Hybrid Fuzzy Multi-Criteria Decision Making Model - Health Insurance

Development of a Hybrid Fuzzy Multi-Criteria
Decision Making Model for Selection of Group

Health Insurance Plans
A Thesis submitted to the University of Manchester for the degree of

Doctor of Philosophy in the Faculty of Humanities
2014
Tarifa Almulhim
Manchester Business School
1
Table of Contents
LIST OF TABLES .................................................................................................................................. 6
LIST OF FIGURES ................................................................................................................................ 9
LIST OF ABBREVIATIONS ............................................................................................................... 12
ABSTRACT.......................................................................................................................................... 13
DECLARATION .................................................................................................................................. 14
COPYRIGHT STATEMENT ............................................................................................................... 15
DEDICATION ...................................................................................................................................... 16
ACKNOWLEDGEMENT .................................................................................................................... 16
ABOUT THE AUTHOR ...................................................................................................................... 17
1. CHAPTER ONE: INTRODUCTION ........................................................................................... 19
1.1 Introduction ................................................................................................................................. 19
1.2 Background to the Problem......................................................................................................... 19
1.3 The Research Problem ................................................................................................................ 22
1.4 Research Objectives and Research Questions............................................................................. 25
1.5 Outline of the Research Methodology ........................................................................................ 26
1.6 Research Contributions ............................................................................................................... 30
1.7 An Overview of the Chapters...................................................................................................... 32
2. CHAPTER TWO: BACKGROUND AND RELATED WORK .................................................. 37
2.1 Introduction ................................................................................................................................. 37
2.2 A Brief History of Insurance and Health Insurance .................................................................... 37
2.3 Studies in Insurance and Health Insurance ................................................................................. 39
2.3.1 A Review of Previous Related Work ................................................................................... 39
2.3.2 Discussion of the Previous Work ......................................................................................... 44
2.4 Identification of Gaps in the Literature ....................................................................................... 46
2.5 Decision Making ......................................................................................................................... 50
2.5.1 A General Overview of MCDM .......................................................................................... 52
2.5.2. Characteristics of MCDM ................................................................................................... 55
2.6 Summary of the Chapter ............................................................................................................. 57
3. CHAPTER THREE: TOWARDS A MCDM FRAMEWORK FOR GROUP HEALTH
INSURANCE PLAN SELECTION...................................................................................................... 59
3.1 Introduction ................................................................................................................................. 59
3.2 Modelling Uncertainty in MCDM .............................................................................................. 60
3.2.1 Analysis of Methods for Modelling Uncertainty ................................................................. 60
3.2.2 Summary of the Analysis ..................................................................................................... 67
3.3 Priority Derivation ...................................................................................................................... 68
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3.3.1 Methods for Prioritisation .................................................................................................... 69
3.3.2 Analysis of Methods for Prioritisation ................................................................................. 77
3.4 Group Decision Making .............................................................................................................. 80
3.4.1 Analysis of Group Prioritisation and Aggregation Approaches........................................... 82
3.5 Importance of Decision Makers in the Group ............................................................................. 85
3.5.1 Analysis of Methods for Aggregating and Prioritisation with Unequal DM Weights ......... 86
3.6 Studying Dependency ................................................................................................................. 89
3.6.1 Analysis of Methods for Studying Dependency .................................................................. 90
3.7 Ranking Alternatives .................................................................................................................. 96
3.7.1 Analysis of Methods for Ranking Alternatives .................................................................... 97
3.7.2 Summary of the Analysis ................................................................................................... 102
3.8 Summary of the Chapter ........................................................................................................... 103
4. CHAPTER FOUR: A HYBRID FUZZY MCDM MODEL ....................................................... 105
4.1 Introduction ............................................................................................................................... 105
4.2 The New Hybrid Fuzzy MCDM Model .................................................................................... 105
4.3 New Extended Methods ............................................................................................................ 113
4.3.1 Fuzzy Set Theory (FST) ..................................................................................................... 113
4.3.1.1 Definition .................................................................................................................... 114
4.3.1.2 Basic Concepts and Operational Laws of Fuzzy Numbers ......................................... 114
4.3.2 The Modified Fuzzy Delphi Method ................................................................................. 119
4.3.2.1The Fuzzy Delphi Method ........................................................................................... 120
4.3.2.2 The Proposed Fuzzy Delphi Method........................................................................... 124
4.3.2.3 Numerical Example..................................................................................................... 126
4.3.3 The Extended Fuzzy Decision Making Trial and Evaluation Laboratory Method ............ 128
4.3.3.1 The DEMATEL Method ............................................................................................. 129
4.3.3.2 The Proposed Extended Fuzzy DEMATEL Method .................................................. 132
4.3.3.3 Numerical Example..................................................................................................... 137
4.3.4 The New Group Fuzzy Prioritisation Method.................................................................... 141
4.3.4.1 Representation of the Fuzzy Group Prioritisation Problem ........................................ 142
4.3.4.2 The Non-linear Fuzzy Preference Programming (FPP) Method ................................. 143
4.3.4.3 The New Fuzzy Group Prioritisation (FGP) Method .................................................. 146
4.3.4.4 Illustrative Examples................................................................................................... 149
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4.3.5 The Modified Fuzzy TOPSIS Method ............................................................................... 156
4.3.5.1 The TOPSIS Method ................................................................................................... 157
4.3.5.2 The New Proposed Fuzzy TOPSIS Method................................................................ 158
4.3.5.3 A Numerical Example................................................................................................. 162
5. CHAPTER FIVE: DEVELOPMENT OF THE DECISION SUPPORT TOOLS
IMPLEMENTATIONS....................................................................................................................... 167
5.1 Introduction ............................................................................................................................... 167
5.2 MATLAB as a Programming Language ................................................................................... 168
5.3 Fuzzy Delphi Method Implementation ..................................................................................... 170
5.3.1 Designing the Fuzzy Delphi System .................................................................................. 170
5.3.2 Interface Design The Fuzzy Delphi Solver ..................................................................... 171
5.4 Fuzzy DEMATEL Method Implementation ............................................................................. 178
5.4.1 Designing the Fuzzy DEMATEL System .......................................................................... 178
5.4.2 Interface Design The Fuzzy DEMATEL Solver ............................................................. 179
5.5 Fuzzy Group Prioritisation Method Implementation ................................................................ 186
5.5.1 Designing the New Fuzzy Group Prioritisation System .................................................... 187
5.5.3 Interface Design The Fuzzy Group Prioritisation Solver ................................................ 188
5.6 Fuzzy TOPSIS Method Implementation ................................................................................... 195
5.6.1 Designing the Fuzzy TOPSIS System ............................................................................... 195
5.6.2 Interface Design The Fuzzy TOPSIS Solver .................................................................. 196
6. CHAPTER SIX: APPLICATION OF THE NEW HYBRID FUZZY MCDM MODEL A
CASE STUDY IN SAUDI ARABIA ................................................................................................. 203
6.1. Introduction .............................................................................................................................. 203
6.2. The Group Health Insurance Plan Selection Problem in Saudi Arabia A case Study........... 204
6.2.1 Aim .................................................................................................................................... 204
6.2.2 Background ........................................................................................................................ 205
6.2.3 Application of the Proposed Model in the Saudi Insurance Market .................................. 207
6.2.3.1 Defining a List of Alternatives and Criteria ................................................................ 209
6.2.3.2 Setting the Critical Selection Criteria and Grouping them into Clusters .................... 215
6.2.3.3 Identifying Dependencies among Clusters.................................................................. 226
6.2.3.4 Weighting of Criteria .................................................................................................. 232
6.2.3.5 Ranking Alternatives................................................................................................... 240
6.2.4 Validation of the Model Results Sensitivity Analysis .................................................... 245
6.2.4.1 Sensitivity Analysis under Varying DM Weights ....................................................... 246
4
6.2.4.2 Sensitivity Analysis under Varying Criteria Weights ................................................. 250
7. CHAPTER SEVEN: CONCLUSIONS ...................................................................................... 257
7.1 Introduction ............................................................................................................................... 257
7.2 Recalling Research Gaps and the Responses in this Thesis ...................................................... 257
7.3 Meeting the Aim of the Research and Addressing the Research Questions ............................. 259
7.4 Limitations of this Research ..................................................................................................... 264
7.5 Recommendations for Possible Future Research ...................................................................... 265
7.6 Final Words............................................................................................................................... 266
8. Bibliography ............................................................................................................................... 268
9. APPENDICES ............................................................................................................................ 285
Appendix A: Journal Publication .................................................................................................... 285
Appendix B: The Modified Mean De-Entropy Algorithm for Determining a Threshold Value .... 294
Appendix C: The Maximum Mean De-Entropy Algorithm (MMDE)........................................... 299
Appendix D: Number of Fuzzy PCJMs .......................................................................................... 303
Appendix E: Comparison Matrices of Decision Criteria and their Local Weights ......................... 305
Appendix F: Decision Matrices for the Four Alternatives under All Criteria ................................ 343
The total word count is 77237 words.
5
LIST OF TABLES
TABLE 2.1: CRITERIA FOR CHOOSING AN INSURANCE PLAN .................................................................................. 45

TABLE 4.1: LINGUISTIC SCALE ADOPTED IN THIS RESEARCH STUDY .................................................................. 119
TABLE 4.2: LINGUISTIC VARIABLES FOR THE PROPOSED FDE METHOD ............................................................. 124
TABLE 4.3: THE PROPOSED FDE RESULTS .......................................................................................................... 127
TABLE 4.4: LINGUISTIC VARIABLES FOR THE NEW EXTENDED FUZZY DEMATEL METHOD ............................. 132
TABLE 4.5: THE RESULTS OF THE EXTENDED FUZZY DEMATEL METHOD (FIRST SCENARIO: I1 = 0.2 , I2 = 0.8 )
................................................................................................................................................................... 138
TABLE 4.6: THE RESULTS OF THE EXTENDED FUZZY DEMATEL METHOD (SECOND SCENARIO: I1 = 0.8 , I2 =
0.2 ) ............................................................................................................................................................ 140
TABLE 4.7: RESULTS FROM THE TWO PRIORITISATION METHODS ....................................................................... 152
TABLE 4.8: INDIVIDUAL AND GROUP RESULTS (WHEN I1 = 0.2, I2 = 0.8) ........................................................ 154
TABLE 4.9: INDIVIDUAL AND GROUP RESULTS (WHEN I1 = 0.8, I2 = 0.2) ........................................................ 154
TABLE 4.10: LINGUISTIC VARIABLES FOR RATING THE ALTERNATIVES .............................................................. 159
TABLE 4.11: THE RESULTS OF THE EXTENDED FUZZY TOPSIS METHOD (FIRST SCENARIO: I1 = 0.2 , I2 = 0.8 )
................................................................................................................................................................... 163
TABLE 4.12: THE RESULTS OF THE EXTENDED FUZZY TOPSIS METHOD (SECOND SCENARIO: I1 = 0.8 , I2 = 0.2 )
................................................................................................................................................................... 164
TABLE 5.1: THE DMS FUZZY JUDGEMENTS FOR APPLYING THE FDE METHOD ................................................. 172
TABLE 5.2: THE DMS FUZZY JUDGEMENTS FOR APPLYING THE FUZZY DEMATEL METHOD .......................... 180
TABLE 5.3: THE DMS FUZZY JUDGEMENTS FOR RANKING ALTERNATIVES ....................................................... 197
TABLE 6.1: PARTICIPANTS RESPONSES REGARDING THEIR BACKGROUND INFORMATION ................................. 218
TABLE 6.2: THE RECIPROCAL FUZZY PCJM FOR DERIVING THE DMS IMPORTANCE WEIGHTS ......................... 219
TABLE 6.3: FINAL WEIGHTS OF THE DMS ........................................................................................................... 221
TABLE 6.4: THE JUDGEMENTS OF THE DMS FOR SETTING CRITICAL CRITERIA ................................................... 222
TABLE 6.5: THE FINAL RESULTS FOR SETTING THE CRITICAL CRITERIA (SELECTION CRITERIA: EVALUATION
INDICES 5) ............................................................................................................................................... 224
TABLE 6.6: GROUPING OF SELECTION CRITERIA ................................................................................................. 225
TABLE 6.7: INITIAL FUZZY DIRECT RELATION MATRICES ................................................................................... 227
TABLE 6.8: THE FUZZY TOTAL RELATION MATRIX FROM THE EXTENDED FUZZY DEMATEL RESULT. ............ 228
TABLE 6.9: THE TOTAL RELATION MATRIX FROM THE EXTENDED FUZZY DEMATEL RESULT......................... 228
TABLE 6.10: INITIAL SPCJM FOR THE GROUP HEALTH INSURANCE PLAN SELECTION PROBLEM ....................... 231
TABLE 6.11: EXAMPLES OF RECIPROCAL FUZZY PCJMS FOR CRITERIA D1-D6 WITH RESPECT TO CRITERION A1
AND THEIR LOCAL WEIGHTS....................................................................................................................... 233
TABLE 6.12: THE UN-WEIGHTED SPCJM ............................................................................................................ 237
TABLE 6.13: THE NORMALISED SPCJM .............................................................................................................. 238
TABLE 6.14: THE LIMIT SPCJM .......................................................................................................................... 239
TABLE 6.15: THE RELATIVE IMPORTANCE WEIGHTS / GLOBAL WEIGHTS OF THE CRITERIA ............................... 240
TABLE 6.16: RATINGS OF THE FOUR ALTERNATIVES BY DM 1 UNDER ALL CRITERIA .......................................... 242
TABLE 6.17: FINAL RANKING OF THE ALTERNATIVE GROUP HEALTH INSURANCE PLANS .................................. 243
TABLE 9.1: RESULTS DERIVED FROM STEPS 1 TO 5 USING THE MODIFIED MEAN DE-ENTROPY ALGORITHM ..... 296
TABLE 9.2: THE RESULTS DERIVED FROM STEPS 1 TO 6 USING THE MMDE ALGORITHM .................................. 302
TABLE 9.3: NUMBER OF FUZZY PCJMS AND QUESTIONS FOR CLUSTER A CRITERIA .......................................... 303
TABLE 9.4: NUMBER OF FUZZY PCJMS AND QUESTIONS FOR CLUSTER B CRITERIA .......................................... 303
TABLE 9.5: NUMBER OF FUZZY PCJMS AND QUESTIONS FOR CLUSTER C CRITERIA .......................................... 303
TABLE 9.6: NUMBER OF FUZZY PCJMS AND QUESTIONS FOR CLUSTER D CRITERIA .......................................... 303
TABLE 9.7: NUMBER OF FUZZY PCJMS AND QUESTIONS FOR CLUSTER E CRITERIA .......................................... 304
TABLE 9.8: TOTAL NUMBER OF REQUIRED FUZZY PCJMS AND QUESTIONS ....................................................... 304
TABLE 9.9: RECIPROCAL FUZZY PCJMS FOR CRITERIA A1 AND A2 WITH RESPECT TO CRITERION B1 AND THEIR
LOCAL WEIGHTS ........................................................................................................................................ 305
6
LOCAL WEIGHTS ........................................................................................................................................ 306
LOCAL WEIGHTS ........................................................................................................................................ 308
TABLE 9.12: RECIPROCAL FUZZY PCJMS FOR CRITERIA A1 AND A2 WITH RESPECT TO CRITERION C1 AND THEIR
LOCAL WEIGHTS ........................................................................................................................................ 309
LOCAL WEIGHTS ........................................................................................................................................ 310
LOCAL WEIGHTS ........................................................................................................................................ 312
LOCAL WEIGHTS ........................................................................................................................................ 313
TABLE 9.16: RECIPROCAL FUZZY PCJMS FOR CRITERIA A1 AND A2 WITH RESPECT TO CRITERION D1 AND THEIR
LOCAL WEIGHTS ........................................................................................................................................ 314
LOCAL WEIGHTS ........................................................................................................................................ 316
LOCAL WEIGHTS ........................................................................................................................................ 317
LOCAL WEIGHTS ........................................................................................................................................ 318
LOCAL WEIGHTS ........................................................................................................................................ 320
LOCAL WEIGHTS ........................................................................................................................................ 321
TABLE 9.22: RECIPROCAL FUZZY PCJMS FOR CRITERIA A1 AND A2 WITH RESPECT TO CRITERION E1 AND THEIR
LOCAL WEIGHTS ........................................................................................................................................ 322
LOCAL WEIGHTS ........................................................................................................................................ 324
LOCAL WEIGHTS ........................................................................................................................................ 325
LOCAL WEIGHTS ........................................................................................................................................ 326
TABLE 9.26: RECIPROCAL FUZZY PCJMS FOR CRITERIA C1-C4 WITH RESPECT TO CRITERION A1 AND THEIR
LOCAL WEIGHTS ........................................................................................................................................ 328
TABLE 9.27: RECIPROCAL FUZZY PCJMS FOR CRITERIA C1-C4 WITH RESPECT TO CRITERION A2 AND THEIR
LOCAL WEIGHTS ........................................................................................................................................ 329
TABLE 9.28: RECIPROCAL FUZZY PCJMS FOR CRITERIA C1-C4 WITH RESPECT TO CRITERION B1 AND THEIR
LOCAL WEIGHTS ........................................................................................................................................ 330
LOCAL WEIGHTS ........................................................................................................................................ 332
LOCAL WEIGHTS ........................................................................................................................................ 333
TABLE 9.31: RECIPROCAL FUZZY PCJMS FOR CRITERIA D1-D6 WITH RESPECT TO CRITERION A1 AND THEIR
LOCAL WEIGHTS ........................................................................................................................................ 335
TABLE 9.32: RECIPROCAL FUZZY PCJMS FOR CRITERIA D1-D6 WITH WITH RESPECT TO CRITERION A2 AND
THEIR LOCAL WEIGHTS .............................................................................................................................. 337
TABLE 9.33: RECIPROCAL FUZZY PCJMS FOR CRITERIA E1-E4 WITH RESPECT TO CRITERION A1 AND THEIR
LOCAL WEIGHTS ........................................................................................................................................ 339
TABLE 9.34: RECIPROCAL FUZZY PCJMS FOR CRITERIA E1-E4 WITH RESPECT TO CRITERION A2 AND THEIR
LOCAL WEIGHTS ........................................................................................................................................ 341
TABLE 9.35: RATINGS OF THE FOUR ALTERNATIVES BY DM 2 UNDER ALL CRITERIA ......................................... 343
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TABLE 9.42: RATINGS OF THE FOUR ALTERNATIVES BY DM 9 UNDER ALL CRITERIA .......................................... 345
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LIST OF FIGURES
FIGURE 1.1 THESIS STRUCTURE ............................................................................................................................ 36

FIGURE 2.1 DECISION MAKING PROCESS (SOURCE: ADAPTED FROM SIMON, 1977) ............................................... 52
FIGURE 4.1: A PROCESS OVERVIEW OF THE PROPOSED FUZZY MCDM MODEL ................................................. 112
FIGURE 4.2: TRIANGULAR FUZZY NUMBER A = (A, B, C)..................................................................................... 115
FIGURE 4.3: TRAPEZOIDAL FUZZY NUMBER = (, , , ) ............................................................................. 116
FIGURE 4.4: TRIANGULAR FUZZY NUMBERS FOR THE PROPOSED FDE METHOD ................................................ 124
FIGURE 4.5: TRIANGULAR FUZZY NUMBERS FOR THE NEW EXTENDED FUZZY DEMATEL METHOD ................ 132
FIGURE 4.6: TWO SIMPLE CASES (SOURCE: ADAPTED FROM TSENG, 2006 AND LIOU ET AL., 2007) ..................... 137
FIGURE 4.7: CAUSE-EFFECT DIAGRAM (FIRST SCENARIO: 1 = 0.2 , 2 = 0.8 ) .................................................. 139
FIGURE 4.8: CAUSE-EFFECT DIAGRAM (SECOND SCENARIO: 1 = 0.8 , 2 = 0.2) ............................................... 140
FIGURE 4.9: AVERAGE COMPUTATION TIME (MINUTES) ..................................................................................... 156
FIGURE 4.10: TRIANGULAR FUZZY NUMBERS FOR RATING THE ALTERNATIVES ................................................. 159
FIGURE 5.1: THE FUZZY DELPHI SYSTEM FLOW CHART...................................................................................... 171
FIGURE 5.2: WELCOME WINDOW FOR THE FUZZY DELPHI SOLVER..................................................................... 173
FIGURE 5.3: DESCRIPTIVE DATA WINDOW FOR THE FUZZY DELPHI SOLVER ...................................................... 174
FIGURE 5.4: THE DMS WEIGHTS WINDOW FOR THE FUZZY DELPHI SOLVER ...................................................... 175
FIGURE 5.5: FUZZY JUDGEMENTS WINDOW FOR THE FUZZY DELPHI SOLVER ..................................................... 176
FIGURE 5.6: DISPLAY RESULTS WINDOW FOR THE FUZZY DELPHI SOLVER ........................................................ 177
FIGURE 5.7: THE FUZZY DEMATEL SYSTEM FLOW CHART .............................................................................. 179
FIGURE 5.8: WELCOME WINDOW FOR THE FUZZY DEMATEL SOLVER ............................................................. 181
FIGURE 5.9: INITIAL DATA WINDOW FOR THE FUZZY DEMATEL SOLVER ........................................................ 182
FIGURE 5.10: THE DMS WEIGHTS WINDOW FOR THE FUZZY DEMATEL SOLVER ............................................. 183
FIGURE 5.11: THE DEMATEL FUZZY JUDGEMENTS WINDOW FOR 1 ............................................................ 184
FIGURE 5.12: THE DEMATEL FUZZY JUDGEMENTS WINDOW FOR 2 ............................................................ 184
FIGURE 5.13: THE FIRST DISPLAY RESULTS WINDOW FOR THE FUZZY DEMATEL SOLVER .............................. 185
FIGURE 5.14: THE FGP SYSTEM FLOW CHART.................................................................................................... 188
FIGURE 5.15: WELCOME WINDOW FOR THE FUZZY GROUP PRIORITISATION SOLVER ......................................... 189
FIGURE 5.16: INITIAL DATA WINDOW FOR THE FUZZY GROUP PRIORITISATION SOLVER ................................... 190
FIGURE 5.17: THE DMS WEIGHTS WINDOW FOR THE FUZZY GROUP PRIORITISATION SOLVER .......................... 191
FIGURE 5.18: THE FUZZY JUDGEMENTS WINDOW FOR 1 FOR WEIGHTING CRITERIA ..................................... 192
FIGURE 5.19: THE FUZZY JUDGEMENTS WINDOW FOR 2 FOR WEIGHTING CRITERIA ..................................... 192
FIGURE 5.20: THE FUZZY JUDGMENTJUDGEMENTS WINDOW FOR 3 FOR WEIGHTING CRITERIA .................... 193
FIGURE 5.21: DISPLAY RESULTS WINDOW FOR THE FUZZY GROUP PRIORITISATION SOLVER ............................ 194
FIGURE 5.22: THE FUZZY TOPSIS SYSTEM FLOW CHART .................................................................................. 196
FIGURE 5.23: WELCOME WINDOW FOR THE FUZZY TOPSIS SOLVER ................................................................. 197
FIGURE 5.24: INITIAL PARAMETERS WINDOW FOR THE FUZZY TOPSIS SOLVER ................................................ 198
FIGURE 5.25: THE DMS WEIGHTS WINDOW FOR THE FUZZY TOPSIS SOLVER .................................................. 198
FIGURE 5.26: THE FUZZY JUDGEMENTS WINDOW FOR 1 FOR RANKING ALTERNATIVES ............................... 199
FIGURE 5.27: THE FUZZY JUDGEMENTS WINDOW FOR 2 FOR RANKING ALTERNATIVES ............................... 200
FIGURE 5.28: DISPLAY RESULTS WINDOW FOR THE FUZZY TOPSIS SOLVER ..................................................... 200
FIGURE 6.1: AN EXAMPLE INCORPORATED INTO THE DMS WEIGHTS QUESTIONNAIRE ...................................... 218
FIGURE 6.2: THE DMS WEIGHTS BY APPLYING THE FUZZY GROUP PRIORITISATION SOLVER ........................... 221
FIGURE 6.3: FINAL RESULTS FOR SETTING THE CRITICAL CRITERIA BY APPLYING THE FUZZY DELPHI SOLVER 223
FIGURE 6.4: EXTENDED FUZZY DEMATEL RESULTS BY USING THE FUZZY DEMATEL SOLVER ..................... 228
FIGURE 6.5: IMPACT RELATION MAP (IRM) ........................................................................................................ 229
FIGURE 6.6: LOCAL WEIGHTS FOR CRITERIA D1-D6 WITH RESPECT TO CRITERION A1 BY USING THE FUZZY
GROUP PRIORITISATION SOLVER ................................................................................................................ 235
9
FIGURE 6.7: FINAL RANKING OF THE ALTERNATIVE GROUP HEALTH INSURANCE PLANS OBTAINED BY THE FUZZY
TOPSIS SOLVER ........................................................................................................................................ 243
FIGURE 6.8: SENSITIVITY ANALYSIS RESULTS CAUSED BY VARYING THE WEIGHTS OF THE DMS...................... 249
FIGURE 6.9: SENSITIVITY ANALYSIS RESULTS CAUSED BY VARYING THE WEIGHTS OF THE CRITERIA............... 253
FIGURE 9.1: LOCAL WEIGHTS FOR CRITERIA A1 AND A2 WITH RESPECT TO CRITERION B1 BY USING THE FUZZY
FIGURE 9.4: LOCAL WEIGHTS FOR CRITERIA A1 AND A2 WITH RESPECT TO CRITERION C1 BY USING THE FUZZY
FIGURE 9.8: LOCAL WEIGHTS FOR CRITERIA A1 AND A2 WITH RESPECT TO CRITERION D1 BY USING THE FUZZY
FIGURE 9.14: LOCAL WEIGHTS FOR CRITERIA A1 AND A2 WITH RESPECT TO CRITERION E1 BY USING THE FUZZY
FIGURE 9.18: LOCAL WEIGHTS FOR CRITERIA C1-C4 WITH RESPECT TO CRITERION A1 BY USING THE FUZZY
FIGURE 9.19: LOCAL WEIGHTS FOR CRITERIA C1-C4 WITH RESPECT TO CRITERION A2 BY USING THE FUZZY
FIGURE 9.20: LOCAL WEIGHTS FOR CRITERIA C1-C4 WITH RESPECT TO CRITERION B1 BY USING THE FUZZY
10
FIGURE 9.25: LOCAL WEIGHTS FOR CRITERIA E1-E4 WITH RESPECT TO CRITERION A1 BY USING THE FUZZY
FIGURE 9.26: LOCAL WEIGHTS FOR CRITERIA E1-E4 WITH RESPECT TO CRITERION A2 BY USING THE FUZZY
11
LIST OF ABBREVIATIONS
AHP - Analytical Hierarchy Process

