1- Associate Professor, Department of Resource Economics, Economics Research Institute, Tarbiat Modares University, Tehran, Iran , aghelik@modares.ac.ir
2- PhD Student in Health Economics, Faculty of Economics and Management, Islamic Azad University, SR.C., Tehran, Iran.
3- Assistant professor, Department of Health Services Management, SR.C., Islamic Azad University, Tehran, Iran
2- PhD Student in Health Economics, Faculty of Economics and Management, Islamic Azad University, SR.C., Tehran, Iran.
3- Assistant professor, Department of Health Services Management, SR.C., Islamic Azad University, Tehran, Iran
Abstract: (110 Views)
Introduction: Game theory provides an analytical and effective framework for strategic decision-making in the health insurance market and can model the interactions among the actors in this market. The aim of this study is to conduct a systematic review of studies conducted on the application of game theory in health insurance policy-making, with a strategic behavior analysis approach. The importance of this framework is evident in designing insurance policies, reducing adverse selection, managing moral hazard, and enhancing efficiency and equity in the health system.
Method: This study followed the PRISMA framework and reviewed 138143 Persian and English articles published between 2011 and 2025 across major scientific databases, including Scopus, ScienceDirect, Web of Science, PubMed, and IEEE. Data were evaluated using the JBI quality appraisal checklist. A comparative analytical approach was then employed to synthesize the findings and identify shared patterns and key conceptual differences among the studies.
Results: Twenty-four studies were included in the analysis, indicating that policymaking grounded in the strategic interactions among insurance actors can enhance efficiency,reduce moral hazard and adverse selection, improve accessibility, and increase beneficiary satisfaction. The design of contracts and incentive–penalty mechanisms further contributes to improving behavioral alignment and reducing conflicts of interest.
Conclusion: Integrating game theory approaches with real data and modeling actors’ behavior provides an effective tool for health insurance policymakers to allocate resources optimally, strengthen social equity, and improve health system productivity. This approach can guide efficient, equitable, and sustainable policymaking in Iran’s health insurance sector.
Method: This study followed the PRISMA framework and reviewed 138143 Persian and English articles published between 2011 and 2025 across major scientific databases, including Scopus, ScienceDirect, Web of Science, PubMed, and IEEE. Data were evaluated using the JBI quality appraisal checklist. A comparative analytical approach was then employed to synthesize the findings and identify shared patterns and key conceptual differences among the studies.
Results: Twenty-four studies were included in the analysis, indicating that policymaking grounded in the strategic interactions among insurance actors can enhance efficiency,reduce moral hazard and adverse selection, improve accessibility, and increase beneficiary satisfaction. The design of contracts and incentive–penalty mechanisms further contributes to improving behavioral alignment and reducing conflicts of interest.
Conclusion: Integrating game theory approaches with real data and modeling actors’ behavior provides an effective tool for health insurance policymakers to allocate resources optimally, strengthen social equity, and improve health system productivity. This approach can guide efficient, equitable, and sustainable policymaking in Iran’s health insurance sector.
Keywords: Game theory, health insurance, policy-making, adverse selection, moral hazard, social equity
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