Abstract for: Breaking Systemic Barriers in Thailand’s Public Dental Care Through Causal Loop Analysis and Policy Consensus

Despite universal health coverage, access to public dental services in Thailand remains limited, especially for vulnerable populations. To understand the underlying dynamics, this study applies system thinking and CLDs to qualitative data from key stakeholders. The goal is to visualize feedback loops that perpetuate service gaps and to identify leverage points for policy intervention. Focus groups with 48 slum community members and interviews with 27 Bangkok dental providers informed six CLDs. The analysis applied Levesque et al.’s (2003) framework to reveal user-provider dynamics and employed qualitative system dynamics to construct the CLDs, identifying distinct feedback mechanisms that drive service barriers and inequities. Six feedback loops reveal systemic drivers of healthcare bottlenecks and inequities: demand outpaces supply, quick fixes mask inefficiencies, vulnerable groups opt out due to access barriers, reliance on private clinics weakens public capacity, reimbursement rates shape provider participation, and payment model differences deepen service gaps. Together, these loops expose root causes behind persistent inefficiency and uneven access. The CLDs reveal that Thailand’s public dental service system is shaped by multiple, interacting feedback loops. Key leverage points include strategic investment to break the growth-underinvestment trap. Data-driven management to address root causes of inefficiency. Targeted support for vulnerable groups to close equity gaps. Balanced public-private partnerships with appropriate incentives. Harmonized payment models to reduce fragmentation and inequity. AI was used for revision of structured abstract.