ANP - Analytic Network Process
CHIC - Cooperative Health Insurance Council
DEMATEL - Decision Making Trial and Evaluation Laboratory
DLS - Direct Least Squares
D-S - Dempster-Shafer
ELECTRE - Elimination and Choice Translation Reality
ER - Evidential Reasoning
EV - Eigenvector
FDE - Fuzzy Delphi
FGP - Fuzzy Group Prioritisation
FL - Fuzzy Logic
FOWA - Fuzzy Ordered Weighted Averaging
FP - Fuzzy Programming
FPP - Fuzzy Preference Programming
FST - Fuzzy Set Theory
GFPP - Group Fuzzy Performance Programming
GM - Geometric Mean
GP - Goal Programming
GUI - Graphical User Interface
HR - Human Resource
IRM - Impact Relation Map
LLS - Logarithmic Least Square
MAUT - Multiple Attribute Utility Theory
MAVT - Multiple Attribute Value Theory
MCDM - Multiple Criteria Decision Making
NIS - Negative Ideal Solution
OR - Operational Research
PC - Pairwise Comparisons
PCJM - Pairwise Comparisons Judgement Matrix
PCPM - Pairwise Comparisons Prioritisation Method
PIS - Positive Ideal Solution
PROMETHEE - Preference Ranking Organisation Method for Enrichment Evaluations
SDM - Supra Decision Maker
SPCJM - Super Pairwise Comparisons Judgement Matrix
TOPSIS - Technique for Order of Preference by Similarity to Ideal Solution
WAGP - Weighted Additive Goal-Programming
WAM - Weighted Arithmetic Mean
WLS - Weighted Least Squares
WPM - Weighted Product Model
WSM - Weighted Sum Model
12
ABSTRACT
A group health insurance plan is an insurance plan that provides healthcare coverage to a selected
group of people. In various countries, group health insurance plans are one of the major benefits
offered through employers in the private sector. In recent years, the numbers of group health
insurance plans offered in the market of health insurance have been increasing rapidly. This is due to
compulsory government policies, which are imposed on employers in the private sector leading to an
increasing demand for this insurance plan. Accordingly, employers may face a wide variety of
available group health insurance plan alternatives. Despite the fact that employers in the private sector
have a crucial and significant role in the health insurance market all over the world, little is known
about how employers evaluate and choose group health insurance plans to cover their employees
against the payments of benefits as a result of sickness or injury. Therefore, the primary concern in
this research is to propose a model to assist employers within the private sector to evaluate alternative
group health insurance plans and to select the most appropriate, in order to provide the perfect health
care environment for their employees.
In this research, a new hybrid Fuzzy Multiple Criteria Decision Making (MCDM) model is proposed
for the selection problem. The proposed model tackles some issues that may be associated with the
selection of the group health insurance plan, such as modelling uncertainty, studying the dependence
among decision attributes, deriving decision attributes importance weights and ranking various
alternatives. In the proposed hybrid model, four extension approaches based on the Fuzzy Delphi,
Fuzzy Decision Making Trial and Evaluation Laboratory (DEMATEL), Fuzzy Group Prioritisation
and Fuzzy Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) methods are
developed. Unlike the existing methods, the four proposed approaches, a new extended Fuzzy Delphi
(FDE) method, a new extended Fuzzy DEMATEL method, a new Fuzzy Group Prioritisation (FGP)
method and a new extended Fuzzy TOPSIS method, consider the importance weight of each member
in group decision making since the selection problem needs evaluations from decision makers (DMs)
with different levels of expertise and different perceptions. In the literature, there is some work on
these methods, but to our knowledge, no research exists that combines these four methods. Moreover,
the proposed model might be applied, due to its novelty, to any MCDM problem uncertainty in
different.
Furthermore, four new prototype decision support tools, termed Fuzzy Delphi Solver, Fuzzy
DEMATEL Solver, Fuzzy Group Prioritisation Solver and Fuzzy TOPSIS Solver were developed in
this study, based on the concepts of the four proposed approaches, in order to provide user-friendly
interfaces for facilitating the application of these approaches. MATLAB software Version R2013a
was adopted as a development environment for prototyping these new decision support tools in this
study. The tools developed were validated internally by using hypothetical examples and checking the
correctness of the results obtained by comparing them to other results generated from other software,
such as Microsoft Excel or LINGO V13.0 software.
In addition, a practical validation of the proposed hybrid Fuzzy MCDM model was investigated
through conducting a case study of the Saudi health insurance industry. The main objectives of the
case study were: 1) investigation of the evaluation process of selecting a group health insurance plan,
including identifying the selection criteria and alternatives, studying the dependency issue, deriving
the criteria weights, and ranking available alternatives; 2) application of the new decision support
tools developed.
In this case study, a group of nine DMs, Human Resources (HR) managers at nine different private
companies in Saudi Arabia, were selected to take part of this case study. Their involvement achieved
the first objective of the case study. At the end of the case study, a sensitivity analysis was conducted
to indicate the robustness and the reliability of the results obtained. It is concluded that the proposed
model is indeed beneficial. Finally, areas for further research were identified.
13
DECLARATION
I declare that no portion of the work referred to in the thesis has been submitted in support of
an application for another degree or qualification of this or any other university or other
institute of learning.
14
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works in the thesis, for example graphs and tables (Reproductions), which may be
described in this thesis, may not be owned by the author and may be owned by third
parties. Such Intellectual Property and Reproductions cannot and must not be made
available for use without the prior written permission of the owner(s) of the relevant
Intellectual Property and/or Reproductions.
IV. Further information on the conditions under which disclosure, publication and
commercialisation of this thesis, the Copyright and any Intellectual Property and/or
Reproductions described in it may take place is available in the University IP Policy
(see http://documents.manchester.ac.uk/DocuInfo.aspx?DocID=487), in any relevant
Thesis restriction declarations deposited in the University Library, The University
Librarys regulations (see http://www. manchester.ac.uk/library/aboutus/regulations)
and in The Universitys policy on Presentation of Theses.
15
DEDICATION
This is for you, Mom & Dad
ACKNOWLEDGEMENT
In the name of God, the Most Gracious, the Most Merciful,
First and foremost, all thanks to Allah who gave me the health and power to complete this
work. Without His guidance and grace this research would not have been finished.
I would like to extend my sincere thanks and appreciation to my main supervisor, Dr. Ludmil
Mikhailov, for his support and valuable guidance during my PhD. I also thank my second
supervisor, Prof. Ling Xu, who was always accessible and offered her advice on my work
every time that I needed it.
Deep respect and profound thanks to my lovely parents, Muneera & Saleh Almulhim, for
inspiring me throughout my life. I truly appreciate all their effort, which has made me who I
am. I value all their prayers, support and love. I am so proud to be their daughter.
Big thanks go to my youngest brother, Aziz Almulhim, for his encouragement and endless
support. Also, credit is due to my siblings for their support and encouragement throughout
my research journey.
Special mention must be made to my colleagues and friends in the Manchester Business
School for their help and cooperation during my PhD.
Finally, it is a pleasure to thank my sponsor, the Ministry of Higher Education and the
country of Saudi Arabia, for offering me this opportunity to achieve my ambition.
16
ABOUT THE AUTHOR
Education:
2009- 2010: MSc. Operational Research and Applied Statistics

University of Salford, Manchester, UK
2001-2005: BSc. Mathematics

King Faisal University, Alhassa, Saudi Arabia
Work Experience:
2005-2007: Alrajhi Bank

Alhassa, Saudi Arabia
2007- Present: Lecturer

King Faisal University, Alhassa, Saudi Arabia
Sep. 2013- PT Graduate Teaching Assistant

Dec. 2013: Manchester Business School, Manchester, UK
Publications and conferences:
Almulhim, T., Mikhailov, L., and Xu, D.-L., "A hybrid Fuzzy Multi-Criteria Decision
Making model to group health insurance policy selection, Manchester Business School
Annual Doctoral Conference, May 2011. Presented
Almulhim, T. and Mikhailov, L., "Deriving priorities from fuzzy group comparison
judgements in the fuzzy analytical network process (FANP), the 3rd Student Conference
on Operational Research (SCOR 2012), 2012, the University of Nottingham, UK.
Accepted & Presented
Almulhim, T., Mikhailov, L., and Xu, D.-L., "Prioritization Method in the Fuzzy Analytic
Network Process by Fuzzy Preferences Programming Method, World Academy of
Science, Engineering and Technology: International conference on Fuzzy Systems and
Neural Computing, 2012, Paris, France. Accepted & Published
17
Almulhim, T., Mikhailov, L., and Xu, D.-L., Deriving Weights from Group Fuzzy
Pairwise Comparison Judgement Matrices, Advances in Intelligent Systems and
Computing, vol. 206, pp. 545-555, 2013. Accepted & Published
Almulhim, T., Mikhailov, L., and Xu, D.-L., "A Fuzzy Group Prioritization Method for
Deriving Weights and its Software Implementation", International Journal of Artificial
Intelligence and Interactive Multimedia, vol. 2, Special Issue on Improvements in
Information Systems and Technologies , no. 3, pp. 7-14, 2013. Accepted & Published
Almulhim, T., Mikhailov, L., and Xu, D.-L., An Extension of the Fuzzy DEMATEL
Method for Group Decision Making, the 22nd International Conference on Multiple
Criteria Decision Making, MCDM2013, 17-21 June 2013, Mlaga, Spain. Accepted &
Presented
Mikhailov, L. and Almulhim, T., Fuzzy ANP Approach for Selection of Group Health
Insurance Plans, 6th European Conference of the International Federation for Medical
and Biological Engineering (MBEC2014), Dubrovnik, Croatia, September, 2014.
Accepted & Published
Almulhim, T., and Mikhailov, L., Development of a Hybrid Fuzzy Multi-Criteria

Decision Making Model for Selection of Group Health Insurance Plans, Expert Systems
With Applications. Submitted
18
1. CHAPTER ONE: INTRODUCTION
1.1 Introduction
This chapter provides an introduction to the PhD thesis entitled Development of a Hybrid
Fuzzy Multi-Criteria Decision Making Model for the Selection of Group Health Insurance
Plans. This chapter is divided into seven sections. Section 1.2 and section 1.3 provide a
background to the problem and a description of the research problem respectively. Objectives
of the study and the research questions are identified in section 1.4. Section 1.5 presents an
outline of the research methodology, followed by research contributions in section 1.6.
Finally, the structure of this thesis is described in section 1.7.
1.2 Background to the Problem
Insurance is the most significant technique for reducing risk. The insurance concept has many
possible definitions, which emerge from various viewpoints. In the economic and legal sense,
insurance provides a contract that is used to protect the policyholder (the insured) against
risks and uncertain losses (Bickelhaupt, 1983). From a business viewpoint, insurance is a risk
management plan that allows a business to transfer all risks and losses to an insurance
company (Mehr & Cammack, 1961). By paying a relative premium (fee) to the insurance
company (the insurer), this company can protect the policyholder (the insured) against the
possibility of risk and large financial loss. In addition, the insured obtains a contract, which is
called an insurance plan. It includes all circumstances, terms and conditions under which the
insured is indemnified during the period of insurance. The insurance market is made up of
many different branches, like most other markets and business. For example, but not
exclusively, the insurance industry includes home insurance, life insurance, vehicle (car)
insurance, health (medical) insurance, travel insurance etc.
19
In recent years, the remarkable growth of health insurance and the strong interest in
purchasing this type of insurance has led to the observation that health insurance deserves a
leading place in the insurance industry. Dickerson (1964) argued that health insurance is the
fastest growing of all the branches of insurance and also the largest market compared with the
other types of insurance industries. Moreover, health insurance is one of the most essential
for the policyholder (the insured) (Dickerson, 1964). This type of insurance plays a vital and
important role in the health care system, by providing access to cover and protecting the
insured against the financial effects of sickness or injury. The term health insurance is
designed to cover individuals or groups of people against financial losses or large health care
expenses that may arise as a result of illness, injury or disability (Bickelhaupt, 1983). The
health insurance contract is similar to other insurance contracts and plans. This contract
represents the agreement between the insured and the insurer; it defines the rights and
responsibilities of the different parties, such as the policyholders (the insured) and the
insurance company (the insurer) (Dickerson, 1964).
As referred to above, there are two main types of health insurance: individual and group
health insurance plans (Bickelhaupt, 1983). The individual health insurance plan is sold to
and insures an individual, whereas the group health insurance plan provides coverage for
groups of persons in one contract and it may, and often does, cover dependents. Generally,
group health insurance costs are lower than the cost of individual health insurance. Group
health insurance is considered as part of an employee benefit plan which insures persons in a
group instead of as individuals (Dickerson, 1964). The group health insurance contract
involves two parties, that is the insurer (the insurance company) and the employer
(policyholder in this case), while the employees (the individual members of the group), who
are each given a certificate which is proof of his/her insurance, but does not make him/her a
party to the contract (Dickerson, 1964).
20
Group health insurance is used heavily to cover and insure employees and is therefore, a
motivation for improving the quality of work. In fact, this type of health insurance can be a
tool which may contribute to stabilising a high quality of work at any company. As well as
this, it is a factor contributing to high productivity in the company and among the employees.
Generally speaking, a reliable group health insurance plan can lead to a better image for any
company.
As for the insurance market, in various countries group health insurance is partly provided
through employers in the private sector. In the USA, about 88% of Americans with health
coverage receive it from an employer based group health insurance plan (Bundorf, 2002). In
the UK, approximately 11% (8 million) 1 of the population were covered by health insurance
coverage through schemes provided via their employer in the private sector (Courbage & De
Coulon, 2004). In 2007, 67% of those insured with health insurance in Canada received their
coverage via their employers, with about 52% in Australia (Gechert, 2010). Moreover, in
developing countries, employers also provide health insurance plans for their employees. In
2008, according to studies by the Council of Cooperative Health Insurance (CCHI) in Saudi
Arabia, 65% of those with health insurance received their coverage through their employers.
In the United Arab Emirates (UAE), about 40% of the population received their insurance
from their employers. Therefore, one can argue that employers play an important role in the
health insurance markets.
In recent years, the numbers of group health insurance plans offered in the health insurance
market have grown rapidly. Accordingly, nowadays employers may face a wide variety of
group health insurance plan alternatives available for the insurance of their employees. Thus,
1
In the UK the percentage of employees who receive their health coverage via their employers is lower than
others countries, due to the fact that healthcare in UK is free provided by England's public health service, the
National Health Service.
21
there is an urgent need for a process which will assist companies in the private sector to
evaluate these alternative group plans and to select the most appropriate one in order to
provide the perfect health care environment for their employees. This may raise the level of
their performance and might meet the employees needs. Meanwhile, it may also help the
companies in the private sector to reduce the expense of purchasing health insurance.
Moreover, interest in group health insurance is growing within companies in the private
sector. This is due to the desires of these companies to shift financial losses and medical
claims management to the insurance companies and to predict medical claims in order to
include them within budgets. Despite the fact that private sector employers have a crucial and
significant role in the health insurance market all over the world, little is known about how
employers evaluate and choose group health insurance plans for their employees. In general,
the literature lacks a suitable group health insurance plan selection model that can assist the
DMs (the employers in private sector) for identifying the selection criteria and then
evaluating the available alternatives offered in the insurance market.
1.3 The Research Problem
In this research project, the problem considered is an evaluation process for the selection of
group health insurance plans, within the context of employers in the private sector evaluating
and then choosing a plan for their employees. Moreover, this research addressed the
evaluation and selection process, in order to understand employers choices and behaviour.
Various criteria2 may affect the selection of one group health insurance plan from a set of
alternative plans available. With these different criteria for the selection of group health
insurance and the various alternatives that are available, the health insurance plan selection
process becomes complicated and complex. According to all health insurance selection
2
A criterion is a canon or standard by which anything is judged or estimated (Smith, et al., 1989, p. 31).
22
criteria, no health insurance plan is totally ideal. For instance, if a private company desires to
purchase a group health insurance plan to cover their employees, the plan may have good
health benefits, but at the same time the premium price of the policy may not be the lowest.
Another policys premium price may be lower, but the accessibility of the medical services
might not be as good. One can argue that the process of selecting the group health insurance
plan should be handled systematically in order to make a good decision. Thus, all possible
criteria need to be taken into account and assessed when evaluating alterative group health
plans in order to select the proper one. As a result, evaluating criteria and alternatives, and
choosing the correct group health insurance, plan from a number of alternatives, can be
considered a decision making problem with multiple criteria. The literature review shows that
the Multiple Criteria Decision Making (MCDM) approach has for a long time made a great
contribution and provided practical tools and methods for solving problems of multiple
criteria and/or alternatives in decision making environments (Zimmermann, 1987; Stewart,
1992; Saaty, 1996; Sen & Yang, 1998; Triantaphyllou, 2000; Xu & Yang, 2001). Hence, it is
an essential inspiration of this thesis to explore how effective and useful the MCDM
approach is in the evaluation and selection of a proper group health insurance plan. Another
inspiration in this thesis is that when a decision is made, there is also a need to look at all of
the potential relationships/dependencies among the criteria, since the assumption of
independence is not consistent with conditions in the real world (Saaty, 1996). For this
reason, studying the relationships/dependence among criteria is a vital task in the design of
the evaluation process for the selection problem.
Since the research problem is considered as an evaluation process, this process should
involve a group of people who have expertise and knowledge in the group health insurance
selection problem. This group is comprised of different decision makers (DMs) with different
levels of expertise and different perceptions. Each DM has unique characteristics with regard
23
to the evaluation process. Besides, the DMs usually make diverging decisions due to their
different perceptions and judgements. Due to vagueness of information and the subjective
nature of the DMs judgements, which are common problems in the selection problem,
uncertainty exists in the process of selecting a proper group health insurance plan. In other
words, the DMs are unable to make reliable judgements regarding the evaluation procedure.
In some cases, the DMs are not fully confident in making accurate judgements because their
experience and knowledge might be limited. Consequently, the group health insurance policy
evaluation and selection problem could be expressed as a group decision making problem
under uncertain environments. However, in real group decision making problems, sometimes
some DMs within the group are more experienced than others. For example, in any group
decision making problem, the judgements/assessments of the executive manager of a
company or the president of an organisation, or even of some experts who are more
experienced than others, might be more effective in the evaluation and selection process.
Thus, the importance of each DM in the group has to be considered in this study and is
defined as the importance weight of the DMs.
This research project focuses on companies in the private sector, as these companies need to
allocate their resources effectively and accurately due to the limitations on those resources
(such as money, manpower, method management, materials, skills and knowledge). In
addition, the private sector companies desire to purchase group health insurance for their
employees in order to enhance their morale and productivity.
This research attempts to identify the selection criteria in order to assist insurance companies
to invent new insurance plans or improve existing plans. In other words, understanding
employers choices and behaviours with regard to selecting the group health insurance policy
will be helpful to insurance companies in improving their plans and achieving the goal of
meeting the employers needs in uncertain environments.
24
1.4 Research Objectives and Research Questions
The aim of this research is to propose an evaluation methodology for alternative group health
insurance plans in order to select an appropriate plan that can be purchased by employers in
the private sector to cover and insure their employees against financial losses or large health
care expenses. This methodology is designed to include group decision making in the
selection process, since this problem requires evaluation from DMs with different levels of
expertise and different opinions. It focuses on the identification of the criteria and difficulties
that lie behind the complexity of the decision making process for selecting a group health
insurance plan and the evaluation of the procedure that influences the final decision, by
conducting a selection process using the proposed model within the context of a real life case
study.
The specific objectives of this research that will realise the research aim are:
1. To analyse the issues involved in the selection of group health insurance plans in
order to address the gap or incompleteness in this research area and to decide the
direction of this study.
2. To investigate existing methods in the literature, such as the MCDM methods and
other operational research techniques, that have been used to handle the insurance
plan selection problem. Moreover, to explore and analyse suitable existing methods,
that can be applied in capturing the group health insurance plan selection problem and
to investigate their extension for modelling the uncertainty aspect in the selection
problem.
3. To explore a proper method to analyse the relationships/dependence among the
criteria in the selection process for group health insurance plans.
25
4. To propose an evaluation model to assist employers in private sector companies, in
choosing the ideal plan in order to provide a health environment for their employees
under the complexity of the various criteria and uncertainty in the judgement process.
5. To design prototype decision support tools to assist the DMs in applying the proposed
model in this study.
6. To implement the proposed model in a real life case study in order to test the
empirical validity of the model.
This research project identifies four main research questions on the selection of a proper
group health insurance plan. The questions are listed below:
1. What is the gap in existing studies used in the insurance plan selection problem and how
can selection be improved?
2. Which tools and methods are valuable and applicable to tackling the issues associated
with the evaluation process for selecting a group health insurance plan?
3. How can those tools and methods be used to propose a novel model to evaluate the group
health insurance plan selection problem?
4. How efficient and useful are the MCDM tools in the evaluation process for selecting a
group health insurance plan?
1.5 Outline of the Research Methodology
A brief overview of the methods used in this study to answer the research questions is
presented here. However, this section does not go into detail on the specific methods utilised
and the rationale justifications for adopting them in this study, as these methods are described
in full in the following chapters.
26
The research methodology consists of several stages with the end of each stage being the start
of the next stage. From the early stages of this work, initial information on all aspects has
been gathered. Thus, the first stage included a general overview of the literature to understand
concepts and terms, to gather initial information, and then to frame the research questions and
objectives.
The second stage includes two main activities. In the first activity, the existing literature in
insurance studies in general, has been reviewed. The discussion and recommendations based
on this review have been used to decide the dominant research methodology to be adopted.
Hence, the conclusion of this activity indicated the applicability of a MCDM modelling
approach for the group decision making process. Therefore, in the second activity, attention is
shifted to reviewing the main concepts of the decision making process and MCDM approach.
A detailed description of the above mentioned activities is presented in chapter two.
The third stage of the research process started with a critical review of the published literature
on MCDM, especially in the area of the group decision making process. The review covered
methods in MCDM for modelling uncertainty, studying relationships/dependence, deriving
criteria importance weights and ranking various alternatives. A detailed explanation of this
stage is presented in chapter three. The outcomes of the aforementioned stages formed the
research methodology model, a novel hybrid Fuzzy Multiple Criteria Decision Making
(Fuzzy MCDM) model, as proposed in chapter four. This model was proposed based on the
modification of four existing methods, the Fuzzy Delphi (FDE), Fuzzy Decision Making
Trial and Evaluation Laboratory (DEMATEL), Fuzzy Group Prioritisation, and Fuzzy
Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) methods. These
methods respectively address the issues such as setting of the selection criteria, studying the
relationships/dependence among the different criteria, deriving the criteria importance
weights, and ranking alternatives. Unlike existing methods, the four proposed approaches, a
27
new extended FDE method, a new extended Fuzzy DEMATEL method, a new Fuzzy Group
Prioritisation (FGP) method and a new extended Fuzzy TOPSIS Method, consider the
importance of the weight of each member in group decision making. For a detailed
explanation see chapter four. Interface prototypes based on MATLAB software, which
support the four proposed methods, are developed in chapter five for implementing these
proposed methods.
The fourth stage included a practical validation of the proposed research methodology model
in the form of a case study in the private sector. According to Yin (1994), the case study is
generally used to validate and test the feasibility of a proposed model. A case study is always
used when the research aim is to understand a contemporary phenomenon from its real life
context (Yin, 1994). In this case study, the choice has been made to specifically focus on
Saudi Arabia. This is not only because it is the researchers home country, but also because
Saudi Arabia is a developing country in Asia and there is still a lack of health insurance
research in developing countries, particularly in Asia, which contains 60% of the world's
current human population. According to the Cooperative Health Insurance Council (CHIC) in
Saudi Arabia, the health insurance sector is a new industry which has been in operation for
just over 14 years. The Saudi health insurance market is the countrys most competitive
market, due to health insurance being compulsory for employers in the private sector to
ensure their employees (Saati & Al-Omair, 2004) and to the fact that Saudi Arabias
economy is the largest in the Middle East region (Al-Mady, 2004). In this case study, a group
of nine DMs, who are Human Resources (HR) managers at nine different private companies
in Saudi Arabia, have been selected. The case study started by identifying the available plans
for group health insurance in Saudi Arabia, and setting the primary list of selection criteria
based on literature reviews and documentary analysis of the official rules and regulation
documents and of the insurance companies web pages. Then, the Supra Decision Maker
28
(SDM) method was used to assess the importance of each DM in the selected group.
Afterwards, the extended FDE method, involving the DMs importance weights, was applied
to reduce the number of criteria, dropping the least significant of them. In doing so, a
questionnaire was developed and distributed to the selected group. The findings of the
extended FDE method were used to group the criteria into clusters. In addition, by
introducing the importance weights of the members in the selected group, the
relationships/dependence among the clusters were defined by applying the new extended
Fuzzy DEMATEL method through a questionnaire. After that, the weights of the selection
criteria are explored by using the new developed questionnaire and then applying the new
FGP method which takes into account the DMs importance weights. Finally, the alternative
rankings were obtained by distributing a ranking questionnaire, followed by applying the new
extended Fuzzy TOPSIS method that also considers the importance weight of each DM in the
selected group. All the questionnaires which have been used in this case study have been pre-
tested in pilot studies and the necessary adjustments have been made. Manchester Business
School Surveys, powered by Qualtrics (created by Scott M. Smith, in 1997), has been used to
construct and distribute all questionnaires. The results of the case study have been tested by
performing a sensitivity analysis with two different scenarios; for more details see chapter
six. At the end of the research process, the findings have been discussed, followed by the
conclusions of the study. Research limitations have been highlighted for future research, as
described in more detail in chapter seven.
Some major assumptions made in this research are listed below:
The evaluation process for the selection of the proper group health insurance plan was
measured and assessed through the employees (HR managers) perspectives and
judgements.
29
The HR managers were allowed to express their judgements independently regarding the
selection problem. This means there was no interaction between the members of the
group in this study.
One of the assumptions in this study is that all sources of information and judgements
were considered as reliable. For example, all the judgements and assessments from the
HR managers in the case study for deriving the weights of the selection criteria were
assumed to be fully reliable. Under this assumption, a reliable aggregated result from
combining the group decision making judgements can be accepted.
1.6 Research Contributions
This research has contributed to knowledge in the form of theoretical and practical
contributions. This study makes a number of significant theoretical contributions in the
following ways:
This study proposes a novel hybrid Fuzzy MCDM model based on the extended FDM,
extended Fuzzy DEMATEL, new Fuzzy Group Prioritisation (FGP) and extended Fuzzy
TOPSIS methods to assist in the selection of a group health insurance policy decision. In
the literature, there are some works on these methods, but there is no research that
combines these methods together. Moreover, the proposed novel hybrid Fuzzy MCDM
model might be applied to any MCDM problem with uncertainty in different areas.
An extension of the original FDE method has been proposed which takes into account the
DMs importance weights in group decision making.
The classical Fuzzy DEMATEL method for studying the relationships/dependence among
the criteria has been extended by including the importance weights of each DM in the
group.
This study proposes a new FGP method for deriving group priorities/weights. The
proposed FGP method overcomes some limitations in the existing prioritisation methods.
30
It models uncertainty in the DMs judgements by using the fuzzy concept. It derives crisp
priorities/weights from a set of incomplete fuzzy judgements and it does not require fuzzy
ranking procedures. Additionally, it takes into consideration the importance of the DMs in
the group.
The original Fuzzy TOPSIS method for ranking alternatives has been extended by taking
into account the importance weights of each DM in the group.
A prototype decision support tool, termed a Fuzzy Delphi Solver, has been developed for
helping the DMs to apply the proposed extended FDE method.
A Fuzzy DEMATEL Solver, a prototype decision support tool, has been developed in this
study in order to assist the DMs in the implementation of the proposed Fuzzy DEMATEL
method for studying the relationships/dependence among different factors. In this
decision support tool, DMs have the flexibility to select either the classic Fuzzy
DEMATEL method (without including the DMs importance weights) or the extended
Fuzzy DEMATEL method (with inclusion of the DMs importance weights).
Based on the proposed FGP methods, a prototype tool, named the Fuzzy Group
Prioritisation Solver, has been developed as a decision support system for deriving
criteria weights. It provides a user-friendly and efficient way to obtain the criteria
weights/priorities and to overcome the complexity of programming.
A prototype of a decision tool is developed in MATLAB, namely the Fuzzy TOPSIS
Solver, to assist DMs to implement the proposed method for ranking alternatives. The
Fuzzy TOPSIS Solver also has the ability to allow the classical Fuzzy TOPSIS method
(without considering the DMs importance weights) and the extended Fuzzy TOPSIS
method (including consideration of the DMs importance weights).
In addition, this study makes some practical contributions as listed below:
31
This study provides a detailed case study and original explanation of the decision making
process in group health insurance plan selection in Saudi Arabia.
The findings of this case study provide some recommendations to enable policy makers
and planners in Saudi insurance companies to develop their group health plans and to
create new plans, which might increase competitiveness in this industry. The findings also
provide knowledge and general information regarding the topic of health insurance,
which can be vital to governments and society.
Finally, this research contributes to knowledge of the subject of health insurance, since
there is a lack of literature in this area.
This research has been presented in a number of conferences: Manchester Business School
Annual Doctoral Conference, Manchester, UK, 2011; 3rd Student Conference on Operational
Research, Nottingham, UK, 2012; International Conference on Fuzzy Systems and Neural
Computing (ICFSNC), Paris, France, 2012; The World Conference on Information Systems
and Technologies (WorldCIST13), Algarve, Portugal, 2013; the 22nd International
Conference on Multiple Criteria Decision Making (MCDM2013), Malaga, Spain, 2013; the
6th European Conference of the International Federation for Medical and Biological
Engineering (MBEC2014), Dubrovnik, Croatia on September 7-11, 2014; and a paper
published in the International Journal of Artificial Intelligence and Interactive Multimedia,
vol. 2, Special Issue on Improvements in Information Systems and Technologies, 2013.
1.7 An Overview of the Chapters
This section briefly overviews the structure of the thesis. The thesis consists of seven
chapters and six appendices. The thesis structure is presented in Figure 1.1 and a brief
description of each chapter is summarised below:
CHAPTER ONE: INTRODUCTION
32
This chapter gives introductory remarks on the research project to the reader. It presents
initial information about the research field and the main purposes of the study. It introduces
the background to the problem, the purpose of the study and its objectives, the research
questions, an outline of the research methodology, the research contributions and finally the
thesis structure.
CHAPTER TWO: BACKGROUND AND RELATED WORK
This chapter starts with a brief history of insurance in order to understand this field. Next, it
covers the literature on health insurance studies and also covers studies regarding other kinds
of insurance, such as life insurance. The main purposes of this chapter are to investigate the
methods that have been applied to solve insurance selection problems and to explore the
research gap within this context. Additionally, a list of criteria used by previous studies for
the selection problem is synthesised so that it can then be used as the basis of the
development of a specific model for group health insurance. A discussion on prior research is
presented here to determine a potential approach to be applied in this research study. Finally,
overviews of the decision making and MCDM fields are given, the latter being the approach
mainly adopted and employed in this thesis.
CHAPTER THREE: TOWARDS A MCDM FRAMEWORK FOR GROUP HEALTH
INSURANCE PLAN SELECTION
The relevant literature is reviewed in this chapter and divided into seven sections. Each
section concludes with a summary. It starts with literature reviews for the modelling of
uncertainty in MCDM. The existing methods and theories for deriving weights by using crisp
and fuzzy judgements are discussed. The existing group decision making methods are
presented, including the different group aggregation processes. In addition, this chapter
33
contains a review of aggregation approaches under unequal individual power, considering
group decision making when each member in the group has a different importance weight.
Then, an overview of different methods for studying interdependency in MCDM is discussed.
In this chapter, methods for ranking alternatives in the MCDM model are reviewed and
discussed.
CHAPTER FOUR: A HYBRID FUZZY MCDM MODEL
This chapter describes the methodology framework proposed in this thesis. A new hybrid
Fuzzy MCDM model, an integrated model combining the extended FDM, extended Fuzzy
DEMATEL, new FGP, and modified Fuzzy TOPSIS methods, is proposed in this chapter. In
the proposed hybrid model, some extension, based on the Fuzzy Delphi, Fuzzy DEMATEL,
non-linear Fuzzy Preference Programming (FPP), and Fuzzy TOPSIS methods, is introduced
to be applied in different circumstances. The extended methods include modelling of
uncertainty in group decision-making by applying the FST concept. In addition, they take
into consideration the fact that each DM in group decision-making could have individual
importance power in the group. The new extended methods, the extended Fuzzy Delphi,
extended Fuzzy DEMATEL, new Fuzzy Group Prioritisation, and modified Fuzzy TOPSIS
methods, are introduced and discussed in detail in this chapter.
CHAPTER FIVE: DEVELOPMENT OF THE DECISION SUPPORT TOOLS
IMPLEMENTATIONS
This chapter explains the processes for software programming on MATLAB. Software
prototypes which support the proposed FDE method, Fuzzy DEMATEL method, the new
Fuzzy Group Prioritisation method and the new extended Fuzzy TOPSIS method are
developed in this chapter. Hence, four prototype decision support tools are developed in this
34
chapter. The first prototype decision support tool, called the Fuzzy Delphi Solver, is
developed to select the critical criteria and reduce the number of criteria in any MCDM
problem. Then, the concept of applying the new modified Fuzzy DEMATEL method for
studying interdependency among attributes is developed as a prototype decision support tool,
the Fuzzy DEMATEL Solver. Next, the design and implementation of a prototype decision
support tool for deriving criteria weights, the Fuzzy Group Prioritisation Solver, are
presented. The last section presents the design and implementation of a prototype decision
support tool for ranking alternatives, termed the Fuzzy TOPSIS Solver.
CHAPTER SIX: APPLICATION OF THE NEW HYBRID FUZZY MCDM MODEL
A CASE STUDY IN SAUDI ARABIA
In this chapter, the proposed hybrid Fuzzy MCDM model is applied to the group health
insurance selection policy problem in Saudi Arabia as a case study for validating and testing
the proposed model. The main aim is to demonstrate the application and effectiveness of the
proposed model in achieving the research objectives.
This chapter explains the methods of data collection, which are conducted during the field
study, including setting of selection criteria and identification of alternatives, grouping of the
selection criteria into clusters, identifying dependencies among clusters, pairwise
comparisons, criteria weights and ranking alternatives. A sensitivity analysis is then
conducted based on two scenarios: changing decision maker weights and changing criteria
weights. This is followed by a discussion of the analysis.
CHAPTER SEVEN: CONCLUSIONS
This chapter concludes the thesis and summarises the work done. It also summarises how the
objectives of this research were addressed and discusses the research limitations.
35
Recommendations for future research are finally made, discussing the implications of the
findings and the future work to be carried out.
Introduction to the research CHAPTER ONE: INTRODUCTION
CHAPTER TWO: BACKGROUND AND RELATED WORK

