Abstract for: Beyond Single-Disease Policies: A System Dynamics Model of Value-Based Payment for Cardiovascular–Kidney–Metabolic Health in Thailand

Thailand’s burden of non-communicable diseases is shaped by reinforcing interactions among obesity, diabetes, hypertension, dyslipidemia, delayed diagnosis, and downstream complications. Existing single-disease policies can fragment incentives by rewarding isolated services and disease-specific outcomes, shifting attention away from overlapping risks, weakening continuity of care, and allowing the accumulation of multimorbidity-related burden. We hypothesize that these feedbacks make disease-specific payment policies insufficient for reducing total cardiometabolic burden. We developed a national-level system dynamics model of cardiovascular–kidney–metabolic (CKM) health in Thailand, spanning healthy, at-risk, cardiometabolic disease, subclinical cardiovascular disease, and clinical cardiovascular disease stages. The model represents screening, diagnosis, disease control, remission, and progression, and incorporates multimorbidity among cardiometabolic conditions. We compared business-as-usual with three payment policies and evaluated costs and benefits from both government and societal perspectives. Preliminary simulations suggest that value-based payment for diabetes care improves disease-specific outcomes, including disease control and remission, but leaves substantial residual risk in overlapping cardiometabolic populations. A broader payment for cardiometabolic disease yields larger reductions in uncontrolled disease, while a bundled payment across the care continuum generates the greatest long-term reductions in cardiovascular complications and appears more attractive to policymakers because it better aligns upstream investment with downstream cost avoidance. The findings support the dynamic hypothesis that fragmented, single-disease incentives can reinforce inefficiency by neglecting multimorbidity and continuity of care. System dynamics modeling makes these feedbacks visible and provides a practical decision-support tool for designing coordinated, whole-pathway value-based payment across the cardiovascular–kidney–metabolic care continuum. This approach may be more policy-relevant than disease-silo reforms when the goal is to reduce both clinical and economic burden. AI was used for grammatical correction and writing style improvement