Prioritizing payment methods for neonatal intensive care units in Iran using TOPSIS

Neonatal Intensive Care Unit (NICU) care is resource-intensive, and the fee-for-service (FFS) payment model, which remains widely used in Iran, may increase the volume of services while providing limited incentives for quality improvement. Therefore, this study aimed to evaluate and prioritize alternative payment models for NICUs in Iran. Four payment models—perinatal bundled payment, NICU episode-based bundled payment, Diagnosis-Related Groups (DRGs), and FFS plus Pay-for-Performance (PFP) plus per diem with procedures—were evaluated using a multi-criteria decision analysis with the Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS). Twenty-one experts in health economics, insurance, and neonatology assessed the models against 14 predefined criteria. TOPSIS analysis ranked the perinatal bundled payment model highest, followed by NICU episode-based bundled payment, DRGs, and FFS plus PFP plus per diem with procedures. Sensitivity analysis showed that the rankings were generally robust, although substantial changes in the weights of key criteria could affect model prioritization. Based on expert judgments, the perinatal bundled payment model was the highest-ranked option for neonatal provider payment in Iran. However, because these findings reflect stakeholder preferences rather than empirical effectiveness, pilot implementation and economic evaluation are needed before wider adoption.