Research literature review
CHAPTER THREE: TOWARDS A MCDM FRAMEWORK FOR

GROUP HEALTH INSURANCE PLAN SELECTION
CHAPTER FOUR: A HYBRID FUZZY MCDM MODEL
Research design
and contributions
CHAPTER FIVE: DEVELOPMENT OF THE DECISION
SUPPORT TOOLS IMPLEMENTATIONS
CHAPTER SIX: APPLICATION OF THE NEW HYBRID FUZZY

MCDM MODEL A CASE STUDY IN SAUDI ARABIA
Research results,
analysis and conclusion
CHAPTER SEVEN: CONCLUSION
Figure 1.1 Thesis Structure
36
2. CHAPTER TWO: BACKGROUND AND RELATED WORK
2.1 Introduction
This chapter sets the background for the study by reviewing the literature and prior research
that pertain to the research questions and objectives. The first half of the literature review
corresponds to the intention to review the previous research on insurance. It provides a brief
review of insurance history to understand the fundamental development of this sector. In
addition, this part explores prior studies related to general insurance and health insurance
problems. The focus is mainly on articles that aim at providing methodologies for insurance
plan selection problems. The aims here are to address the gap or incompleteness in this
research area and to decide the direction of this study, indicating the applicability of a
MCDM approach for modelling this research problem. Therefore, the second half of the
background corresponds to a review of the general concept of decision making and the
MCDM process.
This chapter is divided into six main sections. Following the introduction, section 2.2
provides a brief history of insurance and health insurance. After that, section 2.3 presents the
research on the insurance plan selection problem. Discussion of the existing studies is given
at the end of the section. The gaps and limitations in previous research are then listed in
section 2.4. This is followed by an overview of decision making and the MCDM process in
section 2.5. Finally, section 2.6 provides a summary of the chapter.
2.2 A Brief History of Insurance and Health Insurance
Various systems of insurance were used by the ancient Phoenicians, the Greeks and the
Romans to guard themselves against some of the risks of maritime enterprise, whether in the
form of loans or of mutual guarantee (Frederick, 1876). The loan form is known as
bottomry and it is the forerunner of todays marine insurance (John, 1958). The practice of
insurance as a mutual guarantee is as old as human society itself. This used to be practiced
37
through friendly societies and was organised to aid their poor and unfortunate members from
a fund made up of contributions from all members (Frederick, 1876). The concept of
transferring or distributing risk was practised by Chinese and Babylonian traders in the 3rd
and 2nd centuries Before Christ (BC), respectively (Vaughan, 1997).
A thousand years later, a number of forms of insurance practice were introduced. In the sixth
century BC, the Greeks and Romans introduced the concept of protection against death (life
insurance), and the cost of medical treatment and health care (health insurance) when they
created a type of society called "benevolent societies", which cared for the families of
deceased members, as well as paying funeral expenses of members (Gregg & Lucas, 1973).
During the middle ages, "friendly societies" existed in England, in which people donated
amounts of money to a general sum that could be used for emergencies (Frederick, 1876). In
the late 17th century, insurance was established as a system to shift the risk of a loss, from
one unit (individual or group of people) to another in exchange for payment (Bickelhaupt,
1983). The health insurance concept developed in the early nineteenth century to solve the
problem of access to an income to replace earnings when sick, and later to generally secure
the provision of an acceptable standard of health care (Abel-Smith, 1988). The main purpose
for introducing the health insurance concept was to assist groups of people, such as the more
skilled workers and not too poor farmers, both in the private and public sectors, whose
income was too low to afford to pay health care expenses when they became ill (Abel-Smith,
1992). In 1883, compulsory health insurance started in Germany which had the advantage of
forcing the employer to contribute and subsequently to cover their workers (Bartrip, 1983).
In Western Europe, in the 19th century, forms of health insurance were provided by
employers. Since that time, people have been covered by health insurance through their
employers. This began to grow rapidly during World War II and it is now the principal source
of health insurance for most individuals across the world (Moore, 2011). In the nineties group
38
health insurance was provided through the workplace and employers; it was then offered to
the eligible employees in the company (and often to the employees' family members) (Gruber
& McKnight, 2003).
2.3 Studies in Insurance and Health Insurance
This section explores the literature related to health insurance studies. A particular emphasis
is given to the methods used for the selection and choice of an insurance plan for covering
employees. Although this thesis specifically focuses on the case of health insurance, it is
necessary to also review selection problems in the insurance sector in general, in order to
think more generally about the topic. It is believed that taking general thoughts into account
is fundamental to the development of a comprehensive methodology for a specific area.
Therefore, a number of prior works regarding the methods that have been used for insurance
policy selection and purchasing have been reviewed here. Moreover, the selection criteria for
buying an insurance policy that have been found in the literature have been investigated. The
findings of the review have been analysed and discussed in order to determine the direction
of this study and then adopt the main approach for this research.
2.3.1 A Review of Previous Related Work
There were few papers found in the literature regarding employers choices of group health
insurance plans for insuring and covering employees against medical expenses that might
occur as a consequence of illness, injury or disability. This section provides a review of the
insurance studies literature.
Group health insurance, firstly, is a very important area to study. Some authors have
illustrated the importance of studying employment-based group health insurance plans which
are offered by the employer to cover their employees. Goldstein & Pauly (1976) stated that
group health insurance was increasingly a matter of concern for employers in the private
39
sector. The reason behind this is that employers are interested in understanding group health
insurance so they can take action to minimise medical costs for their employees (Goldstein &
Pauly, 1976). Feldman et al. (1989) studied the demand for employment-based health
insurance plans in 17 firms in the United States. They concluded that there are two reasons
for the current interest in studying employment-based group health insurance plans. First,
employment-based group health insurance plans are the dominant method of financing health
care in the United States (Feldman, et al., 1989). Second, employers desire to limit and
control the level of their health care expenses by covering and insuring their employees.
Offering health insurance plans for employees plays an important role for small employers,
as it is an important duty for large and medium employers to reduce the cost of health
payments (Feldman, et al., 1989). Group health insurance is essential in the private sector in
developed and western countries, it is a significant industry in developing countries as well.
Many developing countries are currently introducing compulsory group health insurance
plans in the private sector in order to attract more resources to the health sector (Abel-Smith,
1992).
Employee demand for health insurance and the relationship between employee preferences
for health insurance and the health plans offered by employers have been investigated in a
few studies (Danzon, 1989; Feldman, et al., 1989; Bundorf, 2002; Gruber & McKnight,
2003). Several factors (criteria) have been considered in some papers for purchasing health
insurance plans, such as period of insurance, deductibles3, coinsurance4 and flexibility of the
insurance contract for cancellation, premium, health benefits, quality of health care providers
3
Deductibles are the part of any claim that is not covered by the insurance company.
4
In health insurance, coinsurance means that the insurance company covers a certain percentage of the losses
up to a certain level.
40
and re-insurance 5 (Goldstein & Pauly, 1976; Summers, 1989; Danzon, 1989; Cutler &
Zeckhauser, 1998; Bundorf, 2002) .
However, there is no study illustrates that how employers select an appropriate group health
insurance plan for covering their workers. In other words, there is a lack of knowledge and
research in the literature that could provide a model for employers, in order to assist them in
the purchasing of a proper health insurance policy to cover their workers.
On the other hand, several methods and techniques have been covered in the literature (for
example, traditional Operations Research (OR) and MCDM methods) for the modelling and
selection of insurance plans in general (Schleef, 1980; Doherty, 1984; Turnbull, 1983;
Schoemaker, 1986; Blomqvist, 1997; Liu & Chen, 2002; Gupta & Li, 2004, 2007; Huang et
al., 2007; Huang et al., 2008 ).
A limited numbers of studies exist in the literature that utilises Operations Research
techniques, which attempt to model insurance purchase and selection problems in general.
The use of linear programming has been proposed for the planning of life insurance
purchases by Schleef (1980). His model illustrates how linear programming can be used to
decide the timing of purchase and the amount purchased for a life insurance plan. He has also
applied linear programming as a basis for comparing different insurance products with
respect to the protection and savings they offer (Schleef, 1983). Other OR approaches for
dealing with the insurance purchasing problem are based on portfolio approaches (Doherty,
1984). Doherty analysed insurance purchases within a portfolio framework to examine the
selection features of rational insurance buying decisions. The expected utility hypothesis has
been proposed to model decisions regarding the purchase of insurance plans (Turnbull, 1983;
5
Re-insurance is an insurance agreement that is purchased by an insurance company (insurer) from another
insurance company (re-insurer) that has high insurance abilities, in order to transfer risk from the insurer to the
re-insurer and to distribute the risk between the two companies.
41
Schoemaker, 1986; Samson, 1987). Von Lanzenauer & Wright (1991) reviewed these OR
concepts, which have been used to model the insurance purchasing problem. Nonetheless,
only a few references are given in this overview regarding the selection of an insurance plan
(for more details see Von Lanzenauer & Wright, 1991).
Regarding the purchase of health insurance and the associated selection problem, a few
researchers have studied this problem by using OR techniques. Blomqvist (1997) applied
dynamic optimisation techniques to construct an optimal non-linear health insurance plan
model and to then analyse the models properties. Liu and Chen (2002) analysed the
purchasing decisions regarding private health insurance with national health insurance in
Taiwan, by using a theoretical model which was based on a comparison of the expected
utility of having health insurance vs. having no insurance. Furthermore, Gupta and Li (2004;
2007) proposed modelling frameworks for selection decisions regarding private long-term
care (LTC)6 insurance in order to help people make better LTC insurance purchase decisions.
They focused on LTC insurance policies during retirement. In their 2004 study, they
developed an optimal long-term care decision making framework for an individual planner
by applying a dynamic programming analysis to the decision tree and then obtaining the
optimal solution by making a trade-off between LTC costs, LTC premium and coverage
(Gupta & Li, 2004). In 2007, they formulated the same problem as a nonlinearly constrained
mixed integer optimisation problem and solved it by employing an appropriately constructed
heuristic. After that, decisions were obtained by making trade-offs between immediate
consumption and saving for long-term needs, LTC insurance premium and coverage (Gupta
& Li, 2007). In addition, in both studies, sensitivity analyses of the optimal decisions were
performed (Gupta & Li, 2004; 2007).
6
An Insurance product which is be sold in USA, UK and Canada.
42
In the literature, a number of ideas and MCDM methods have been proposed by researchers
to help individuals and organisations to make a good selection of general or life insurance
policies. Puelz (1991) applied the Analytical Hierarchy Process (AHP) for the selection of
an optimal life insurance contract. He aimed to build a model to achieve individual
satisfaction with a life insurance contract, which was based on four factors (criteria): net
payment index, contractual flexibility, strength and reputation of the insurance company,
and accumulation of cash value. Another application, using the MCDM method for
insurance policy selection, is an evaluation model for the selection of life insurance and
annuity insurance policies using AHP and Fuzzy Logic (FL) (Huang, et al., 2007). The
authors considered four factors (criteria) for building the insurance purchasing model: age,
annual income, educational level and risk preference. They used fuzzy variables to
represent the linguistic expressions of human beings and the AHP to create the desired
importance weights for the evaluation model by interviewing five experts with at least three
years of work experience in an insurance company. In 2008, Huang, Lin & Lin proposed a
model for insurance consultants to assist their customers in the selection of an appropriate
insurance policy from among five insurance plans, including life, annuity, health, accident
and investment insurance. The Delphi technique was considered to integrate more experts
opinions. Therefore, they employed the AHP, FL and the Delphi technique for the model
framework and twenty experts with at least three years of insurance consulting experience
were selected (Huang, et al., 2008). Moreover, they used the same factors which were used
in their previous study.
Shapiro (2004) reviewed a number of studies that utilised FL and MCDM methods,
including extended FL techniques, in the insurance industry. Eventually, he concluded that
FL techniques have been successfully implemented into the insurance field and indicated
43
that the fuzzy concept is a useful tool for addressing situations of imprecision and
uncertainty.
2.3.2 Discussion of the Previous Work
The above review of the insurance studies literature shows some shortcomings. Although OR
techniques have been widely proposed, one can criticise these techniques. In the first place,
mathematical programming methods and the expected utility hypothesis might fail to capture
uncertainty (von Lanzenauer & Wright, 1991), which is a significant element in group health
insurance decision making, as mentioned before. Indeed, the OR models do not manage the
uncertainty issue, which occurs due to the vagueness and imprecision of judgements in
decision problems. Secondly, one of the major reasons for the failure of traditional OR
techniques in selection process problems is that they recommend solutions to problems
without allowing for a DMs judgement, experience and insight (Mathieu & Gibson, 1993).
Looking back at the description of the research problem (Section 1.3), where the uncertainty
aspect is reflected in the process of selection, one can argue that OR methods are not suitable
for handling the research problem, whereas MCDM modelling approaches are powerful
methods for making decisions, capable of modelling such a complex problem. Previous
results were used as guidance for deciding the dominant method to be adopted for this
research. Therefore, for the purpose of evaluating the different criteria for the process of
selecting and purchasing a proper group health insurance policy from various alternatives,
both qualitative7 (e.g. the strength of the insurer) and quantitative factors (e.g. the cost of
premiums) must be considered. Thus, group health insurance selection is a kind of MCDM
problem and MCDM methods need to be employed to handle it appropriately.
7
Qualitative factors look to take account of these other issues that may influence the outcome of a decision.
44
Another shortcoming of the prior research is that most articles discuss the modelling of
insurance choices only for the purpose of purchase by individuals (Schleef, 1980; Blomqvist,
1997; Gupta & Li, 2004; 2007; Huang, et al., 2007; Huang, et al., 2008) and there are no
studies that handle the problem of insuring a group of people. In addition, the previously
mentioned articles discussed insurance selection problems using the cases of developed
countries, such as the USA. Nowadays, many developing countries are currently starting
presents compulsory health insurance plans based on the historical experience of the
developed countries. However, those developing countries have different characteristics than
developed countries such as poor healthcare and high rates of population growth. This
indicates there is a need to study the cases of developing countries where the demand for
health insurance has been increasing during the past decade as a result of growth of
population (Abel-Smith, 1992). Moreover, there are no such studies regarding how employers
select an appropriate group health insurance plan for their workers. In other words, there is a
lack of knowledge and research in the literature that provides a model for employers, in order
to assist them in the purchasing of the proper health insurance policy to cover and insure their
workers.
Based on the review of the literature concerning the choosing and purchasing of an insurance
plan (Goldstein & Pauly, 1976; Summers, 1989; Danzon, 1989; Puelz, 1991; Cutler &
Zeckhauser, 1998; Bundorf, 2002), all relevant selection criteria can be listed, as in table 2.1.
Table 2.1: Criteria for Choosing an Insurance Plan
Criteria for purchasing a health insurance plan

