificial intelligence and ethical decision-making in accounting and auditing: Analysis of related challenges," Judgment and Decision Making in Accounting, vol. 2, no. 7, pp. 87-114, 2023, doi: 10.30495/jdaa.2023.705528.

[24] M. Nazarpour, S. H. Nasl-Mousavi, and M. S. Hosseini Shirvani, "Application of artificial intelligence in tax auditing," Danesh-e Hesabdari, vol. 20, no. 81, pp. 198-226, 2020. [Online]. Available: https://sid.ir/paper/967020/fa.

[25] K. Harunkolayi and G. Barzegar, "Explaining financial variables affecting the prediction of financial recovery using an artificial intelligence approach," Economic Modeling, vol. 17, no. 61, pp. 89-104, 2023, doi: 10.30495/eco.2023.1982463.2737.

[26] H. R. Azizi-Balabiglu and M. Soleimani, "The role of artificial intelligence in sustainable financial development," presented at the First International Conference on Management Capability, Industrial Engineering, Accounting and Economics, Babol, 2023. [Online]. Available: https://civilica.com/doc/1690938.

[27] S. Khodayari-Siar, "The role of artificial intelligence in sustainable financing and the development of sustainability reporting standards," presented at the First International Conference on Management, Accounting and Economics with a Future-Oriented Approach, Bushehr, 2023. [Online]. Available: https://civilica.com/doc/1797221.

[28] M. Hashemi Gohar, S. Jalili, and O. Alizadeh, "The effect of corporate governance on the relationship between corporate sustainability performance and dividend policy," ed, 2023.

[29] W. R. Wang, "Research on China's tax policy for responding to public health emergencies under the background of big data," presented at the 2020 International Conference on Modern Education and Information Management (ICMEIM), 2020.

[30] M. A. Rosen, "The future of sustainable development: Welcome to the European Journal of Sustainable Development Research," European Journal of Sustainable Development Research, vol. 1, 2017.