1) Health benefits 2) Re-insurance
3) Premium prices 4) Flexibility of the insurance contract
5) Deductibles in the plan 6) Period of insurance
7) Co-insurance 8) The quality of health service providers
45
The limitation here is that the criteria are not clearly defined and they are proposed based on
the authors experience and historical data, which leads to issues of bias and datedness.
Therefore, it could be argued that some of these sources can be used in order to define diverse
criteria for selection problems, such as documentary analysis (the official rule and regulation
documents and insurance companies web pages) and DMs (in this case, for the purchase of
group health insurance plans, employers are the decision makers). Note that a final set of
criteria and their definitions, for evaluating the process of selecting group health insurance,
are proposed and defined in chapter six (after conducting the case study).
In the previous studies of insurance plan selection, selection criteria are assumed to be
independent of each other. In real life, these criteria are likely to influence each other. For
example, Puelz (1991) identified and derived importance weights for four independent
criteria: insurers financial strength, contractual features (e.g. period of insurance, conversion
to another plan, coverage limit), premiums/net payment and cost indices (e.g. cash values,
dividends), by using the AHP approach. In fact, these four criteria are interrelated/
interdependent to a certain extent. For instance, premiums may be related to other criteria. In
other words, sometimes the DM desires to pay a high premium for the insurance in order to
obtain more coverage or more options for conversion to another plan. Moreover, premium
and insurers financial strength may be negatively or positively correlated. Additionally, there
may even be relationships/dependency among the other criteria. Since the criteria importance
weights are traditionally computed by assuming that the criteria are independent, it is possible
that the importance weights may be computed by including the dependence relations, which
could be different. Possible changes in the criteria importance weights can change the final
ranking of the alternatives. Therefore, it is necessary to employ analyses which measure the
possible dependencies among criteria and take them into account in the selection process.
46
Finally, two studies (Huang, et al., 2007; 2008) tackled the insurance selection problem as a
group decision making problem by interviewing a group of experts to determine the factors
and criteria required for evaluating insurance. Huang et al. (2007 and 2008) assumed the
importance of each expert in the group to be equivalent. However, assuming that all the
individuals/experts/DMs in the group have the same weight of importance and have equal
experience in assessing all of the criteria is not realistic. In a real situation, no single member
can be expected to have the same level of experience as the others. For example, in any group
decision making problem, the judgements/assessments of an executive manager of a
company, the president of an organisation or even of some DMs who are more experienced
than others, might be more effective in the final decision. Therefore, one aim of this study is
to involve a group of individuals/DMs in the process of selecting group health insurance in
order to study the relationships among the different criteria and to then derive the relative
importance of the different criteria and alternatives. Thus, the importance of each DM in the
group has to be considered in this study and is defined as the importance weight of the DMs.
The previous results and their drawbacks are used in the next section to outline the gaps in
the existing studies.
2.4 Identification of Gaps in the Literature
This section outlines the gaps in the literature concerning the insurance selection problem.
The shortcomings of the prior studies, based on the review of the literature in the previous
pages, are summarised below:
The proposed models for selecting an insurance plan are not detailed enough to represent
the characteristics, features and surrounding environment of the insurance market.
Besides, the existing studies do not consider features of the health insurance market or
group health insurance selection principles.
47
In terms of uncertainty, which occurs due to the subjective judgement associated with the
opinions of human beings, there were only two studies (Huang, et al., 2007; 2008) that
model uncertainty in the insurance selection problem by combining the AHP and the FL
concept. However, more investigation is required to find a proper way to model
uncertainty in decision making problems; this will be discussed in more detail in the next
chapter.
The literature is lacking a model that considers the different selection criteria for choosing
the proper insurance plan. In other words, most of the previous studies have identified a
number of selection criteria which are based on the authors experience or on historical
data, and some of these criteria are not clearly defined. As suggested in the previous
section, other sources are recommended in order to reach a suitable research methodology
and collection of data that can be adapted to the specific requirements of the study.
None of the existing published research on the selection of insurance plans studied the
relationships/dependency among the criteria, which is a crucial issue that should be
addressed in the decision making problem. A good structuring of the decision making
problem would seek to study dependencies among criteria (Saaty, 1996). Therefore, it is
necessary to employ analyses which measure the possible dependencies among criteria
and take them into account in the selection process.
The published articles related to the selection of an insurance plan as a group decision
making problem disregard the fact that each expert in the group has a different level of
expertise which might affect the final results and decision. Thus, the consideration of
the importance of each expert in the group will be investigated in this research study.
From the literature review, it seems that there are no studies that deal with the problem of
evaluating the selection of a group health insurance plan. The citation of past research, on
the previous pages, shows that OR techniques and MCDM methods have been used by
48
researchers in order to deal with the problems of the general insurance plan selection
process. Attempts have been made to propose only methods for assisting individuals in
purchasing types of insurance such as life, annuity and health insurance (Puelz, 1991;
Gupta & Li, 2004; 2007), whereas the study of the group health insurance selection
problem for covering a group of workers has been almost neglected. Thus, this research
aims to propose an evaluation model for alternative group health insurance plans in order
to select the appropriate plan that can be purchased by employers to cover their
employees.
In terms of the areas to which these studies have been applied, it seems that insurance
research has studied cases in developed countries, while this kind of research has been
almost ignored in developing countries. It can be argued that the developing countries
have different characteristics than developed countries that must be investigated. In fact,
the group health insurance industry is gaining more interest in developing countries. That
because currently those countries turned to enforce the employers in the private sector to
purchase this kind of insurance as a result of high rates of population growth and
increasing number of immigrant workers , which leads to the an increasing demand for
the purchase of these insurance plans. For that reason, a case study was conducted in a
developing country (Saudi Arabia); more details will be discussed in chapter six.
The above mentioned results define a clear gap in the existing literature on the evaluation of
the selection process for insurance plans. For that reason, this research, essentially, addresses
this gap and attempts to fill it.
The review of the existing literature on insurance selection studies has indicated the
applicability of a MCDM modelling approach, which is a decision making tool. It was
therefore decided that this approach would be used as the dominant research methodology.
49
As a result, the next section briefly overviews the decision making process followed by an
introduction to the MCDM approach.
2.5 Decision Making
Decision making is a normal part of our daily lives with hundreds and thousands of decisions
having to be made in the personal and business fields every day. It is a cognitive process of
ranking and evaluating available alternatives from a list of options in order to choose the
most desirable one (Zimmermann, 1987). Mallach (1993) described a decision as a reasoned
choice among alternatives. Decision making can be characterised as a process of choosing or
selecting sufficiently good alternative/s or course/s of action, from a set of alternatives to
attain a goal or goals (Ribeiro, 1996, p. 155). From these definitions, each decision making
process includes a decision goal, a set of alternatives and a set of decision criteria. In decision
making, these three characteristics can be described as follows:
The decision goal/s states the things desired by the DM/s (Zimmermann, 1987).
The alternatives represent the different options for action available to the DM/s to be
ranked or evaluated (Triantaphyllou, 2000).
The decision criterion is a characteristic property by which something can be judged
(Smith, et al., 1989). These criteria are either qualitative or quantitative in nature and the
precedence between them may vary dramatically under different circumstances.
Usually, a decision making process is an intuitive and easy task when considering decision
problems with a single criterion. However, it becomes very complicated and requires
sophisticated methods when ranking and evaluating different alternatives or actions with
multiple criteria (Tzeng & Huang, 2011). Under these circumstances, the DM/s aims to reach
the most successful decision by balancing the conflicting criteria (Belton & Stewart, 2002).
50
According to Simon (1977), the decision making process can be categorised into three
phases:
1. Intelligence phase: in which the DM/s examines the economic, technical, political and
social environment to identify the new conditions and situations that call for a new action
and decision. This phase might involve, for instance, comparing the current status of a
project or process with its plan. The final result of the intelligence phase is a decision
statement.
2. Design phase: in which the DM/s designs and develops possible courses of action. This
includes the formulation of a model, setting the criteria for the choice and searching for
alternatives.
3. Choice phase: in which, in traditional terms, the decision is made. It involves evaluation
and ranking of the alternatives that were developed in the design phase and choosing one
of them. The end product of this phase is a decision that can be carried out; for example,
the DM/s selects the best alternative from a list of alternatives.
A fourth stage, Implementation, was later added by Simon to the above process. Such a
decision making process is considered as the most general model. Based on Simons stages in
rational decision making, the decision making process can be designed as depicted in Figure
(2.1). This process fits well with the selection of a group health insurance plan as one could
clearly identify the intelligence, design and choice phases. The former two phases are more
complicated than the latter phase as they require some methods to solve the research problem
discussed in section 1.3.
51
Choice Phase
Intelligence Phase Design Phase - Model conducting and
- Situation identification - Alternatives identification implementation(running the
model and interpreting the
- Problem formulation - Setting criteria results)
- Setting objectives/goals - Building a model - Choice
- Sensitivity analysis
Figure 2.1 Decision Making Process (source: adapted from Simon, 1977)
As discussed earlier in section 1.3 and sub-section 2.4, the research problem is considered as
a decision making problem under multiple criteria and alternatives. Therefore, an approach is
required to solve this kind of problem. According to many authors (Hwang & Yoon, 1981;
Zimmermann, 1987; Stewart, 1992; Mallach, 1993; Sen & Yang, 1998; Triantaphyllou, 2000;
Belton & Stewart, 2002; Tzeng & Huang, 2011), MCDM is one of the most well known
branches of decision making over the last three decades for solving decision problems in the
presence of multiple criteria and alternatives. MCDM has become one of the most important
and fastest growing subfields of Operations Research and Management Science.
2.5.1 A General Overview of MCDM
The term MCDM is used as an umbrella term that describes a collection of formal
approaches which seek to take formal account of multiple criteria in helping individuals or
groups explore decisions that matter (Belton & Stewart, 2002, p. 2). Its techniques are
described as a set of approaches that can help individuals or groups of people in researching
important complex decision making problems. Their aim is to guide the DM/s in determining
the course of action that best achieves the long-term goals (Stewart, 1992). The motivations
for developing the MCDM approaches to decision making emerged from the limitations of
the traditional approaches to the study of single criterion decisions (Banville, et al., 1998).
52
There is no uniform classification of MCDM approaches. As a result, there are many ways to
classify them, such as the form of the model (e.g. linear, non-linear, stochastic), the
characteristics of the decision space (e.g. finite or infinite) or the solution process (prior
specification of preferences or interactive). Hwang & Yoon (1981) and Zimmermann (1987)
provided a general classification of the MCDM field into two categories, based on different
purposes and different data types, as follows:
Multiple Objective Decision Making (MODM): MODM studies decision problems in
which the decision space is continuous. It is therefore not associated with problems in
which alternatives have been predetermined. The DMs primary concern is to design the
most promising alternative with respect to limited resources. MODM is used for design,
dealing with the problem or resolving a set of conflicting goals that cannot be achieved
simultaneously. A typical example is mathematical programming problems with multiple
objective functions (Triantaphyllou, 2000).
Multiple Attribute Decision Making (MADM): MADM is associated with problems
with a discrete decision space; it involves evaluation of a definite set of alternatives
according to a predefined set of evaluation attributes. An attribute is a property, quality or
characteristic of an alternative. For evaluating an alternative, a criterion is set up for
each of its attributes and the attribute is examined against the criterion. Because of the
one to one correspondence between an attribute and a criterion, sometimes attributes are
also referred to as criteria. In the context of MCDM, the word attributes and criteria are
used interchangeably. (Xu & Yang, 2001, p. 14). Triantaphyllou stated that very often
the terms MADM and MCDM are used to mean the same class of models (i.e., MCDM)
(Triantaphyllou, 2000, p. 2). MCDM is used mainly for selection and evaluation, dealing
with the problem of choosing an alternative from a set of determined alternatives.
53
According to Xu & Yang (2001) there are two typical categories of MCDM problem and the
distinction between the two categories is based on the number of alternatives under
evaluation: the first involves a finite number of alternative solutions and the other having an
infinite number of solutions. Usually, in problems related to evaluation and selection, the
number of alternative solutions is limited whereas, in problems associated with design, the
potential alternative solutions could be infinite. If this is the case, the problem is referred to as
MODM instead of as a MCDM problem. Looking back to the research problem, one can
notice that it is a decision selection problem with a finite number of alternatives available.
Therefore, the problem tackled in this study should be considered as a MCDM problem.
Generally, MCDM problems are complex and ill-structured. Whatever the MCDM approach
used, the decision making processes is composed of three main steps, as suggested by Belton
and Stewart (2002):
1. Problem identification and structuring: this means understanding the problem, the
surrounding environment, the key stakeholders, values, goals, etc.
2. Model building and utilisation: this includes defining preference measurement scales,
defining evaluation criteria and specifying decision alternatives. In this step, the criteria
should be assigned weights to reflect their relative importance to the decision. Then all
available options are measured against each criterion and these measurements then
facilitate the selection of one satisfactory choice. A DM/s is usually assisted in
highlighting conflicts among the criteria and then a feasible compromise, which is the
closest to the ideal solution, may be suggested.
3. Model testing and taking action: challenging the original intuition and thinking by
conducting sensitivity analysis and testing the process outcomes, then reaching a final
action and decision.
54
Under the MCDM process, the main quantified and formal procedures that should be utilised
for any decision making involving multiple criteria and finite alternatives are listed below
(Triantaphyllou, 2000):
Determine the relevant criteria and alternatives associated with the problems considered.
Attach numerical measures to the relative importance of the criteria and to the impacts of
the alternatives on these criteria.
Process the numerical values to determine a ranking for each alternative.
Many methods have been proposed for solving MCDM problems and each one has different
characteristics. These methods are described and discussed in the next chapter, but before
introducing these methods, the fundamental characteristics of MCDM are given in the
following sub-section.
2.5.2. Characteristics of MCDM
In the last three decades, dozens of MCDM methods have been developed for solving
MCDM problems as reviewed by Hwang and Yoon (1981). These methods require that the
criteria to be assigned weights of importance (Triantaphyllou, 2000). Indeed, the relative
importance of each criterion across criteria is called priority/weight. In the literature, there is
a massive number of methods in MCDM to derive those priorities/weights which are
discussed in chapter three.
MCDM methods have already turned out to be applicable in business practice. The following
features contribute to the applicability of MCDM methods to solving complex problems
(Belton & Stewart, 2002):
The aim of MCDM is to assist DM/s to learn about the problem, to express their
judgements about criteria importance and preferences concerning alternatives, to confront
55
other participants judgements, to understand the values of the final alternatives and to
employ them in problem solving activities;
MCDM methods do not replace intuitive judgement or experience and they do not
dominate creative thinking. Their role is to complement intuition, to verify ideas and to
support problem solving;
MCDM methods can deal with mixed sets of data, quantitative and qualitative, including
expert opinions;
MCDM offers a process that leads to rational, justifiable and explainable decisions; and
In MCDM, one can compare different methods and assess their convenience for solving a
problem. The most useful ones are theoretically simple, visible and computer supported.
Usually in MCDM problems there is difficulty and complexity associated with making
decisions due to conflict among criteria, uncertainties in subjective judgements and different
preferences among different DMs. From this premise, one can argue that the outcome of a
MCDM problem cannot fully satisfy all stakeholders. This leads to the different types of
solutions or outcomes of a MCDM problem listed by (Hwang & Yoon, 1981):
Optimal solution (ideal solution, superior solution): an optimal solution to the MCDM is
one which results in the maximum value for each of the objective function functions
simultaneously. A solution that satisfies all the criteria is normally not obtainable (Xu &
Yang, 2001).
Non-dominated solution (efficient solution): a solution in which one criterion at least is
better satisfied by another solution.
Satisfying solution: a solution that satisfies a specified minimum requirement on all its
attributes.
Preferred solution: the one that meets all the expectations of the DM.
56
In terms of demonstrating the MCDM problem, the most commonly used way to represent
the problem is a decision matrix. According to Zimmermann (1987), the decision matrix is
a matrix in which element indicates the performance of alternative when it is
evaluated in terms of decision making criterion (for = 1,2, , and = 1,2,3, ). It is
also supposed that the weights of importance of the decision criteria (denoted as , for =
1,2,3, ) can be derived based on the DM/s judgements (more details are given in chapters
three and four). The decision matrix can be represented as follows:
1 2 . .
1 2 . .
1 11 12 1
= 12 22 (2.1)
.2 (
2
)
1 2

The above matrix is used in MCDM methodology i.e. to find the global ranking of
alternatives.
2.6 Summary of the Chapter
This chapter presents a review of literature, with the aim of providing foundations in order to
propose a model for the group health insurance selection problem. In summary, first of all, a
brief review of the history of the insurance industry has been given in this chapter to
understand the basic information about this industry (section 2.2). Section 2.3 presented all of
the reviewed literature that tackles the various issues related to insurance modelling and
selection problems. The proper studies presented above summarised the dominant themes and
techniques in the literature regarding the solving of selection problems in insurance plan
purchasing; these are OR techniques and MCDM approaches. In addition, criteria which
appeared in the literature were explored, in order to summarise a general set of criteria (see
table 2.1), which will be used later in this thesis to suggest a final list of criteria for evaluation
57
in the selection process for a group health insurance plan. The results of the literature review
defined a gap in the health insurance literature which was discussed in section 2.4. It is
concluded that there is a real need for a model to assist employers in the evaluation of
different available alternative plans for group health insurance and in the selection of the best
plan to cover their employees within the context of developing countries. From this section,
this thesis becomes the first study to address that problem. Moreover, the analysis of the
literature review considered that the selection problem in this study is a decision making
problem under an environment of uncertainty and a DM/s in this selection process is also
likely to deal with a number of dependent and correlated criteria. Traditional OR techniques
have been commonly used to address insurance plan selection problems (Schleef, 1980;
1983; Turnbull, 1983; Doherty, 1984; Schoemaker, 1986; Samson, 1987; Blomqvist, 1997;
Liu & Chen, 2002; Gupta & Li, 2004; 2007). However, it can be argued that these traditional
OR techniques may fail to capture the uncertainty issue (von Lanzenauer & Wright, 1991).
On this point, the MCDM approach is likely to be the right choice for this thesis, mostly
because of its ability to handle several types of uncertainty and subjectivity. Therefore, in
section 2.5, attention is shifted to reviewing the discipline of decision making, followed by a
general overview of MCDM.
As a consequence of this chapter, the next chapter presents an extensive review of the
literature related to MCDM methods in order to develop a MCDM model for the group health
insurance plan selection problem.
58
3. CHAPTER THREE: TOWARDS A MCDM FRAMEWORK FOR
GROUP HEALTH INSURANCE PLAN SELECTION
3.1 Introduction
The nature of group health insurance plan selection is a complex MCDM problem under
conditions of uncertainty and includes quantitative and qualitative criteria. The research
problem may also include dependency relationships within the decision criteria. Moreover,
the importance weights of the DMs might affect the priorities among the criteria, the
ranking of the alternatives and the final decision. Therefore, the aims here are to explore the
literature review corresponds to the goal of this thesis, which is to develop a new model to
tackle the problem of the selection of a group health insurance plan for covering employees
in the private sector.
Accordingly, this chapter reviews and investigates the most frequently used theories and
tools in group MCDM for modelling uncertainty, generating the decision criteria weights,
studying dependency, deriving the importance of DMs in the group and ranking
alternatives. Such reviews are crucial for understanding the limitations and advantages of
those theories and tools. This will help in adopting proper tools and theories to develop a
new group MCDM model to tackle this research problem.
This chapter is divided into eight main sections. Following the introduction, section 3.2
reviews tools for handling uncertainty in MCDM problems. Next, section 3.3 discusses
methods for deriving the weights of the decision elements. This is followed by an overview
of group decision making approaches in section 3.4. Section 3.5 considers the issue of the
importance of the DMs within a group. The rationality and the limitations of methods for
studying dependency are discussed in section 3.6. Section 3.7 aims to review methods for
ranking alternatives in MCDM. Finally, section 3.8 provides a summary of the chapter.
59
3.2 Modelling Uncertainty in MCDM
This section provides a review of different tools, which can model the uncertainty issue in
MCDM problems. Before starting the review, it is necessary to define the meaning of the
term uncertainty. The Chambers Dictionary (Schwartz, 1998) defines uncertain as: not
definitely known or decided; subject to doubt or question. In the context of practical
applications in MCDM, Zimmermann (2000) proposed a definition of uncertainty:
Uncertainty implies that in a certain situation a person does not dispose about information
which quantitatively and qualitatively is appropriate to describe, prescribe or predict
deterministically and numerically a system, its behavior or other characteristica.
According to Durbach & Stewart (2012), there are two different types of uncertainty:
external and internal uncertainties. External uncertainty represents concern about issues
outside the control of the DM/s. It refers to, and results from, lack of understanding or
knowledge about the consequences of a particular choice (Stewart, 2005). Internal
uncertainty relates to the process of problem structuring and analysis, as well as to
ignorance, complexity of information, subjective judgements and imprecision in human
judgements (Durbach & Stewart, 2012).
Looking back to the research problem (section 1.3), the uncertainty in this research is
internal uncertainty which occurs as a result of imprecise human judgements. In other
words, it is common that people may not be 100% sure when making subjective
judgements. Thus, in the next section, tools to model internal uncertainty are reviewed and
analysed.
3.2.1 Analysis of Methods for Modelling Uncertainty
Since the problem of selecting a group health insurance plan is subject to internal
uncertainty due to imprecision and subjectivity in the DMs judgements, methods for
60
representing uncertain information in decision making are summarised and analysed in the
following:
Probability Theories: The most thoroughly mathematical treatment of uncertainty is
by theories of probability. Uncertainty is expressed in terms of a measure of the
subsets/actions from a universal set of alternatives (events) (Tsokos, 1972; Johnson &
Kotz, 1972; Gardiner, 1983). The uncertainty measure is a function that gives a number
between 0 and 1 to each subset of the universal set/event; the number is called the
probability of the subset/action. A probability of 0 means that the event will not occur,
while a probability of 1 means that the event will occur for sure. In theories of
probability, the total probability of the event space is 1; in other words, the sum of the
probabilities of all the events in the space must equal one.
The application of probability concepts would require the specification of a
(multivariate) probability distribution, (), for each action, , with the outcome that
the decision requires a comparison of the probability distributions (sometimes called
lotteries in this context) (Stewart, 2005).
According to Liu et al. (2002), two major schools of thought exist under the probability
theories umbrella: the Frequentists and the Bayesians. Frequentist methods, which
include classical statistical techniques, define and estimate the probability as the ratio
between the frequency of occurrence of an event and the total number of observations
(Pate-Cornell, 1996). On the other hand, the Bayesian probability theory (subjective
probability) uses the common probability approach and defines the concept of
probability as a degree of belief based on available evidence (Neapolitan, 1990).
A drawback of this theory is having to model uncertainty in the MCDM model based
only on expectations and having to subject the results to an expectation model (e.g.
multi-attribute utility theory) (Stewart, 2005). However, simple expectation models do
61
not take full account of the range of outcomes which may occur. In a probability theory
such as the Bayesian theory, the probability of an event is the degree of belief placed in
its occurrence by the DM/s on the basis of the available data (Liu, et al., 2002). This
limitation represents the inability of probability theories to represent ignorance and
incomplete data, which might occur in decision making problems. In other words, one
criticism of probability theories is that they do not provide an explicit mechanism for
dealing with ignorance (Durbach & Stewart, 2012). The Dempster-Shafer (D-S) theory
of evidence provides such a mechanism to model ignorance (Durbach & Stewart, 2012).
Another limitation is that probability theories (e.g. the Bayesian approach) require a
large number of prior probabilities, which leads to a difficult computational process
(Liu, et al., 2002). Moreover, the assumption of that events are independent is a major
limitation in probability theories (Liu, et al., 2002). Such an assumption is not
appropriate in the case of the evaluation criteria in the process for selecting group health
insurance, which are very much interrelated and dependent on each other.
Finally, probability theory requires knowing the probability being assigned to each
circumstance in advance, so it takes a lot of time and effort on the part of researchers.
Because of the above limitations, probability theories have difficulty in modelling
uncertainty. As a result, the probabilistic approach cannot be utilised to evaluate
selection problems under conditions of subjective uncertainty and with dependencies
between the selection criteria.
The Dempster-Shafer (D-S) Theory: The D-S theory was formally established by
Shafer (1976) as a mathematical tool for reasoning with incomplete and uncertain
information. The idea of upper and lower probability boundaries is used in the D-S
theory to model uncertainty by means of a range with upper and lower probabilities
instead of using a single probability value (Liu, et al., 2002). Instead of identifying a
62
probability value, the D-S theory allows one to set constraints and boundaries on the
probability value by using belief functions (Yager, et al., 1994). The D-S theory
overcomes the limitations of the probability theories by representing the uncertainty that
occurs due to ignorance (Liu, et al., 2002).
The D-S theory is based on two main pillars: the idea of obtaining degrees of belief in
one hypothesis from subjective probabilities for related hypotheses and Dempsters rule
of evidence combination that is used for aggregating the degrees of belief for
independent pieces of evidence (Shafer, 1990; Shafer, 1992).
Liu et al. (2002) summarised the disadvantages of the D-S theory as follows:
1. The theory assumes that all pieces of evidence or sources of information are
independent. Thus, the assumption of independent sources of evidence is always a
matter of criticism as it is not appropriate to model reality.
2. The computational complexity of its rule of evidence combination. Therefore, the
D-S theory has the main shortcoming of not being very popular due to the difficulty
of the computational process.
However, Stewart (2005) argued that invoking the concept of the D-S theory of
evidence often tends to make MCDM models even more complex and thus less visible
to DMs, further aggravating the difficulties of implementation.
Indeed, the Evidential Reasoning (ER) approach applies Dempsters evidence
combination rule to combine weighted criteria in MCDM. The ER approach has been
developed by Yang and Singh (1994), and Yang & Sen (1997) as a reasoning tool
capable of handling various forms of uncertainty and representing ignorance and
incomplete assessment. The ER framework includes the concept of the attribute
hierarchy (Xu & Yang, 2001). However, many MCDM problems cannot be structured
as a linear top-to-bottom form of attribute hierarchy. Moreover, in the ER approach
63
DM/s are required to make personal judgements in terms of degrees of belief which are
the same as probabilities when there is no ignorance in the judgement.
These are the main shortcomings and limitations of the D-S theory, and this revised
approach needs to be considered in decision making problems in environments of
uncertainty. Hence, the limitations of the D-S theory do not support its practicality and
usefulness in this research.
Rough Set Approach: This is a mathematical approach for modelling uncertainties and
was introduced by Pawlak in 1982. It has been used in many different research areas
(Pawlak, 1982; 1997; Greco, Matarazzo, & Slowinski, 1999; 2001; 2002). Its
methodology is concerned with the classification and analysis of imprecise, uncertain or
incomplete information and knowledge, and it is considered one of the first non-
statistical approaches in data analysis (Pawlak, 1982).
The basic assumption of rough set theory is that human knowledge about a universe
depends upon capability to classify the objects it contains. A rough set is a formal
approximation of a crisp set (i.e. conventional set) in terms of a pair of sets, which give
the lower and the upper approximation of the original set. The pair of crisp sets, called
the lower and upper approximations of the original set, represents a rough set.
Imprecision in this approach is expressed by a boundary region of a set8.
One of the disadvantages of rough set theory is its dependence on complete data
(Nabwey, 2011). Nevertheless, in real life decision making applications, there are often
cases of incomplete and missing data and knowledge.
Another limitation of rough set theory is inefficiency in computation, which limits its
suitability for large data sets in real world applications (Hu, et al., 2004). In other
8
A set is a collection of any objects which are somehow related to each other and which can be considered as
a whole.
64
words, the process of using rough set theory is very time-consuming, and thus the
model is very inefficient and unfeasible.
Considering the above mentioned limitations, one can argue that rough set theory is not
an appropriate way to deal with uncertainty information in this research study.
Fuzzy Set Theory (FST) 9 : Another approach, which copes with the problem of
imprecise judgements, is known as fuzzy set theory. FST was proposed by Professor
Lotfi Zadeh at the University of California in 1965 (Zadeh, 1965) in order to deal with
uncertainty using natural words because of the lack of precise crisp numbers to
represent uncertainty. The notion of FST provides a convenient point of departure for
the construction of a conceptual framework which parallels in many respects the
framework used in the case of ordinary sets, but is more general than the latter and,
potentially, may prove to have a much wider scope of applicability, particularly in the
fields of pattern classification and information processing. Essentially, such a
framework provides a natural way of dealing with problems in which the source of
imprecision is the absence of sharply defined criteria of class membership rather than
the presence of random variables (Zadeh, 1965, p. 339). Indeed, imprecision here is
meant in the sense of vagueness and ambiguity rather than lack of knowledge and
information regarding the value of a factor. FST provides a great approach for dealing
with ill-defined problems, which suffer from imprecision due to vagueness in peoples
judgements (Buckley, 1984).
FST uses linguistic variables and membership functions with varying grades to model
uncertainty inherent in natural language. FST starts with a set of objects, . If is a
fuzzy subset of then there is a function, () , which maps the elements of into
by numbers between 0 and 1. These numbers represent the degrees of membership of
9
The preliminaries of fuzzy set theory (FST) will be introduced in chapter four.
65
these elements in the set, . The classical set (subset) elements of the set definitely do
belong to the set, while in a fuzzy set (subset) elements of the set have a degree of
membership in the set. In other words, in FST the elements of can belong to a set to a
degree k (0 k 1), in contrast to classical/crisp set theory where an element must
definitely belong or not to a set. For example, in classical set theory one can be
definitely ill or healthy, whereas in FST we can say that someone is ill (or healthy) with
a certainty of 60 percent (i.e. to a degree of 0.6). In FST, membership is not a matter of
confirmation or rejection, but rather a matter of degree.
FST and rough set theory are two different approaches for modelling uncertainty. In
FST, uncertainty is addressed by fuzzy membership, whereas uncertainty is expressed
in rough set theory by the boundary region of a set (Pawlak, 1997).
The FST have some limitations as Liu, et al. (2002) argued in their paper. They stated
that in the FST is not always clear how to construct reasonable membership functions.
Moreover, the choice of appropriate definitions for the operators can be problematic
(Liu, et al., 2002). However, these problems have not stopped many researchers to
utilise the FST for handling the uncertainties issue. In another words, there are many
advantages of using FST. In the first place, it provides an alternative technique for
mapping an input space to an output space. It is also tolerant of imprecise data and
therefore, provides a simple way of obtaining relationships based on experimental data
(Mendel, 1995). Moreover, FST is capable of dealing with incomplete data because
there are no absolute rules for data requirements (Liu, et al., 2002). In addition, its
techniques have fewer requirements about the precision of information compared with
other techniques (Liu, et al., 2002).
In FST, uncertain and imprecise judgements by DM/s is taken into account through the
application of fuzzy numbers instead of crisp numbers by using linguistic scales.
66
Applying fuzzy numbers in MCDM problems is a straightforward process due to the
flexibility of using linguistic variables to assess the DM/s judgements. Thus, FST has
attracted the attention of many researchers and practitioners all over the world for
modelling the uncertainty. Although Liu et al. (2002) listed some disadvantages of FST,
these drawbacks have not stopped many researchers from using the FTS concept for
handling uncertainty. In other words, FST and its applications have developed very
extensively over recent years (Pawlak, 1982). In the literature, there is a huge amount of
research integrating FST with other MCDM methods to model the uncertainty aspect of
any decision making problem (Laarhoven & Pedrycz, 1983; Buckley, 1984;
Triantaphyllou & Lin, 1995; Chang, 1996; Mikhailov, 2003; Mikhailov & Singh, 2003;
Erdogmus, Aras, & Koc, 2006; Tuzkaya & nt, 2008; Ayag & Ozdemir, 2009; Wu,
Lin, & Chen, 2009; Erturul & Karakaolu, 2008; Sun & Lin, 2009; Ic & Yurdakul,
2010; Buyukozkan & Cifci, 2012). In addition, a number of papers are available which
study uncertainty within a FST theory approach (Kraslawski, 1989; Ayyub & Lai, 1992;
Juang, et al., 1992; Crump, et al., 1993; Liou & Yeh, 1997). FST claims to process
linguistic information/judgements for modelling uncertainty. Practically, the DMs
usually feel more confident to provide linguistic information/judgements instead of
giving their preferences/judgements in exact ratios or single numeric values (Buckley,
1985).
3.2.2 Summary of the Analysis
The previously reported review indicates very clearly that probability theories, the D-S
theory, rough set theory and FST are the most frequently used frameworks for handling
information about internal uncertainty in decision making. Despite the aforementioned
limitations, FST can provide a vital alternative to probability theories, the D-S theory or
rough set theory for modelling this uncertainty.
67
The subjective nature of peoples opinions, incomplete judgements and dependencies
between selection criteria in this research are major barriers against using the tools of
probability theories, the D-S theory and rough set theory. Therefore, FST offers great
potential in modelling uncertainty in this study. Its advantage over these other theories is its
ability to represent imprecise and incomplete judgements, which is a typical problem in the
evaluation process for the selection of a group health insurance plan. Obviously, FST is the
most applicable of these tools for the modelling of uncertainty due to the huge numbers of
papers published in the literature, as mentioned in the above section. Moreover, FST
requires less time regarding the computation process because there are many software
programmes that can be applied in analysing and designing FST concepts.
Therefore, for this thesis, the FST approach is considered as the most appropriate and
practical method to handle uncertainty.
3.3 Priority Derivation
Priority derivation plays a very significant role in any decision making problem (Wang, et al.,
2005). The priorities represent the weights of the decision elements (in MCDM, these
elements could be criteria or alternatives) (Mikhailov & Singh, 1999). In MCDM, the weights
of the decision elements reflect the DMs opinions and judgements with respect to the
relative importance of the different criteria (Bryson & Mobolurin, 1994; Sen & Yang, 1998;
Belton & Stewart, 2002).
In order to analyse the evaluation process in the selection of a group health insurance plan,
the weights which represent the importance of the selection criteria play a significant role; it
is generally agreed that the importance of each criterion is not always equal in reality. Thus,
the next section provides an overview of prioritisation/weighting methods for deriving
priorities/weights of the decision elements which are commonly mentioned in academic
68
literature, in terms of their applicability and limitations. The appropriate method for this
thesis is then discussed and finalised.
To derive proprieties, let us assume we are working with any set of decision elements,
1 , 2 , . . , , a priority vector = (1 , 2 , . , ) , which represents the relative
importance of the decision elements, 1 , 2 , . . , , may be obtained by applying various
prioritisation/weighting methods.
3.3.1 Methods for Prioritisation
The prioritisation methods in MCDM are usually based on the preferences of a DM, or a
group of DMs, which can be extracted using various methods (Siraj, et al., 2012). These
techniques are based on either direct weighting or the Pairwise Comparisons (PC) method.
In direct weighting, the DM/s is directly asked to give values between 0 and 1 to each
element in order to assign their importance. These values are then normalised to sum up to
one to obtain the weights of the decision elements. The ratio of the weights also indicates the
ratio of the importance of the corresponding attributes and vice versa (Mustajoki &
Hmlinen, 2000). Some methods for deriving criteria weights, using direct assignment of
weights are: the Simple Multi-Attribute Rating Technique (SMART) (Edwards, 1977;
Pyhnen & Hmlinen, 2001), SMART Exploiting Ranks (SMARTER) (Edwards &
Barron, 1994) and SWING weighting methods (von Winterfeldt & Edwards, 1986).
SMART assesses weights for each of the elements to reflect their relative importance to the
decision in two steps. First, the DM/s rank the criteria in order of importance by using a
traditional scale, i.e. ten points are given to the least important elements. Then, the next least
important criterion is chosen, more points are assigned to it, and so on, to reflect its relative
importance. The final weights are obtained by normalising the sum of the points to one
(Edwards, 1977; Pyhnen & Hmlinen, 2001). Edwards and Barron (1994) presented a
69
new version of SMART, called SMART Exploiting Ranks (SMARTER), which only uses the
ranking of elements to derive the weights.
Although the procedure is straightforward, the main limitation of SMART is the
independence between the weight and the ranges of values of elements (Edwards & Barron,
1994). As suggested by many researchers, the weights of elements should reflect the range of
those elements (von Winterfeldt & Edwards, 1986; Edwards & Barron, 1994; Fischer, 1995;
Pyhnen & Hmlinen, 2001). Laboratory experiments have shown that DM/s do not
adjust the weights properly, as the range of elements varies (Pyhnen & Hmlinen, 2001).
In order to overcome that limitation, the SWING weighting methods (von Winterfeldt and
Edwards, 1986) were then developed by explicitly incorporating the ranges of possible values
of elements into the weight elicitation process. The SWING process starts by asking the
DM/s to firstly identify the most important element that he/she needs to improve its value
from the worst to the best level and assign 100 points to this most important element.
In SMARTER, the weights are based only on the ranks of the elements. Thus the DM/s is
asked to select the second most important element for overall improvement and to assign
points less than 100 to that element change. This procedure is continued with all the
remaining elements. Finally, the given scores are normalised to sum up to one to get the
elements weights (von Winterfeldt & Edwards, 1986; Pyhnen & Hmlinen, 2001). The
SWING method is similar to SMART, but in SWING weighting starts from the most
important elements which are used as a reference, while SMART employs the least important
one.
There are two main concerns when SMART, SMARTER or SWING is employed for
deriving weights. Firstly, the given scores may be influenced by the ranking order of the
elements instead of by the strength of the DMs preferences. Secondly, sometimes the DM/s
is incapable of assigning and giving a direct score for the elements to generate their
70
importance weights by using a limited set of score scales, for example, scoring a weight of
100 or using a scale from 0 to 1.
In response to this logic, when the DM, or a group of DMs, is unable to directly assign
element weights, the PC (Pairwise Comparison) method, proposed by Thurstone (1927), can
be used. Psychological experiments have shown that weight derivation from PC is much
more accurate than direct weighting (Saaty, 1980). Among various weighting methods, PC
methods are often used as an intermediate step in many MCDM methods, such as AHP (one
of the most widely used decision making techniques based on the PC method), Analytic
Network Process (ANP), PROMETHEE (Brans & Mareschal, 2005) and the ER (Xu, et al.,
2008). Consequently, it is highly recommended for decision making problems because it is
strongly rational compared with the direct weighting methods. Therefore, the rationality of
the PC method makes it a practical method for deriving the relative weights of elements from
participants/experts in this thesis.
The PC method requires construction of Pairwise Comparison Judgement Matrices (PCJMs).
In order to construct a PCJM, the DM is asked to compare, pairwisely, any two elements
( , )( , = 1,2, . . ) and provide a numerical/linguistic judgement for their
relative importance. Thus, the DM/s gives a set of ratio judgements to indicate the strength of
his/her preferences by using some fixed preference scales, which are structured in a
reciprocal PCJM , = { } . Then, the weights or priority vectors of the elements
can be derived from . The deriving of the priority vectors, = (1, 2 , . , ) , from a
PCJM is called a prioritisation problem. The relationship between the weights and the
judgements is simply given by (Saaty, 1982):

( , = 1,2,3, ) (3.1)

Further details regarding the prioritisation problem and the weight derivation process
employed in this thesis will be explained in chapter four.
71
There are many Pairwise Comparison Prioritisation Methods (PCPMs), which can be applied
to derive a priority vector from a PCJM. The most widely used PCPMs are: the Eigenvector
(EV) method (Saaty, 1977), the Direct Least Squares (DLS) method and the Weighted Least
Squares (WLS) method (Chu, et al., 1979), the Logarithmic Least Squares (LLS) method/the
Geometric Mean method (Saaty & Vargas, 1984), the Goal Programming (GP) method
(Bayson, 1995) and the Fuzzy Programming (FP) method (Mikhailov, 2000). Choo and
Wedley (2004) summarised and analysed 18 PCPMs for deriving priority vectors from
PCJMs. They concluded that no method performs best in all situations and no method
dominates the other methods.
The EV method is the original approach applied by Saaty (1977) to derive priorities in the
AHP. The method is based on the idea that small variances in the comparison judgements

from the perfect ratio lead to small variances in the eigenvalues of the PCJM, , as in

equation 3.1, around the eigenvalues of the consistent one, . By applying the Frobenius
Theorem, Saaty proved that the principal eigenvector of can be used as the priority vector.
Therefore, it can be transformed to solve the equation:
= , with > (3.2)
Where A is the matrix of pairwise comparisons, is the largest eigenvalue of A and
= (1 , 2 , . , ) . The EV method provides a consistency index (CI) as a measure of
the reliability or consistency of information obtained from human judgements. According
( )
to Saaty (1977), the CI can be calculated by: CI = . For each size of matrix, ,
(1)
random matrices were generated and then the mean CI value which is known by Random
Index (RI) was computed. Using these values, the consistency ratio (CR) is defined as the
CI
ratio of CI to RI: CR = RI , where RI denotes the average CI value of random
reciprocal matrices (refer to Saaty (1977) to obtain the average RI for matrices of various
72
orders). The CR is a measure of how a given matrix compares to a purely random matrix
in terms of their CI, i.e. a measure of pair comparison coherence. If the CR value is large,
the DM might be requested to revise the PCJM and the normal acceptable value is 10% or
less. In addition, the inconsistency must be deleted, either accepted or reduced by
improving the quality of the information (Saaty and Vargas, 1984). Although this method
presents a rational estimate of the priority vector, the results are not satisfactory when the
inconsistency in the DMs judgements is large (Mikhailov & Singh, 1999).
Chu et al. (1979) proposed the DLS method based on the assumption that the components of

the priority vector = (1 , 2 , . . , ) should best satisfy the property

( , = 1,2,3, ) . Therefore, the weights can be estimated by solving a
constrained optimisation problem which minimises the Euclidean distance (Chu et al, 1979):
2

= =1 =1 ( ) (3.3)

. : = 1 , > 0 = 1,2, . ,
=1
This optimisation problem is non-linear, has multiple solutions and no tractable form. In
order to reduce the solutions of the optimisation problem to a system of linear equations
which can straightforwardly be solved, Chu et al. modified equation (3.3) and formed the
WLS method:
2
= =1 =1( ) (3.4)

. : = 1 , > 0 = 1,2, . ,
=1
The system of linear equations can be solved as discussed in Chu et al. (1979).
73
The LLS method or, as it is also known, the Geometric Mean method, proposed by Saaty
& Vargas (1984), uses the multiplicative properties of the PCJM and applies an
optimisation procedure to minimise a logarithmic objective function, subject to
multiplicative constraints as follows:
2
= =1 =1(ln ln + ln ) (3.5)
. : = 1 , > 0 = 1,2, . ,
=1
This method gives a unique solution, which is rather simple and convenient from the
computational point of view.
The GP (Goal Programming) approach is another method to solve the prioritisation
problem and derive the relative weights. This method was proposed by Bryson (1995). It
aims to generate the priority vector whose associated values are, on average, the closest to
the PC information obtained from the evaluators (experts, judges.). Therefore, Bryson
used the consideration that the priorities are desired to satisfy the equalities:
+
( ) ( ) = , , = 1,2, . , , > (3.6)

Where + 1 and 1 are additional deviation variables and cannot both be greater
than 1. The priorities are generated by solving the following linear goal programming
problem (Bryson, 1995):
log = min =1 > (log + + log ) (3.7)
. .: log w log + log + + log = log , , = 1,2, . , , >
74
Where all + and are non-negative. It requires no assumptions and provides a set of
meaningful consistency indicators. However, these indicators need more evaluator
involvement than other methods.
The Fuzzy Preference Programming (FPP) method was proposed by Mikhailov (2000); it
can be considered as an optimisation method. He assumed that when there are priorities,
(1)
evaluation elements, , are needed, each one of them being an estimation of the
2

real ratio . If the PCJM, , is consistent, then = 0 for all , =

1,2, . , , > . This can be represented as a system of linear equations:
= 0 (3.8)
(1)
where the matrix, , = , is obtained from the elements of . In the
2
inconsistent cases it is desirable to find values of , so that 0.
Thus, we can formulate the problem for assessing priorities as follows (Mikhailov, 2000).
Find a positive priority vector, , that satisfies equation (3.8) and the normalisation
equation: =1 = 1, > 0, = 1,2, . , .
The solution can be obtained by solving a linear programming problem (Mikhailov, 2000)
(3.9)
. . : + + + ,
, = 1,2, . , , 1 0
=1 = 1 , > 0 , = 1,2, . ,
where + and are the right and left tolerance parameters, which represent the
admissible interval of approximate satisfaction of the crisp equality = 0. is an
75
additional variable to measure the intersection and it is a consistency index of the FP
method.
In fuzzy environments, comparison judgements can be represented as fuzzy numbers in
order to model uncertainty. Thus, a fuzzy PCJM can be constructed and used to derive the
priority vectors in MCDM problems subject to uncertainty. Many researchers have
proposed fuzzy Pairwise Comparison Prioritisation Methods (fuzzy PCPMs) for deriving
the priority vector based on fuzzy PCJMs. For instance: Van Laarhoven and Pedryczs
method (Van Laarhoven & Pedrycs, 1983), Buckleys method (Buckley, 1984), the
synthetic extent analysis method (Changs method) (Chang, 1996) and Mikhailovs linear
and non-linear methods (Mikhailov, 2003).
The earliest concept in fuzzy PCPMs was proposed by Van Laarhoven and Pedrycz in 1983,
using comparison matrices with fuzzy members and their membership functions. They used
fuzzy extensions where the values of the judgement are fuzzy numbers such that ,
applied the Logarithmic Least Squares method to obtain the fuzzy priorities
, = 1, 2, . . , ,
and handled the decision making problem subject to uncertainty (Larrhoven and Pedrycz,
1983).
Buckley (1984) proposed a fuzzy PCPM method which extended Saatys hierarchical
analysis. This method allowed the expression of the comparison judgement ratios as a fuzzy
number or fuzzy set. In Buckleys method, the comparison is described using fuzzy numbers
to derive the fuzzy priorities. The Geometric Mean method is employed in this method to
calculate the fuzzy weights and these are combined in the usual manner to determine the final
fuzzy weights for the decision elements as follows (according to Buckley, 1984):
1
= (=1 ) , , = 1,2, , (3.10)
Then the weights can be generated by:
76

= (3.11)
1 + 2 +
Another approach for fuzzy prioritisation, called Synthetic Extent Analysis, was proposed by
Chang (1996). The author used a simple arithmetic mean algorithm to find fuzzy priorities
from comparison matrices, whose elements are represented by fuzzy numbers. Equations to
compute weights based upon this method can be seen in Chang (1996).
As mentioned above, Mikhailov (2000) proposed the Fuzzy Preference Programming
(FPP) Method to derive priorities from crisp PCJMs. In 2003, this method was modified to
derive crisp priorities from the fuzzy number or fuzzy set intervals of judgements. The
FPP method applies alpha-cut decomposition of the fuzzy judgements into a series of
interval comparisons and the assessment of the priorities from Pairwise Comparison
intervals is formulated as an optimisation problem in order to maximise the DMs
satisfaction with a specific crisp priority vector. The FPP method transforms the interval
prioritisation task into a fuzzy linear programming problem; its purpose is to derive the
optimal crisp priorities. The overall crisp scores of the prioritisation elements are obtained
by aggregating the optimal priorities which correspond to different alpha-cut levels. The
non-linear Fuzzy Preference Programming method is modified to derive priorities directly
from fuzzy judgements without applying the alpha-cut transformations, but it requires the
solution of a non-linear optimisation programme (Mikhailov, 2003).
3.3.2 Analysis of Methods for Prioritisation
As mentioned before, there are several methods to derive priorities from PCJMs in the
literature. Saaty and Vargas (1984) argued that the consistency is the most important
criterion to be considered in all of these methods. Saatys original EV method is the most
common method used for deriving priorities. However, the EV method is criticised for not
77
being good enough for very large inconsistencies in the DMs judgements (Mikhailov,
2000).
Many researchers have supported the LLS method over Saatys original EV method
(Crawford & Williams, 1985; Barzilai, 1997). Golany and Kress (1993) studied several
methods for obtaining weights. They concluded that, in all cases, there is no method for
deriving priority that is better than any other method, and that each method has different
weaknesses and advantages but not one of them is dominated by the other methods.
Mikhailov and Singh (1999) made a comparison between the existing EV, DLS, WLS,
LLS, GP and FPP methods. They stated that the overall objective of the study was directed
at method selecting. They used three comparison criteria: total deviation (TD), minimum
violations (MV), and conformity (C). They concluded that the new FPP method
outperforms some of the existing methods, especially for cases where the PCJMs have
large inconsistencies, but in general, it does not dominate the other methods. Nevertheless,
the FPP method can be applied when some of the elements of the PCJMs are missing,
whereas other methods cannot handle this issue. The main limitation of the above
mentioned methods is that they are not capable of handling the subjective and uncertain
judgements.
Thus FST, used to represent the PCJMs, and fuzzy PCPMs have been proposed to solve
the prioritisation problem for generating weights. The first fuzzy PCPM was proposed by
Laarhoven and Pedrycz in 1983. This method employs fuzzy numbers to formulate a
system of linear equations for obtaining the weights. The limitation in this method is that
there is no unique solution given to the linear equation. Another fuzzy PCPM for deriving
weights in a fuzzy environment is Buckleys method. Although it provides a unique fuzzy
solution for the fuzzy PCJMs, the computational requirement is incredible in Buckleys
method. Another fuzzy PCPM approach is Changs method, which applies a simple
78
arithmetic mean algorithm to find fuzzy priorities from fuzzy PCJMs. However, the
arithmetic mean is a very naive prioritisation approach and can be used only if the fuzzy
PCJMs are consistent (Mikhailov, 2003).
The three fuzzy PCJMs mentioned above derive fuzzy priorities. Therefore, they require
an additional fuzzy ranking procedure in order to convert the fuzzy priorities to crisp
priorities. The problem is that using different ranking methods might lead to different
ranking results (Mikhailov, 2003). Thus, the core disadvantages of these three fuzzy
prioritisation methods are the additional ranking method and the huge number of fuzzy
addition and multiplication operations in the computational requirements. However, this
drawback of the existing fuzzy prioritisation methods can be overcome by using the FPP
method. The linear and non-linear versions of the FPP method (Mikhailov, 2003) derive
the weights from incomplete fuzzy PCJMs. Moreover, in comparison with the existing
prioritisation approaches above, the priorities calculated by FPP are nonfuzzy numbers so
that the fuzzy ranking procedure is no longer required. Therefore, it can be argued that the
linear and non-linear versions of the FPP method have advantages over other fuzzy
PCPMs. Unlike the existing fuzzy PCPMs the linear and non-linear versions of the FPP
method do not require the construction of reciprocal matrices. For these reasons, the FPP
linear and the FPP non-linear methods are used to propose a new fuzzy PCPM to derive
the weights in this thesis. Note that the details of the linear and non-linear FPP methods,
especially their mathematical formulations, are not described in depth here because they
will be discussed later in chapter four.
However, this research problem tackles the group decision making problem as discussed
in chapter one (see section 1.3). All of the PCPMs and fuzzy PCPMs discussed in the
previous sections are approaches to derive the priorities/weights from the PCJMs and
79
fuzzy PCJMs of a single DM. Consequently, there is a need to review group prioritisation
approaches for deriving priorities from PCJMs provided by a group of DMs.
Prioritisation methods to generate the relative weights of the decision elements which are
commonly seen and used in the literature were reviewed in the previous section. Among
various weighting techniques, fuzzy PCPMs are selected as a basis for the weighting process
for this thesis. This is mainly due to the fact that they are more rational and capable of
modelling uncertainty in the DMs judgements. Although fuzzy PCPMs have been developed
for deriving weights from fuzzy PCJMs, most of them can be criticised. So far, the linear and
non-linear versions of the FPP method are likely to be the right choice for generating the
weights in this thesis, mainly because of their ability to handle uncertainty. In addition, the
FPP method can derive crisp (nonfuzzy) priorities from an incomplete fuzzy PCJM and do
not need an additional ranking procedure, unlike the existing fuzzy PCPMs. Thus, this
method can be adopted for additional investigation in order to propose a new fuzzy PCPM for
this research problem. For further clarification, a detailed illustration of the linear and non-
linear versions of the FPP method will be discussed in chapter four of this thesis.
All the above mentioned fuzzy PCPMs solve the prioritisation problem based on the fuzzy
PCJMs offered by a single DM. However, looking back to the description of the research
problem, it can be seen that the group decision making issue is associated with the problem of
group health insurance plan selection. Thus, reviewing the prioritisation approaches for
groups of DMs is required in next section.
3.4 Group Decision Making
In the foregoing sections, the prioritisation methods mainly focus on a single DM. When
more than one DM is involved in the process for deriving weights, a group prioritisation
80
procedure needs to be considered. In this research, a group of DMs/experts should be
engaged to achieve the research objectives and answer the research questions (see chapter
one). Therefore, there is a need to review and analyse group prioritisation methods for
deriving the weights of the decision elements. Before doing so, it is necessary to state the
concept of group decision making.
DeSanctis and Gallupe defined group decision making as two or more people who are jointly
responsible for detecting a problem, elaborating on the nature of the problem, generating
possible solutions, evaluating potential solutions, or formulating strategies for implementing
solutions (1987, p. 590). From the definition by Ramanathan and Ganesh, group decision
making involves weighted aggregation of different individual preferences to achieve a single
collective preference (1994, p. 249).
In the group decision making process, the problem is to find a mathematical method for
aggregating the information/preferences expressed by the group members and to determine
the weights/priorities or ranking for the decision elements (Indrani & Saaty, 1993).
Aczbl & Saaty (1983) proposed many axioms, which manage the process of group preference
aggregation. The following are the most common axioms for group preference aggregation
(Ramanathan & Ganesh, 1994):
1. Universal domain: The group preference aggregation method should define a pattern of
group preference for all rationally possible individual preferences. That means it should
provide the group preference for any particular set of individual preferences.
2. Pareto optimality: If A and B are two elements/attributes and if all the group members
favour A to B then the group decision should be in favour of A.
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3. Non-dictatorship: The group preference is aggregated by individual preferences. None of
the individual preferences become the preferences of the group automatically; they are
always independent from each other.
4. Recognition: Group preferences are arrived at only after considering all the member
preferences.
All these axioms have been considered by many researchers to understand their applicability
in any possible group decision making environment.
3.4.1 Analysis of Group Prioritisation and Aggregation Approaches
As mentioned above, two main stages must be considered in any group decision making
problem: the aggregation stage and the prioritisation stage. In the existing literature relating
to group decision making, the two common ways of dealing with the aggregation and
prioritisation phases are dependent on whether the group wants to act together as a unit or as
separate individuals, and two aggregation approaches are specified: Aggregating Individual
Judgements (AIJ) or Aggregating Individual Priorities (AIP) (Forman & Peniwati, 1998).
Both ways involve two independent stages: the group aggregating phase and the group
prioritisation phase (Bryson & Joseph, 1999).
In AIJ, the DMs judgements, for each set of PCJMs, are aggregated into a new set of
aggregated group judgements. This is then converted as if it contains the judgements
provided by a new individual and the group solution is derived from the preference of the
priorities of this individual. This can be done by applying an aggregation method, which
combines the individual preferences/PCJMs into a group preference/PCJM. Then, an
appropriate prioritisation method should be utilised to obtain a single group priority vector
(Forman and Peniwati, 1998).
82
In AIP, the prioritisation is obtained by utilising a proper prioritisation method that derives
a number of individual priorities from a group of PCJMs provided by a group of DMs.
After that, the group aggregation is obtained by applying an additional aggregation method
which combines the individual priorities into a group priority vector (Forman and Peniwati,
1998).
Different aggregation methods have been proposed in the literature to handle the
aggregation phase in group decision making. In both AIJ and AIP, the weighted arithmetic
mean (WAM) and the geometric mean (GM) are the methods commonly used, in order to
achieve group aggregation. Aczbl and Saaty (1983) argued that for AIJ, the GM is more
suitable, because it protects the reciprocal properties of the aggregated PCJMs. Forman and
Peniwati (1998) claimed that the GM should be applied in AIJ, whereas either the GM or
WAM are meaningful in AIP for aggregating the individuals priorities. Ramanathan and
Ganesh (1994) analysed the WAM and GM aggregation procedures, using the axioms for
group preference aggregation and showed that the GM method, as an aggregation method,
fails to satisfy the Pareto optimality axiom, which is described above. Thus, in this thesis
the WAM method is applied for aggregating the individual judgements of within a group of
DMs, when the need arises to do so.
For handling the prioritisation phase, a proper prioritisation method is required to derive the
group priorities/weights for decision elements from PCJMs. As discussed in sections 3.3.1
and 3.3.2, the FPP methods of deriving proprieties from fuzzy PCJMs, are suitable to be
applied in this thesis for handling subjective uncertainty in DMs judgements, which is
associated with the evaluation process for selecting a group health insurance plan. Besides,
the linear and non-linear versions of the FPP method were also adopted for such purpose.
However, the FPP method generates the weights from a fuzzy PCJM provided by a single
DM. In group decision making, a new Group Fuzzy Performance Programming (GFPP)
83
method has been proposed by Mikhailov (2004), in order to achieve the group prioritisation
stage. Mikhailov (2004) proposed the GFPP method based on a fuzzy programming
optimisation approach, which maximises the group satisfaction with the final group
solution. The GFPP method combines the aggregation and prioritisation stages into a single
integrated stage. It does not require a full set of fuzzy PCJMs, so it can deal with the fact
that some DMs judgements may be missing. In addition, it does not require an additional
ranking procedure to transfer the fuzzy priorities to crisp ones, unlike the existing methods.
Nevertheless, the GFPP method assumes that all the decision makers place the same
importance on weight, but the reality is that they have different weights of importance.
Furthermore, the link between the actual value of the deviation parameter and the DMs
judgements is unclear. Therefore, Mikhailov et al. (2011) proposed a Weighted GFPP
method for the fuzzy group prioritisation problem by introducing the importance weights of
DMs. Unlike the existing fuzzy PCPMs, the proposed Weighted GFPP method does not
require an additional aggregation method, an additional ranking procedure or a full set of
judgements. Moreover, it can be used for group decision making under conditions of
uncertainty (Mikhailov, Didehkhani & Sadi-Nezhad, 2011). For further explanation, a
detailed description of the Weighted GFPP will be discussed in chapter four of this thesis. As
a consequence, the Weighted GFPP method is adopted in this study for further investigation,
in the direction of proposing a new fuzzy PCPM for solving the prioritisation problem, which
will be discussed in chapter four.
The general notions of the aggregation and prioritisation phases in group decision making
were discussed above. It has been shown that the WAM method is a suitable method to
employ for aggregation of the judgements of a group of DMs. The analysis of the existing
84
fuzzy PCPMs demonstrated that the Weighted GFPP method is a proper method to derive the
weights from fuzzy PCJMs provided by a group of DMs. That is because it eliminates most
of the drawbacks of the existing fuzzy PCPMs. The Weighted GFPP method has some
attractive features; it does not require any aggregation procedures or a fuzzy ranking
procedure. It derives crisp priorities/weights from a missing set of fuzzy judgements and
incomplete fuzzy PCJMs. Moreover, the Weighted GFPP method considers weights of the
DMs. However, it has a limitation that will be discussed shortly.
In summary, the issue of the importance of the DMs in a group has been considered in group
decision making (Mikhailov et al., 2011). One can argue that this issue can occur in the
aggregation phase, as well as in the prioritisation phase. This demonstrates the need to study
the notion of the degree of importance of the DMs in the group and to investigate methods to
obtain these degrees. Thus, that issue will be discussed in detail in the next section.
3.5 Importance of Decision Makers in the Group
Many of the early aggregation and prioritisation methods assume that DMs, in all group
decision making problems, play their roles with the same weight of importance. Often, in the
decision making process this is a logical drawback. Usually, the experts/DMs come from
various research domains, or have different knowledge backgrounds, which thus necessitates
them having different weights in deciding group preferences. In real group decision making
problems, there are sometimes important experts such as the executive managers of the
organisation. Also, some experts are more experienced than others; therefore, the final
decision should be influenced by the degree of importance of each expert. Consequently, a
good method of aggregating and prioritising must consider the assigned degree of importance
of each expert in the form of DMs relative weights. The following section provides an
85
analysis of aggregating and prioritisation methods in group decision making that take into
account the importance weights of the DMs in the group.
3.5.1 Analysis of Methods for Aggregating and Prioritisation with Unequal DM Weights
Regarding the aggregation phase in group decision making, Ramanathan & Ganesh (1994)
showed that the WAM method satisfied all the axioms of group preference aggregation.
Additionally, the significant property of the WAM method is its capability to consider the
weights of importance of the decision makers (Li, et al., 2011). Hence, the WAM method is
used in the aggregation stage in this thesis. The entries for the aggregated group preferences
are shown mathematically in (3.11).
= =1 (3.12)
where:
is the importance weight of an expert ( = 1,2, ), and the number of experts, >
0 ; =1 = 1.
refers to the preference/judgement given by expert , where , , = 1,2, . . . , , and is
the number of elements in the group decision making problem.
refers to the aggregated preferences/judgements.
In the fuzzy environment, when the DMs express preferences/judgements as fuzzy numbers
and the difference in the importance of each DM presents as a crisp value, the Fuzzy WAM
method can be written as follows (Xu & Cai, 2012):
= =1 (3.13)
where:
is the importance weight of an expert ( = 1,2, ), and the number of experts,
> 0 ; =1 = 1.
86
refers to the fuzzy preference/judgement given by expert , where , , = 1,2, . . . , ,
and is the number of elements in the group decision making problem.
refers to the aggregated fuzzy judgements.
Clearly, the key step of the WAM method is to determine the weight vector =
(1 , 2 , ) , which is an interesting and important issue. Thus, the question now is how the
DMs importance weights can be obtained? There are a few articles in the published research
literature measuring the importance weights of experts/DMs. Two of the most popular
methods for deriving the DMs importance weights are:
A Participatory (PA) method (Ramanathan & Ganesh, 1994): In this method each
member of the group is asked to rate all members (including him/herself) by providing a
true opinion of the importance of each member compared with the others. However, this
method assumes that DMs give their true opinions; it is possible for a group of DMs to
change their importance weights by providing false or biased answers. Thus, this
method may lead to a personal upward bias in this the evaluation process.
A Supra Decision Maker (SDM) method (Saaty, 1980): In this method, a single expert is
required to be allocated, who may be called a Supra Decision Maker (SDM), to compute
the DMs weights by constructing a PCJM or fuzzy PCJM for the group of DMs. Then,
any priority derivation method in MCDM is applied. To construct the PCJM or fuzzy
PCJM, the SDM compares, pairwisely, the DMs attributes based on the nature of the
decision problem. French et al. (2007) stated that the existence of a SDM in group
decision making, allows the complete elicitation and decision analysis process for each
individual to be viewed, and this knowledge to be used unselfishly to construct a single
decision analysis for the group.
Thus, for assigning the DMs importance weights in this study, the SDM method is
adopted. In this method, the SDM is selected based on his/her reputation and years of
87
experience. For modelling uncertainty, the SDM constructs a single fuzzy PCJM for the
group of DMs by studying factors related to the attributes of the DMs, in terms of their
level of experience in the health insurance market. After that, the adopted prioritisation
method for a single fuzzy PCJM, the non-linear FPP method (as discussed in section
3.4.2) , is used to derive the DMs weights. That is because, non-linear FPP does not
require an aggregation of the priorities derived at the different -thresholds, unlike linear
FPP (Mikhailov, 2003).
Based on the discussion in section 3.4.1, it can be noted that the Weighted GFPP method
proposed by Mikhailov et al. (2011) is an appropriate prioritisation method to derive the
element weights from a fuzzy group PCJM and it also takes into account the DM weights.
However, this method requires an additional aggregation technique to obtain the priority
vector at different -thresholds. Consequently, this process is time consuming, due to the
several computation steps needed to apply the -threshold concept. In view of that, the fuzzy
PCPMs in group decision making under the situation of uncertainty is still not developed
properly. A new approach is needed to handle the prioritisation problem under uncertainty
more appropriately.
In group decision making, many methods for the aggregation and prioritisation processes
suppose that all the DMs in the group have equal importance weights. In actual real
situations, DMs have different levels of accessible information, thinking capabilities and
experience. Therefore, the importance weights of DMs should be considered in the process of
aggregation and prioritisation in group decision making. Reviewing the aggregation and
prioritisation methods that take into consideration the DMs importance weights was very
useful for adopting the methods for this thesis. It can be concluded that the WAM method
88
and the SDM method are suitable for aggregation of group preferences/judgements and for
obtaining the DMs importance weights, respectively. On the other hand, it has been argued
that for deriving a group of priorities from a group fuzzy PCJM provided by a group of DMs,
the Weighted GFPP method can be used. This can then be modified and developed to propose
a new prioritisation method in this research study in order to overcome all the drawbacks in
the existing methods.
3.6 Studying Dependency
The general assumption in MCDM theory is to assume that the decision elements are
independent (Saaty, 1996; Ozturk, 2006). This assumption makes the MCDM solutions less
valuable than they could be and the DM/s who accepts the final solutions cannot be sure that
he/she has made the right trade off among the alternatives (Ozturk, 2006). Saaty (1996) stated
that when a decision is to be made, there is a need to look at all the potential relationships/
dependencies10 among the decision elements. He declared that good problem structuring for
MCDM would seek to study dependence between the decision elements. In the existing
literature, many researchers have recognised that in many decision making problems the
decision elements are mutually dependent (Carlsson & Fuller, 1994; 1995; Karwan, et al.,
1995; Saaty, 1996). As a consequence, in recent years, investigating dependency in MCDM
problems has become more important (Ozturk, 2006).
Looking back over the research problem in section 1.3. and the discussion in section 2.3.2,
one can argue that studying the relationships/dependence between the decision elements is a
vital task in building the MCDM model for the problem of the selection of a group health
insurance plan. Therefore, an overview of up-to-date methods in the field of MCDM dealing
10
A dependence relationship is a relationship in which some elements are dependent on the others and some
are not.
89
with dependence among the decision elements is offered in the next section in order to
choose an appropriate method for studying the dependency issue in this research.
3.6.1 Analysis of Methods for Studying Dependency
This section is intended to review and analyse some methods that can be used to study the
relationships/dependence among the decision elements in the MCDM field:
Regression Analysis Method: This is a statistical process for estimating the
relationships among factors. Many techniques for carrying out regression analysis have
been developed, such as linear regression, linear least squares and non-linear
regression. In MCDM, the regression analysis process has been used to study the
relationships among the decision criteria (Saaty, 1996; Leskinen, et al., 2003). In
regression analysis, historical data is often used to study such relationships between
factors. This method is not suitable to apply to any decision making problem because it
does not take into account the current conditions of the problem and it does not
consider experts opinions and judgements. Besides, another limitation of regression
analysis is that it is likely to reach the conclusion that there is a strong link between
two factors, whereas the degree of influence of other, more important factors may not
be estimated. Moreover, regression analysis does not handle the subjective uncertainty
issue in decision making problems. These reasons, it should trigger the search for a
more suitable method for studying dependency among the decision elements.
Analytic Network Process (ANP) Method: The ANP, proposed by Saaty in 1996, is
a relatively new MCDM method which can deal with all kinds of interactions
systematically. The ANP approach is capable of handling dependence among elements
by obtaining multiple weights through the development of a super-matrix,
introduced by Saaty (1980). The ANP is a new theory that extends the AHP, a theory
90
that depends on the values and judgements of individuals and groups, to cases of
dependence and feedback and generalises on the super-matrix approach. The ANP
approach replaces hierarchies with networks (Saaty, 1996). The most important
innovation of the ANP is having a network of influence among the elements and
clusters. The network (feedback) structure does not have the linear top-to-bottom form
of a hierarchy, but looks more like a network, with cycles connecting its components
or elements and loops connecting a component to itself11.
The ANP has been extensively applied in many MCDM studies in order to study
dependence among decision elements (Meade & Sarkis, 1998; 1999; Sarkis &
Sundarraj, 2002; Meade & Presley, 2002; Leskinen, et al., 2003; Saaty, T. L., 2004;
Cheng & Li, 2005; Saaty & Vargas, 2006; Bayazit, 2006; Wu & Lee, 2007; Demirtas
& stn, 2009; Tseng, et al., 2009; Das & Chakraborty, 2011; Buyukozkan & Berkol,
2011). These published papers illustrate how ANP has received remarkable attention
for incorporating dependency into decision making. However, this does not mean that
ANP is a perfect method for such purposes, as one of the weaknesses of the ANP is
that it may not reflect human preferences properly when the DM/s are unable to
provide crisp values for assessing and measuring the causal relationships among the
criteria. Thus, it can be argued that the ANP fails the task of studying dependency
among the decision elements in MCDM problems under conditions of uncertainty. The
inability of the ANP to capture these subjectivity assessments has led the researcher to
seek more suitable approaches for studying dependency under the environment of
uncertainty.
Fuzzy ANP Method: As has been pointed out, human judgements, with regard to
assessments, are often unclear and hard to estimate by exact/crisp numerical values;
11
Refer to Saaty (1996) for more details.
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once more FST is needed in handling uncertain problems characterised by vagueness
and imprecision. Due to the uncertainty involved, as well as the inherent subjective
nature of human judgements, the concept of fuzziness in human judgement within
the framework of ANP was introduced (Mikhailov & Singh, 2003).
The Fuzzy ANP has been widely applied to handle and study the
relationships/dependency among criteria in any MCDM problem under uncertainty
(Mikhailov & Singh, 2003; Tuzkaya & nt, 2008; Promentilla, et al., 2008; Ayag &
Ozdemir, 2009; Wu, et al., 2009; Yksel & Dagdeviren, 2010; Vinodh, et al., 2011;
Govindan, et al., 2013).
However, in the most complex situations with multiple criteria, using the ANP and
Fuzzy ANP for determining the dependency among numerous and multiple criteria is a
very difficult task. Indeed, the classical tool to measure the dependency among the
criteria using ANP/Fuzzy ANP is to distribute a questionnaire to the DM/s in which
they are asked to answer two kinds of questions for each criterion (Saaty & Vargas,
2006):
1- Given a criterion, which of two elements has greater influence (is more dominant)
with respect to that criterion?
2- Which of two elements influences a third element more with respect to a criterion?
Thus, in the case of multiple criteria, the number of questions required to measure the
dependency is a concern which might lead to alienating and time consuming issues. A
solution to this could be to group the multiple criteria into clusters and then study the
dependency among these clusters.
Therefore, there is a need to find a better alternative for studying dependency among
clusters in a more straightforward way than ANP/ Fuzzy ANP.
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Decision Making Trial and Evaluation Laboratory (DEMATEL) Method: This
was developed by The Battelle Memorial Institute through its Geneva Research Centre
(Gabus & Fontela, 1972; 1973). It was applied to illustrate dependence among
essential elements (which could be objectives, criteria, alternatives or clusters) and
simplify the relationships between elements using crisp values. It is based upon a
graph theory, enabling us to solve problems visually, so that we may divide multiple
elements into a cause-and-effect group to better understand causal relationships to
construct a network structure with interdependent relationships (Yang & Tzeng, 2011).
Wu (2008) and Lee et al. (2010) summarised the key advantages of using the
DEMATEL method as:
1. It expresses the causal relationships/dependency and influence level between
elements in a complicated MCDM problem.
2. It is not limited by the independence assumption of statistical methods or by the
sample amount, and avoids the inference error caused by elements with causal
relationships/dependency and difficulties due to sample collection.
3. It simplifies the relationships/dependency between elements in complicated
problems into justified cause and effective relationship, through an impact relation
map (IRM). The IRM portrays a basic concept of contextual relation among the
elements of the system, in which the numeral represents the strength of influence.
In order to manage the complex structure of the IRM effectively, the less important
influence values should be ignored.
4. The DEMATEL adopted the expert opinion method, which can avoid the problem
of subjects not completely understanding the problem under study. Moreover, it is
a suitable method to present dependency among the elements by gathering the
opinions from a group of experts.
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In recent years, the DEMATEL method has become popular for solving dependence
and feedback problems in research on the application of MCDM (Yang, et al., 2008;
Wu, 2008, Tsai & Chou, 2009; Huang, et al., 2010; Lee, et al., 2010; Chen & Chen,
2010; Yang & Tzeng, 2011; Wang & Tzeng, 2012; Lu, et al., 2013).
In the DEMATEL method for establishing the IRM, human judgements for deciding
the relationship between elements are usually given by crisp values. However, in many
cases, crisp values are inadequate in the real world. Human judgements about
preferences are often unclear and hard to estimate by exact numerical values; this has
created the need for FST.
Fuzzy Decision Making Trial and Evaluation Laboratory (Fuzzy DEMATEL)
Method: In this method, the FST (Zadeh, 1965) is applied to the DEMATEL method
for gathering group ideas and analysing the relationships/dependency MCDM
problems in fuzzy environments by using linguistic assessments instead of numerical
values. In group decision making, the Fuzzy DEMATEL method has been widely
utilised for measuring the relationships/dependency among the elements in MCDM
problems by gathering group opinions (Chen-Yi, et al., 2007; Lin & Wu, 2008; Tsai, et
al., 2010; Jassbi, et al., 2011; Chou, et al., 2012; Buyukozkan & Cifci, 2012; Liu, et
al., 2012; Chang & Ishii, 2012; 2013; Wang & Wu, 2014).
The Fuzzy DEMATEL method has the same advantages that are mentioned above for
the DEMATEL method. Additionally, the Fuzzy DEMATEL method considers the
fact that human assessments and preferences are often uncertain due to the subjective
nature of human judgements and are not easy to estimate by crisp numerical values. As
a result, it can be argued that the Fuzzy DEMATEL method would be a great
alternative method for capturing the dependency issue in this research. Notably, the
Fuzzy DEMATEL method has never been used to solve the evaluation problem for the
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selection of insurance plans and applying this method could be an original contribution
to knowledge. For these reasons, this study applies the Fuzzy DEMATEL method to
study the relationships/dependency among elements and also to determine the degrees
of influence of those elements. It is also used to obtain a total relation matrix and to
then apply this to the related issue of proposing a method for deriving criteria weights.
However, in the existing literature, the Fuzzy DEMATEL method assumes that all the
DMs are equivalent in their relative weights of importance in the context of the
problem considered.
In some complex group decision making problems, this has its logical drawbacks. This
research proposes a Fuzzy DEMATEL method for group decision making with non-
equal importance weights for the individual DMs in the group. The importance
weights of individual DMs in the group are presented as crisp numbers and used in a
fuzzy aggregation procedure. For further clarification, a detailed illustration proposing
the Fuzzy DEMATEL method will be delivered in chapter four of this thesis.
To conclude, assuming that the decision elements in MCDM problems are independent of
each other is not realistic. This may lead to obtaining a useless final solution. Many
researchers like Carlsson & Fuller (1994; 1995) and Saaty (1996) have stated the issue
relevant to MCDM is the concept of dependency between elements (criteria, alternatives,
clusters, or objectives) and they have argued that some of the elements in MCDM might
support each other, which should be exploited in a problem solving method. As mentioned
earlier in chapter two (section 2.3.2), there may even be a relationship/dependency among
the selection criteria in the process of selecting a group health insurance plan. Therefore,
the tools that are very often used for measuring dependency in MCDM problems were
reviewed in the previous section. Reviewing the limitations of the techniques used for
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studying the dependency issue, it was useful to research a better alternative to tackle that
issue. It can be concluded that, the subjectivity, uncertainty and dependency issues
associated with the selection problem could be better handled by adopting the Fuzzy
DEMATEL method.
3.7 Ranking Alternatives
As stated by Triantaphyllou (2000), there are three steps in utilising any decision making
technique involving numerical analysis of alternatives:
1. Determine the relevant criteria and alternatives.
2. Derive the importance weights of the criteria.
3. Determine a ranking of each alternative.
Section 3.3 discussed the methods for deriving a priority vector = (1 , 2 , . , ) , which
represents the relative importance of a set of decision criteria denoted as 1 , 2 , . . , . This
section is concerned with the methods for ranking available alternatives, in order to choose
the most desirable one in any MCDM problem. The ranking process can be described as
follows. Assume that for a set of alternatives 1 , 2 , . . , , the DM/s has determined the
performance value of for ( = 1,2, , , and = 1,2, . . ) . Then the problem
examined in this section is how one can rank the alternatives when all the decision criteria are
considered simultaneously. This problem can be expressed in a matrix, termed a
decision matrix, which can be presented as given in equation (2.1). In the following
subsection a number of MCDM methods for solving the above problem (i.e. step 3 above) are
discussed and analysed.
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3.7.1 Analysis of Methods for Ranking Alternatives
This subsection reviews and discusses the ranking methods in MCDM. In the literature,
several methods have been used to deal with the problem of ranking alternatives.
The weighted sum model (WSM) is a commonly used compensation approach where the
overall score, , for an alternative, , is calculated as (Fishburn, 1967):
= =1 (3.14)
The alternative, , with the maximum score is considered to be the most appropriate (or
winner). It is useful only for simple problems involving the same unit of measurement (e.g.
feet, stones, Euros, etc.), as it is not justifiable to simply add different units together. Thus, it
can be applied for single dimension problems and it is inappropriate for multi-dimensional
MCDM problems (Triantaphyllou & Lin, 1995) .
The weighted product model (WPM) is similar to WSM, where multiplication is used to rank
alternatives. The overall score, , for alternative, , is calculated as (Triantaphyllou,
2000):
= =1( ) (3.15)
The alternative, , with maximum score is considered to be the most appropriate (or
winner). WPM, unlike WSM, supports the use of ratio measurements in order to aggregate
criteria with different units of measurement (Triantaphyllou & Lin, 1995).
In uncertain cases, Triantaphyllou and Lin (1995) extended the WSM and WPM methods to
evaluate and rank finite alternatives by using FST and fuzzy numbers. They proposed the
Fuzzy WSM and the Fuzzy WPM for ranking alternatives. They assumed that the DM DMs
use fuzzy numbers in order to express the weights of importance of the criteria (denoted as
= (
1 , ) ) and the performance value of the alternatives (denoted as ). The
2, . ,
notion of fuzzy numbers will be discussed presently in the next chapter.
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However, Fuzzy WSM and Fuzzy WPM are very simple methods to deal with a single
decision making problem and they cannot properly be applied in group decision making
problems (Triantaphyllou, 1995).
Another way of ranking alternatives is to use outranking approaches. These are most popular
in continental Europe (Stewart, 1992). Outranking approaches build a preference relation,
usually called an outranking relation, among alternatives evaluated on several criteria (Belton
& Stewart, 2002). Alternatives are compared according to every criterion, in order to gather
evidence to support or oppose assertions like alternative A is at least as good as alternative
B. In most outranking approaches, the outranking relation is built through a series of
pairwise comparisons of the alternatives. ELECTRE and PROMETHEE are the most famous
tools in this approach (Belton & Stewart, 2002).
The ELECTRE (Elimination and Choice Translation Reality English translation from the
French original) method was first proposed by Benavoun, Roy and Sussman in the 1960s.
ELECTRE methods usually involve two main steps (Roy, 1991). First, the alternatives are
compared pairwise in order to build an outranking relation. In the second step, this outranking
relation is exploited in order to propose a recommendation to the DM. Different versions of
ELECTRE have been developed by Roy and associates at LAMSADE, University of Paris
Dauphine, including ELECTRE I, II, III, IV and TRI. All of these methods are based on the
same fundamental concepts, but differ both operationally and according to the type of the
decision problem and its degree of complexity. Specifically, ELECTRE I is designed for
selection problems, ELECTRE TRI for assignment problems and ELECTRE II, III and IV for
ranking problems (Marzouk, 2010). See Triantaphyllou (2000) and Belton & Stewart (2002)
for the details and history of the ELECTRE family of methods. The most apparent weakness
of these methods is that they yield an incomplete ranking system and only produce a core of
leading alternatives (Triantaphyllou, 2000). This means that these methods are sometimes
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incapable of identifying the most preferred alternative. Another limitation is that the
ELECTRE family of methods is especially suitable when there are decision problems that
involve a few criteria with a large number of alternatives (Lootsma, 1990).
In the fuzzy environment, several researchers have recently proposed various fuzzy
ELECTRE methods in the literature (Montazer, et al., 2009; Sevklia, 2010; Hatami-Marbini
& Tavana, 2011; Zandi, 2011; Rouyendegh & Erkan, 2012) . Nevertheless, the fuzzy
ELECTRE methods have the same drawbacks as mentioned above for the traditional
ELECTRE methods.
The PROMETHEE (Preference Ranking Organisation Method for Enrichment Evaluations)
method, developed by Brans fat the Free University of Brussels in 1982, is another
outranking approach for a finite set of alternative actions to be ranked and selected according
to a number of, often conflicting, criteria, (see Brans & Mareschal, 2005, for more
information). Behzadian et al. (2010) summarised and reviewed comprehensively
PROMETHEE-based methodologies and their applications. Their literature review stated that
the methods of PROMETHEE have successfully been applied in many fields and a number of
researchers have used them in decision making problems.
PROMETHEE proceeds to a pairwise comparison of alternatives for each single criterion, in
order to determine partial binary relations denoting the strength of preference of an
alternative A over alternative B. In an evaluation table, the alternatives are evaluated on
different criteria. The implementation of PROMETHEE requires additional types of
information: the weights (information on the relative importance or the weights of the criteria
considered) and the preference function (information on the DM preference function, which
he/she uses when comparing the contribution of the alternatives in terms of each separate
criterion) (Behzadian et al., 2010). The PROMETHEE method is extended to deal with fuzzy
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input data. The Fuzzy PROMETHEE method has been used for ranking alternatives in many
studies (Diakoulaki & Koumoutsos, 1991; Geldermann, et al., 2000; Goumas & Lygerou,
2000; Albadvi, 2004; Wang, et al., 2008). The main drawback of the PROMETHEE and
Fuzzy PROMETHEE methods arises from the many non-intuitive and various information
inputs that are required, such as the preference function (Belton & Stewart, 2002). This tends
to make the PROMETHEE algorithm difficult and complicated for DMs.
The AHP, proposed by Saaty (1980), is based on the method of pairwise comparison to
assess the relative importance of criteria and alternatives. The major advantage of AHP is its
ability to deal with qualitative and multi-dimensional decision criteria. A logical way to
check the consistency of the DMs judgement is also offered in the AHP, so that reliability of
the results can be confirmed (Ramanathan, 2001). The applications of AHP are numerous and
it has been used worldwide (Zahedi, 1986; Vaidya & Agarwal, 2006). According to Saaty
(2008), one can use AHP to make a decision by using the following four steps:
1. Problem definition: Objectives and type of knowledge sought.
2. Structuring a decision hierarchy: Decision goal at the top, the main objectives, decision
criteria, through to the intermediate levels and the alternatives at the lowest level.
3. Constructing a set of pairwise comparison matrices.
4. The comparison results, priorities, are aggregated to obtain the final priorities and ranking
of the alternatives.
In the final step, the AHP deals with the decision matrix, which can be constructed by using
the relative importance of the alternatives in terms of each criterion. The DM/s is asked to
build pairwise comparisons of the impact of the alternatives on the -th criterion and then
any prioritisation method can be applied to generate the alternatives relative importance
weights (more on this is presented and discussed by Saaty, 1980; 1982).
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The fuzzy version of the AHP has been developed in order to deal with fuzzy environments
in decision making problems and to select the best alternative according to the decision
criteria (Laarhoven & Pedrycz, 1983; Boender, et al., 1989). Fuzzy AHP methods have been
widely applied in MCDM problems for ranking the alternatives from fuzzy PCJMs (Weck, et
al., 1997; Erdogmus, et al., 2006; Duran & Aguilo, 2008; Ayag & Ozdemir, 2009; 2011; Wu,
et al., 2009; Yksel & Dagdeviren, 2010).
Although the standard AHP and Fuzzy AHP methods have been widely used for ranking
alternatives in MCDM, there has been a debate about them from a theoretical point of view
(Belton & Gear, 1983; Belton & Stewart, 2002). The major theoretical problem with AHP
and Fuzzy AHP, as mentioned in the literature, is the rank reversal problem. This means, in
certain situations, the introduction of a new alternative, which does not change the range of
outcomes on any criterion, but may lead to a change in the ranking of the other alternatives
(Belton & Gear, 1983; Belton & Stewart, 2002). As a result, when new alternatives are added
in AHP and Fuzzy AHP, the evaluations that are already done on the old alternatives have to
be discarded and a new evaluation has to start from the beginning, taking into account the
whole set of alternatives, including the new alternatives (Xu & Yang, 2001).
TOPSIS or the technique for order preference by similarity to an ideal solution is another
widely-used technique to score and rank alternatives. It was proposed by Hwang and Yoon
(1981). The main principle of this method is to select the alternative which has the shortest
distance from the positive ideal solution (PIS) and the longest distance from the negative
ideal solution (NIS). TOPSIS is claimed as one of the most straightforward methods and it is
suitable for a large scale problem comprising of large numbers of criteria and alternatives. A
complete ranking can be achieved using this approach, unlike the ELECTRE methods
(Triantaphyllou, 2000). Furthermore, the TOPSIS method can address the rank reversal issue
problem caused by using the AHP.
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Moreover, the Fuzzy TOPSIS method has been adopted for ranking the alternatives in many
MCDM applications under uncertainty (Triantaphyllou & Lin, 1995; Chen, 2000; Yong,
2006; Salehi & Tavakkoli-Moghaddam, 2008; Erturul & Karakaolu, 2008; Sun & Lin,
2009; Ic & Yurdakul, 2010; Buyukozkan & Cifci, 2012).
The prominent advantage of Fuzzy TOPSIS is its simplicity and ability to yield an
indisputable preference order (Ic & Yurdakul, 2010). It has a sound logic that represents the
rationale of human choice (Shih, et al., 2007). Fuzzy TOPSIS has become the most popular
method for ranking alternatives in MCDM problems, due to a simple computation process
that is easy to understand and implement in real cases (Shih, et al., 2007). Moreover, it has
been proven that the Fuzzy TOPSIS method is one of the best methods for tackling the rank
reversal issue that some MCDM methods cause (Erturul & Karakaolu, 2008). The Fuzzy
TOPSIS method yields the ranking for each alternative with respect to each criterion in
individual/group decision making problems. It models the uncertainties in MCDM problems
by using linguistic assessments instead of numerical values. All of these features make Fuzzy
TOPSIS a proper technique for ranking alternatives. Therefore, the Fuzzy TOPSIS method is
adopted in this study for that purpose. A further explanation regarding Fuzzy TOPSIS will be
delivered in the next chapter. Nevertheless, the group version of Fuzzy TOPSIS does not take
into account the DMs importance weights. As discussed before, it can be argued that
ignoring the importance weights of the DMs is not logical in group decision making
problems. Therefore, there is a need to tackle that limitation. Considering this need, a new
modification of group Fuzzy TOPSIS is proposed in the next chapter.
The ranking of alternatives is the last step in any decision making problem, to select the most
preferred alternative with respect to the decision criteria. The previous section reviewed and
discussed methods that are very often used for ranking alternatives. Obviously, there is no
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perfect method for ranking alternatives. On the other hand, the suitability, usability and
fitness for purpose of the method should always be given a high priority when devising it.
Among various ranking methods, it is possible to consider group Fuzzy TOPSIS to be a
viable method for ranking alternatives because it overcomes all the drawbacks in the existing
methods (i.e. FWSM, FWPM, Fuzzy ELECTRE, Fuzzy PROMETHEE, and Fuzzy AHP).
However, group Fuzzy TOPSIS has one limitation in terms of disregarding the DMs
importance weights. This limitation flags up the need for a new modification for group Fuzzy
TOPSIS. The discussion about improving group Fuzzy TOPSIS is continued in the next
chapter.
This chapter offers a review of literature regarding methods and tools in MCDM to deal
with the aggregation, prioritisation and ranking stages in group decision making problems
in the presence of the issues of uncertainty and dependency. Reviewing the advantages
and limitations of those methods and tools was a very useful task for investigating the
proper methods that should be adopted in this research and used to propose a new MCDM
model.
In summary, section 3.2 offers a review and analysis of literature that models uncertainty
in the MCDM field. It concludes that FST is a realistic way to tackle subjective
uncertainty in DMs judgements. For section 3.3, attention is shifted to discussion of the
idea of using fuzzy PCJMs to derive the weights of the decision elements in MCDM
problems. This section proposes an overview of methods which can be used to determine
the relative weights/priorities of the decision elements. Aggregation and prioritisation
methods for group decision making were discussed in section 3.4. Among various
prioritisation methods, the Weighted GFPP method (Mikhailov, et al., 2011) is selected as
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a basis for the prioritisation process for this thesis. The WAM method is adopted to be
employed for aggregating the judgements of the group of DMs. In this section, the
assumption of equal importance weights for DMs was discussed and considered as a major
limitation for aggregation and prioritisation methods. As a consequence of this, section 3.5
offers a discussion regarding aggregation and prioritisation methods existing in the
published literature which take into account the importance weights of the DMs in the
group decision making problem. Moreover, it reviews the methods for obtaining the
relative importance weights of the DMs. It is considered that the SDM method is an
appropriate method to gain the importance weights of the DMs. Next, in section 3.6 the
concept of dependency in MCDM problems was discussed. Furthermore, the most used
methods in the literature for studying dependency were reviewed and it is concluded that
Fuzzy DEMATEL can be adopted in this study. Finally, for ranking alternatives different
approaches were discussed and analysed in section 3.7. So far, the Fuzzy TOPSIS method
is likely to be the right choice for ranking alternatives in this thesis. On the other hand, it
was argued that the Fuzzy DEMATEL and the Fuzzy TOPSIS methods have the same
drawback regarding the assumption of the equality of importance weights among the DMs
within the group.
All in all, the adopted methods in this chapter, the Weighted GFPP, Fuzzy DEMATEL and
Fuzzy TOPSIS methods for deriving criteria weights, studying dependency and ranking
alternatives respectively, have the same limitation. They have taken DMs in all group
decision making situations to play their roles with the same weights of importance. Thus,
there is a need to overcome that limitation in the adopted methods. Considering this need,
in the next chapter new modifications of the Weighted GFPP, the Fuzzy DEMATEL and
the Fuzzy TOPSIS methods are proposed and a new Hybrid Fuzzy MCDM model is then
developed.
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4. CHAPTER FOUR: A HYBRID FUZZY MCDM MODEL
4.1 Introduction
In this chapter, a new hybrid Fuzzy MCDM model, integrating the extended Fuzzy Delphi,
extended Fuzzy DEMATEL, new Fuzzy Group Prioritisation, and modified Fuzzy TOPSIS
methods, is proposed for the selection problem in this research study. In the proposed hybrid
model, some extensions based on the Fuzzy Delphi, Fuzzy DEMATEL, non-linear FPP, and
Fuzzy TOPSIS methods are introduced to apply in different circumstances. The extended
methods include synthesis of uncertainty into group decision making by applying the FST
concept. In addition, they take into consideration the fact that each DM in the decision
making group could have individual importance power within the group. This is a new step
and a new field of study for the existing MCDM tools. Accordingly, this chapter formulates
the technical contributions of this research to the literature on MCDM tools.
This chapter is divided into four parts. Following the introduction, the novel hybrid Fuzzy
MCDM model is proposed and described step by step in section 4.2. Section 4.3 then
proposes and discusses the detailed concepts of the extended approaches in this study: the
extended Fuzzy Delphi method, the extended Fuzzy DEMATEL method, the new Fuzzy
Group Prioritisation method and the extended Fuzzy TOPSIS method. Moreover, in section
4.3, numerical examples are provided in each sub-section (i.e. in sub-sections 4.2.2, 4.2.3,
4.2.4, and 4.2.5) to illustrate the results computed by the new extended methods. A summary
of the chapter is given in section 4.4.
4.2 The New Hybrid Fuzzy MCDM Model
This study suggests a novel hybrid Fuzzy MCDM model based on the following quantitative
decision models: the Fuzzy Delphi, Fuzzy DEMATEL, non-linear FPP, and Fuzzy TOPSIS
methodologies to assist in reaching group health insurance plan decisions. In the literature,
there are some works on these methods, but to our knowledge no research exists that
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combines these four methods. Therefore, this study proposes a new integrated approach that
can cope with the interdependencies among various criteria in a fuzzy environment by
introducing the importance of DMs in the group decision making process. In other words, this
research is the first one that integrates these four methods: the FDE method (for selecting the
critical criteria), the Fuzzy DEMATEL method (for studying the dependency), the non-linear
FPP method (for deriving the relative weights of criteria), and the Fuzzy TOPSIS method (for
ranking the alternatives) in order to solve the selection problem by taking into account the
importance weights of each DM in the group decision making.
As the proposed model is novel, it might be applied to other MCDM problems. It is expected
that this proposed hybrid Fuzzy MCDM model will offer a quantitative decision model based
on modifications of the Fuzzy Delphi, Fuzzy DEMATEL, non-linear FPP, and Fuzzy
TOPSIS methodologies. It will also determine the weights of criteria and find the final
ranking of the alternatives, helping the DMs to evaluate those alternatives in the selection
process. In this research study, the proposed model will provide recommendations that can
help managers or DMs in private companies to decide the most appropriate group health
insurance plan to insure their employees.
The hybrid Fuzzy MCDM model consists of five main steps. The general view of the
proposed hybrid Fuzzy MCDM model is shown in Figure 4.1. For steps two to five in the
proposed hybrid Fuzzy MCDM model, a tool is needed to collect the DMs opinions. Among
different data collection tools, the questionnaire is the most frequently used in social science
research (Oppenheim, 2000). That is because questionnaires are often used to survey peoples
beliefs, attitudes, feelings, or opinions regarding an issue under investigation. Questionnaires
have the advantage of allowing researchers to reach a large number of participants at a
relatively low cost (Gillham, 2000). It is also easy to analyse data and to avoid any bias by
applying statistical analysis to the coded data. Questionnaires can also be administered
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online. Therefore, the DMs opinions are collected and gathered through questionnaires in
this study.
Prior to sending out the questionnaires, it is necessary to undertake a pilot test in order to
refine the questionnaires, eliminate potential problems and make them as concise as possible
(Flynn, et al., 1990; Gillham, 2000). The pilot test aims to ensure that the wording used in the
questionnaire is clear for the participants. According to de Vaus (2002), this process
improves the reliability of the questionnaire by eliminating ambiguous or difficult questions
which may lead to unreliable answers, as a number of participants might understand such
questions in a different way (de Vaus, 2002).
The proposed model consists of five main steps, as follows:
Step 1: Pre-research Phase
In the pre-research phase, a list of available alternatives for the research problem is identified
from the published literature. Afterwards, a primary list of criteria for selecting the
appropriate alternative is set. The selection of criteria is based on the literature review and
documentary analysis. An intensive literature survey is conducted to seek information about
potential selection criteria. Previous studies and research on similar problems are used and
reviewed in order to reveal related selection criteria for the problem at hand. The
documentary analysis of the official documents and web pages is used in this step as a
secondary resource to obtain more information about the selection criteria.
Step 2: Extended Fuzzy Delphi (FDE) Method Phase for Setting the Critical Selection
Criteria and Grouping them into Clusters
In order to keep the number of criteria at a manageable level, the new extended FDE method
is used in this step, introducing the importance weights of DMs. The new extended FDE
method is proposed shortly in section 4.3.2. The main purpose of applying this proposed
method is to cut the number of selection criteria by selecting the most critical criteria for the
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decision at hand, based on the DMs opinions and considering their weights of importance
within the group.
As discussed in the previous chapter (section 3.5), the SDM approach with the non-linear
FPP method are suitable tools to obtain the DM importance weights for the group. Thus, the
SDM and the non-linear FPP methods are utilised for the purpose of finding the relative
importance weights of the experts/DMs. These weights are used in this step, as well as steps
3, 4 and 5, in the proposed hybrid Fuzzy MCDM, as illustrated in Figure 4.1. After obtaining
a list of critical and key selection criteria, these criteria are grouped into clusters for the sake
of simplicity. A process is needed to group related criteria into families so that small
numbers of clusters can be obtained. Saaty stated that A cluster allows one to think about
grouping criteria that share a set of attributes (1999:7). A classification of the criteria into
clusters is a useful process in order to model the problem correctly and efficiently and to
make the computation process easier. Besides, placing a large number of criteria in each
cluster leads to a huge increase in the number of PCJMs required, making the computation
process complicated and sometimes infeasible.
Step 3: The Extended Fuzzy DEMATEL Method Phase for Measuring Dependency
among Clusters
By introducing importance weights for each DM in the selected group, the
relationships/dependence among the clusters are defined by applying the new extended Fuzzy
DEMATEL method through a new questionnaire. The outputs of the extended fuzzy
DEMATEL are then used to construct a Super Pairwise Comparisons Judgement Matrix
(SPCJM) for calculating the relative weights of the criteria.
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To illustrate the SPCJM concept, consider as the -th cluster12 ( = 1, , ) which has
elements/criteria denoted as 1 , 2 , . The SPCJM concept of a system of
clusters is denoted as shown below:
1 .
11 12 11 1 2 1 2
1 11
. 11 12 1
. .
11
. .
.
1 21 22 2
.
.
W= (4.1)
. ..
.
1
..

[ 1 2 ]
The typical entry in the SPCJM is called a block of the SPCJM and represents the
relationship between the -th cluster and the -th cluster, as illustrated below:
( )
1 (1) 1 (2) 1
( )
2 (1) 2 (2) 2
=
(4.2)

( ) ( )
[ 1 (2) ]
Each column of is a local priority vector of each element that is derived from Fuzzy
PCJMs by applying a prioritisation method. Some entries may be zero, corresponding to
those elements that have no influence (Saaty and Vargas, 2006). After that, a normalised
SPCJM is produced by adjusting the SPCJM to column stochastic format so that the sum
of the elements in each column is equal to one. Then, to derive the global priorities of
12
Many MCDM problems which cannot be structured as a linear top-to-bottom form of hierarchy with
different levels, can be structured as a non-linear network with clusters. The cluster is a logical grouping of
elements within a given decision.
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elements/criteria, the normalised SPCJM is raised to limiting powers until the row
elements converge to the same value for each column of the matrix (Saaty and Vargas,
2006). The reason for raising the SPCJM to an arbitrarily large number is to capture the
transmission of influence along all possible paths of the SPCJM (Saaty, 2005).
The process of studying dependency among clusters via applying the new extended Fuzzy
DEMATEL method is proposed in detail in section 4.3.3.
Step 4: The New Fuzzy Group Prioritisation (FGP) Method Phase for Deriving the
Weights of the Criteria
In the fourth step, the DMs produce fuzzy PCJMs by using pairwise questionnaires in order
to obtain criteria weights based on the primary structure of the SPCJM. Then, the new
proposed Fuzzy Group Prioritisation (FGP) method is applied to derive a local priority
vector. The local priority vector for each fuzzy PCJM will be needed to complete the SPCJM.
In other words, local priority vectors obtained by applying the FGP method in this step are
entered in the appropriate columns of the SPCJM to obtain global priorities in a problem with
interdependent influences.
The proposed FGP method has some advantages. It models the uncertainty in the DMs
judgements by using FST. It derives crisp priorities/weights from a set of incomplete fuzzy
judgements and does not require fuzzy ranking procedures. Additionally, it takes into
consideration the importance of the DMs in the group. The mathematical procedure for the
proposed FGP method is discussed in detail in section 4.3.4.
Step 5: The Extended Fuzzy TOPSIS Method Phase for Ranking the Alternatives and
Reaching the Final Decision
For ranking the alternatives and reaching the final solution, it is proposed to use an extension
of the Fuzzy TOPSIS technique for group decision making that includes the importance
weight of each DM within the group. In doing so, a ranking questionnaire is developed and
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distributed to the DMs to gather their opinions and judgements on rating the alternatives with
respect to each criterion. The weight of each criterion and the weight of each DM in the
group are involved in this step in order to reach the final ranking. The steps of the proposed
Fuzzy TOPSIS method are presented in section 4.3.5.
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Creating a list of alternatives
Literature review
Step 1
Defining an initial list of selection criteria
DMs opinions
Applying the extended Fuzzy Delphi (FDE) Method for setting the
critical selection criteria Importance weights
of DMs
Step 2
Grouping the critical selection criteria into clusters
DMs opinions
Step 3
Using the proposed extended Fuzzy DEMATEL method to study the
dependency among clusters
Importance weights
of DMs
DMs opinions
Step 4
Deriving the weights of the criteria (local priorities) and obtaining the
global weights
Importance weights
of DMs
DMs opinions
Step 5 Ranking the alternatives and reaching the final decision by the proposed
fuzzy TOPSIS method
Importance
weights of DMs
Figure 4.1: A Process Overview of the Proposed Fuzzy MCDM Model
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4.3 New Extended Methods
This section provides the technical contributions of this research study. By taking into
account the importance weights of the DMs in the group, it presents the proposed extended
methods which are termed: the extended FDE, the extended Fuzzy DEMATEL method, the
new FGP method and the extended Fuzzy TOPSIS method. This section begins by describing
the notation, definitions, and mathematical operations of FST. This is followed by section
4.3.2, which includes the FDE method, the new extended FDE method, and an illustrative
example. Section 4.3.3 introduces the extended Fuzzy DEMATEL method for studying
interdependency among attributes. It includes the classical Fuzzy DEMATEL method, the
new proposed Fuzzy DEMATEL method, and a numerical example. Section 4.3.4 proposes
the new FGP method for deriving group priorities/weights from fuzzy PCJMs. It starts with a
representation of the fuzzy group prioritisation problem, then the proposed method, followed
by numerical examples. Section 4.3.5 presents the new proposed Fuzzy TOPSIS method,
followed by numerical examples.
4.3.1 Fuzzy Set Theory (FST)
Fuzzy Set Theory (FST) was proposed formally for the first time by Lotfi Zadeh (1965), from
the University of California in Berkeley. The theory has been expanded and deepened since
its first appearance and has been applied in many areas (Zimmermann, 1991).
As discussed in a previous chapter, the FST is a suitable way of dealing with uncertainty in
the MCDM model. Thus, the FST is applied in this research to model the uncertainty issue.
But first of all, it is best to provide clear definitions of the terminology and concepts that are
used in the FST literature in order to explain the theory accurately.
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4.3.1.1 Definition
The FST treats vague data as probability distributions in terms of set memberships. A fuzzy
set is a class of objects with a continuum of grades of membership. Such a set is characterised
by a membership (characteristic) function, which assigns to each object a grade of
membership ranging between zero and one. A tilde ~ will be placed above a symbol if the
symbol represents a fuzzy set.
Let be a collection of objects denoted generically by , then a fuzzy set in is a set of
ordered pairs:
= {(, ()) , } (4.3)
where (x) is called the membership function (generalised characteristic function), which
maps to the membership space M = [0,1]. A fuzzy set is denoted by an ordered set of pairs,
the first element of which denotes the element and the second is the degree of membership. In
the FST, the membership values are indicated by a value in the range [0,1] , with 0
representing absolute Falseness and 1 representing absolute Truth. It is worth noting that
there is no certain way to demonstrate the membership function and it is mostly experimental
and perceptual.
4.3.1.2 Basic Concepts and Operational Laws of Fuzzy Numbers
This section reviews some basic and related definitions of FST from Zadeh (1965).
Definition 1: Notations of Fuzzy Numbers
A fuzzy number,
, is a special fuzzy subset of the set, , of real numbers, which satisfy the
following conditions (Dubois & Prade, 1980):
a) There exists a 0 so that the degree of its membership, (0 ) = 1; 0 is called
the mean value of

.
b) The membership function, , is left and right continuous.
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Laarhoven and Pedrycz (1983) defined a fuzzy number, , on , to be a triangular fuzzy
number, which can be defined by a triplet (, , ) as shown in Figure 4.2. The
parameters, , and , respectively indicate the smallest possible value, the most promising
value, and the largest possible value that describe a fuzzy event. Its membership function is
defined as:
( )( ) , [, ]
(, , ) = { ( )( ) , [, ] (4.4)
0 ,
It is easy to see that a triangular fuzzy number, = (, , ) , is reduced to a real number,
, if = = . Conversely, a real number, , can be written as a triangular fuzzy
number, = (, , ).
= (, , )
Figure 4.2: Triangular Fuzzy Number
, on , to be a trapezoidal fuzzy number, which

Buckley (1985) defined a fuzzy number,
= (, , , ), as shown in Figure 4.3. Its membership function is

can be defined by
defined as:
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( )( ) , [, ]
1 , [, ]
(, , , ) = { (4.5)
( )( ) , [, ]
0 ,
If = then the number becomes triangular and if = = = it is a crisp value.
= (, , , )
Figure 4.3: Trapezoidal Fuzzy Number
Definition 2: Fuzzy Algebraic Operations
= (1 , 2 , 3 ) and
Let = (1 , 2 , 3 ) be two triangular fuzzy numbers. The algebraic
and
operations of can be expressed as follows (Zadeh, 1965):
Fuzzy addition :

= (1 + 1 , 2 + 2 , 3 + 3 ) (4.6)
Fuzzy subtraction:

= (1 1 , 2 2 , 3 3 ) (4.7)
Fuzzy multiplication:
= (1 , 2 , 3 ), , 0,
(4.8)

= (1 1 , 2 2 , 3 3 ) (4.9)
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Fuzzy division :
)1 = (1 , 2 , 3 )1 = ( 1 , 1 , 1 ) , 1 > 0
( (4.10)
3 2 1
= (1 , 2 , 3 ) , 1 > 0, 1 > 0
(4.11)
3 2 1
The basic operations for a trapezoidal fuzzy number are such that if 1 (1 , 1 , 1 , 1 ) and
2 (2 , 2 , 2 , 2 ) be two trapezoidal fuzzy numbers, then:
Fuzzy addition:
1 2 = ( 1 +2 , 1 +2 , 1 +2 , 1 +2 ) (4.12)
Fuzzy subtraction:
1 2 = ( 1 2 , 1 2 , 1 2 , 1 2 )) (4.13)
Fuzzy multiplication:
1 2 = ( 1 2 , 1 2 , 1 2 , 1 2 ) (4.14)
Fuzzy division :
1 2 = ( 1 /2 , 1 /2 , 1 /2 , 1 /2 ) (4.15)
Definition 3: Linguistic Variable
A linguistic variable is a variable whose values are linguistic terms (Zadeh, 1975). In fuzzy
decision making environments, the concept of a linguistic variable is very useful in dealing
with situations which are too complex or too ill-defined to be reasonably described in
conventional quantitative expressions. In MCDM, the FST and the linguistic variable
approach are very helpful tools to deal with the vagueness of human thoughts and language in
making decisions. Indeed, the linguistic variable approach is usually employed by DMs to
express their assessments with qualitative linguistic variables, and then fuzzy numbers are
used to quantify those qualitative linguistic variables. For instance, the ratings of alternatives
using qualitative attributes could be expressed as linguistic variables such as Very Poor (VP),
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Poor (P), Medium Poor (MP), Fair (F), Medium Good (MG), Good (G), and Very Good
(VG). For example, poor and very good can be represented by triangular fuzzy numbers
(2, 3, 4) and (8, 9, 10), respectively.
In almost all of the literature that applies fuzzy sets to quantify linguistic variables, triangular
and trapezoidal fuzzy numbers have been used as the best choices due to the fact that
triangular and trapezoidal fuzzy number membership functions are linear. The linearity
property makes their application very easy and straightforward for associated computations
(Jamalnia & Soukhakian, 2009). Moreover, triangular and trapezoidal fuzzy numbers are
symmetric and have a unique maximum value in their degree of membership functions. These
characteristics make them more suitable to fit to the features of linguistic terms (Jamalnia &
Soukhakian, 2009). In particular, triangular fuzzy numbers are commonly used because they
have a very simple form of implementation with linear functions and their membership
functions can be constructed with only a few parameters, which can even be reduced to two
parameters, as in the case of symmetric fuzzy numbers. Based on the above reasons, all fuzzy
numbers are assumed to be triangular fuzzy numbers to quantify qualitatively variable
linguistic expressions throughout this research.
In the literature, different studies have used five-level, seven-level, or nine-level linguistic
scales, which are converted into triangular fuzzy numbers. Chen & Ku (2008) summarised all
applications of triangular fuzzy numbers and presented the fuzzy numbers associated with
linguistic terms. This study focuses on five-level linguistic scales in triangular fuzzy numbers
because the five-level scales are not only easy to use, but are also the type of scale most
studied using fuzzy numbers. Moreover, this study adopts the five-level scales proposed by
Baykasolu et al. (2013), where there is no intersection (no overlap) between the triangular
fuzzy numbers. The reason behind this is to make the process of using the triangular fuzzy
numbers and the fuzzy aggregation stage very clear and understandable for all the
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respondents/DMs, who may have no knowledge of the FST and fuzzy numbers. Hence, five-
level linguistic scales will be used in this study, as seen in Table 4.1.
Table 4.1: Linguistic Scale Adopted in this Research Study
Fuzzy Numbers Linguistic terms Fuzzy scale

Equal Importance (EI); No Influence (No); Very Poor (VP) (1 , 1 , 1)

Fair Importance (MI); Very Low Influence (VLI); Poor (P) (2 , 3 , 4)

Strong Importance (SI); Low Influence (LI); Fair (F) (4 , 5 , 6)

Very Strong Importance (VSI); High Influence (HI); Good (G) (6, 7 , 8)

Extreme Importance (EI); Very High Influence (VHI); Very Good (VG) (8 , 9 , 10)
Definition 4: Distance between Two Triangular Fuzzy Numbers
= (1 , 2 , 3 ) and
Let = (1 , 2 , 3 ) be two triangular fuzzy numbers, then the vertex
method (Chen, 2000) is used to calculate the distance between them, as follows:
( ) = 1 [(1 1 )2 + (2 2 )2 + (3 3 )2 ]
, (4.16)
3
Definition 5: Operation with -level
For a given -level ( [0,1] ), any triangular fuzzy number, = (, , ) , can be
decomposed into an interval set () = [(), ()], where:
() = ( ) + ; () = ( ) + (4.17)
4.3.2 The Modified Fuzzy Delphi Method
Saaty (1990) stated that the most creative task in making a decision is to choose the factors
that are important for that decision. That means finding those key criteria that directly affect
the problem that requires a decision. Additionally, large numbers of criteria make building
the MCDM model more complex and difficult. Thus, there is a need to use a method to
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obtain a consensus from a group of DMs in order to screen for important criteria and then
select the critical criteria.
From the literature review of insurance studies in section 2.3.1, it can be noted that the Delphi
(DE) method is employed to generate the critical criteria by reaching agreement among
independent DMs in group decision making (Huang, Lin & Lin, 2008). However, the
traditional Delphi method has always suffered from low convergence of expert opinions, high
cost of execution, and the possibility that opinion organisers may filter out particular expert
opinions. Ishikawa et al (1993) thus proposed the concept of integrating the traditional Delphi
method and the FST to improve the vagueness and ambiguity of the DE method. The FDE
method does not have the above mentioned weaknesses. Therefore, this study adopts the
reformed FDE method, which is based on triangular fuzzy numbers. This method is applied
to identify the key criteria and then to reduce the number of criteria.
To lay the foundation for extending the DE method to fuzzy environments, the essentials of
the FDE method are discussed below.
4.3.2.1The Fuzzy Delphi Method
The Delphi (DE) method is a technique used to obtain the most reliable consensus from a
group of experts/DMs and was first developed by Dalkey and Helmer (1963). The DE
method uses expert/DM responses to a series of questionnaires. The participants
(experts/DMs) do not interact with one another (Wu, et al., 2009) and they are forced to
adjust their opinions so as to meet the mean value of all the expert opinions (Ma, et al.,
2011). It is an iterative process to reach the consensus of a panel of experts by using various
questionnaires and it has successfully been applied in different fields (Huang, et al., 2007). It
can also be considered as a group decision making methodology. However, the results
obtained by the traditional DE method could be ambiguous due to the differences in the
meanings and understandings of the experts estimations (Ishikawa, et al., 1993; Hsu &
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Yang, 2000; Kuo & Chen, 2008; Hsu, et al., 2010). Furthermore, the experts are often
uncertain when assigning evaluations as crisp numbers. Therefore, Ishikawa et al. (1993)
integrated the traditional DE method and the FST and established the FDE method to
improve the vagueness of the DE method. Robbins (1994) stated that the decision making
group should probably not be too large (a minimum of five and a maximum of 20). The FDE
requires only a small number of samples and the results obtained are objective and reasonable
(Kuo & Chen, 2008; Ma et al., 2011). The advantages of using the FDE method are listed
below:
The simplicity with which all experts opinions can be covered in just one
investigation as well as the simplicity of the calculation process (Ma, et al., 2011).
It can provide similar results to those obtained by the traditional DE method, but the
time taken and the number of questionnaires can be reduced by using the FDE
method. So, it achieves greater economic effectiveness by reducing investigation time
and cost (Kuo & Chen, 2008).
It induces fuzziness and uncertainty in human thinking within the process by applying
the FST concept (Ishikawa, et al., 1993).
In particular, the individual features and professional knowledge of each expert can be
reflected more reasonably and suitably than in the traditional DE method (Wu &
Fang, 2011).
The FDE method is adopted in this study in order to:
Select the key and critical criteria for the selection problem.
Reduce the number of criteria by dropping the least significant ones or merging some
of them together so as to make the structure of the problem more manageable. This is
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in order to avoid the existence of too many criteria, which will otherwise make the
later PCJM stage of the selection problem difficult and complicated.
Limit the additional questionnaires to one instead of using multiple questionnaires for
collecting the decision making groups expert opinions.
Reduce the time and cost by reducing the number of repetitions of the questionnaire
needed to achieve a consistency in expert opinions.
Find out the common understanding among the decision making group of experts, and
to achieve consensus in the decision making group; to act as a filter process.
The steps of the FDE method are as follows (Hsu, et al., 2010):
Step 1: Collecting the opinions of the DMs in the group. Find the satisfactory level for the
importance of each criterion given by each DM by using triangular fuzzy numbers
representing the linguistic variables in the questionnaire. The questionnaire should comprise
all of the primary criteria for the problem being considered.
Step 2: Aggregating the DMs opinions. The second step is to establish new triangular fuzzy
numbers by using the experts assessments, which were gathered at the earlier step, in order
to achieve a consensus from the group of the DMs. The computing formula is illustrated as
follows:
Assuming that the importance level of criterion , given by DM of DMs, is:
= ( , , ); = 1,2 . , , = 1,2, , (4.18)
Then the new triangular fuzzy number of criterion can be presented as follows:
= ( , , ) where:
1
= min( ), = =1 , = max( ) (4.19)

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where is the number of experts; is the number of criteria; is the minimum of all DMs
assessments for criterion ; is the arithmetic mean of all DMs assessments for criterion ;
is the maximum of all DMs assessments for criterion .
Step 3: Calculating crisp values. The numbers, , generated from step 2 cannot be used for a
direct evaluation. Therefore, a Centre-Of-Gravity (COG) method can be utilised as a fuzzy
ranking method to convert the triangular fuzzy members to crisp values, , as follows:
[ + ( )]
= +
3
[ +( )] + 2
= + 3
= + 3
(4.20)
Step 4: Selecting significant criteria. In order to select the critical criteria, by setting a
threshold , the impact of extreme values can be dealt with as follows:
If , then the elements should be selected;
If < , then the elements should be eliminated.
However, the existing FDE method has some limitations. Firstly, the min and max operations
for the upper and lower values in the aggregation step (step 2) are not appropriate if the
sample has a wide range of upper and lower bounds. In other words, the min and max
operations for and will isolate some values, which will affect the results dramatically.
Secondly, this method assumes that all DMs in the group have the same importance for
decision making. This is not logical when we have a group of DMs with different levels of
expertise, as discussed in the previous chapters. As a consequence, a modification of the FDE
method is proposed in this research to overcome the above mentioned limitations. The
modified FDE method is presented in the next section.
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4.3.2.2 The Proposed Fuzzy Delphi Method
The modification of the FDE method is proposed in this section. Its goal is to integrate the
opinions of all the DMs to eliminate unimportant criteria. The proposed FDE method is
demonstrated as follows:
Step 1: Gathering the DMs opinions. Each DM in the group is asked to go through a
questionnaire to specify the level of importance of each criterion. Five-level linguistic terms
can be employed in the questionnaire and can be represented as triangular fuzzy numbers, as
in Table 4.2 and Figure 4.4. The purpose of the questionnaire is to gain an understanding of
the criteria that must be taken into account within the MCDM problem under study. The
questionnaire focuses on asking the DMs to evaluate the acceptable level of importance of
each criterion.
Table 4.2: Linguistic Variables for the Proposed FDE Method
Fuzzy Numbers Linguistic terms Fuzzy scale

Very Unimportant (VU) (1 , 1 , 1)

Unimportant (U) (2 , 3 , 4)

Neutral (N) (4 , 5 , 6)

Important (I) (6, 7 , 8)

Very Important (VI) (8 , 9 , 10)
VU U N I VI
1
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0
1 2 3 4 5 6 7 8 9 10
Figure 4.4: Triangular Fuzzy Numbers for the Proposed FDE Method
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The outcome of the questionnaire is a decision matrix, as follows:
1 2 . .
1 1 1 1 2 1
= 2
. 2 1 2 2 2 (4.21)

(
1
2
)
where:
is the -th criterion, = 1,2, . . , .
is the -th decision maker in the group, = 1,2, .
is the assessment of for the -th criterion.
Step 2: Aggregating the assessments from the DMs. In this step, the Fuzzy WAM (3.13) is
used in order to set up the triangular fuzzy numbers for integrating all of the DMs opinions
by introducing the importance weights of each expert ( = 1,2, ). Thus, the aggregated
judgement is represented as:
= ( , , ) = =1 (4.22)
where is the aggregated triangular fuzzy number for criterion ( = 1,2, . . , ), is the
number of criteria, is the importance weight of , > 0, =1 = 1, and is the
number of DMs in the group.
Step 3: Calculating crisp values. From Step 2, the numbers, , cannot be used for a direct
evaluation because they are fuzzy numbers. Therefore, there is a need to use a fuzzy ranking
method to convert a triangular fuzzy member to a crisp real number. Generally, there are
three kinds of fuzzy ranking methods: the mean of maximal, Centroid (Centre-Of-Gravity
(COG)), and -cut methods (Zhao & Govind, 1991; Van Leekwijck & Kerre, 1999). This
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study applied a COG method as a fuzzy ranking method due to its simplicity and the fact that
it does not require an analysts personal judgement. The COG method is applied here to
convert the triangular fuzzy members to crisp values and to then define the evaluation
indices, , as follows:
[ +( )] + 2
= = + = + (4.23)
3 3
Step 4: Screening evaluation indices. In order to select the critical criteria, a threshold is
set, so that the impact of extreme values can be eliminated. The principle of screening is as
follows:
If , then the criterion should be selected;
If < , then the criterion should be eliminated.
4.3.2.3 Numerical Example
A theoretical example is designed to show the computational process (steps 2 and 3
specifically) of the modified FDE method proposed in the previous section. Moreover, this
example demonstrates how the importance weights of DMs influence the final result.
In this example, we assume that three criteria, 1 , 2 and 3 , are assessed using the linguistic
variables in Table 4.2 by a group of two decision makers, 1 and 2 . In order to show the
influence of the importance weights of the DMs on the final result, two situations are
investigated when the DMs have the following different weights:
A. 1 = 0.2 , 2 = 0.8 this means 2 is more important and powerful than 1
B. 1 = 0.8 , 2 = 0.2 this means 1 is more important and powerful than 2
Assume that a questionnaire is used to collect the DMs opinions regarding the importance
level of the criteria and the product of the questionnaire is a decision matrix as follows:
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1 2 1 2
1 (6,7,8) (4,5,6)
= = 1
2 ( ) 2 ((1,1,1) (8,9,10))
3 3 (2,3,4) (1,1,1)
From the steps of the FDE method, a result was obtained through equations (4.22 and 4.23)
by using Microsoft Excel, and is shown in Table (4.3). It can be seen from Table 4.3, for
situation A where the weight vector for the two DMs is = (0.2, 0.8), that 2 , with the
highest evaluation index, 7.4, is the top criterion among all of the criteria. However, for
situation B, where 1 is more important than 2 , 1 is the top criterion. In more detail, it
can be seen from Table 4.3 that the judgement of 2 , with the highest importance weight,
2 = 0.8 , and who gave the judgement, Very Important (VI), for 2 , has a strong influence
on the final results. On the other hand, for situation B, the final results in Table 4.3 are
dependent on 1 , who has the highest importance weight, 1 = 0.8. In situation B, 1 ,
the highest importance DM, gave the judgement, Important (I), for 1 , which was in first
place with the highest value of evaluation index, 6.6. Therefore, it can be argued that the final
results, by applying the modified FDE method, tend to be influenced by the importance
weights of the DMs in the group.
Table 4.3: The Proposed FDE Results
Criteria Situation A Situation B

1 5.4 6.6
2 7.4 2.6
3 1.4 2.5
To sum up, the conventional FDE method is modified to encompass the DMs opinions in the
creation of an improved criteria selection and in the screening of alternate criteria within one
investigation. The main advantage of the proposed FDE method for collecting group
decisions is that the importance weights of each DM in the group are considered in this
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method. In addition to the fuzzy aspects in human thinking, uncertain and subjective
judgements can also be indicated. Moreover, it reduces the number of criteria, which make
the MCDM model simpler. In this proposed method, more objective criteria can be screened
through the statistical results and the final product is a list of critical and key criteria.
Ultimately, the investigation time and costs are reduced in this proposed method compared
with the traditional DE method.
4.3.3 The Extended Fuzzy Decision Making Trial and Evaluation Laboratory Method
The classical Decision Making Trial and Evaluation Laboratory (DEMATEL) (Gabus &
Fontela, 1972, 1973) method has been successfully applied in many fields to evaluate the
dependencies and relationships among elements (e.g. clusters, criteria, or alternatives) using
crisp values. It is a powerful method that helps in gathering group knowledge for forming a
structural model, as well as in visualising the causal relationship between complex factors
through a cause-effect diagram and a dependency matrix. The matrices or diagrams represent
a contextual relation between the factors in the system, in which a numeral stands for the
strength of influence. Additionally, the DEMATEL method may be further used to divide the
causal elements and affected elements in a MCDM model, such as the AHP or ANP method
(Saaty, 1980, 1996). It allows DMs to analyse, as well as solve, visible problems. In doing so,
DMs can separate multiple measurement elements into groups based on cause and effect to
identify causal relationships.
However, in real world situations, crisp values are inadequate to deal with the ambiguities of
human judgements. In other words, human judgements about preferences are often unclear
and hard to estimate by exact numerical values. Thus, FST (Zadeh, 1965) is applied to the
DEMATEL method for gathering group ideas and analysing the cause-effect relationship of
MCDM problems in fuzzy environments. In the literature, many researchers employ the
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Fuzzy DEMATEL method (Chen-Yi et al., 2007; Lin & Wu, 2008; Jassbi et al., 2011; Chou
et al., 2012; Buyukozkan & Cifci, 2012) by using linguistic assessments instead of numerical
values. Indeed, they consider the fact that human assessments and preferences are often
uncertain due to the subjective nature of human judgements and are not easy to estimate by
crisp numerical values. According to the definition of Fuzzy DEMATEL, the linguistic
matrices present the relationships between factors. In the matrices, the numeral value
represents the influence of each factor. Therefore, the Fuzzy DEMATEL method can
transform the cause and effect relationship into a visible structural model.
Nevertheless, to our knowledge, no study using the Fuzzy DEMATEL method has considered
the importance weights of members in group decision making. Often, in a group decision
making process, this has its logical drawbacks. In the real world, the group decision is heavily
influenced by the importance weights of the members. For example, the judgements/opinions
of the executive manager of a company or the president of an organisation, or even of some
experts who are more experienced than others, might have more effect on the final decision.
Moreover, the DMs have different importance weights, which reflect their experience and
knowledge. Therefore, it is necessary to take the importance weights of the DMs into
consideration in the process of Fuzzy DEMATEL.
In particular, it is inappropriate to use the existing Fuzzy DEMATEL method to deal with
group decision making problems, which consider the importance weights of each expert.
Thus, an extended Fuzzy DEMATEL method, which takes into account the importance
weights of DMs in a fuzzy environment, is proposed.
4.3.3.1 The DEMATEL Method
Before describing the new proposed Fuzzy DEMATEL method, it is essential to discuss the
fundamental steps in the classical DEMATEL method.
129
The calculation steps of the classical DEMATEL are as follows (Lee, et al., 2010; Yang &
Tzeng, 2011):
Step 1: Generating a direct relation matrix. Experts/DMs are asked to point out the degree
that each element, , affects each other element, , and this is denoted as , assessed on a
scale designed on five levels: 0 (no influence), 1 (low influence), 2 (medium influence),
3 (high influence), and 4 (very high influence). The assessments by each expert will give us
an initial experts direct matrix, , where is the number of experts ( = 1,2, , ). The
diagonal elements of each matrix, , are all set to zero. The initial experts direct matrix
can be represented as:
1 2 ..
1 0 12 1

= [
]
= 2
. 21 0 2 (4.24)

( 1 2 0 )
where is the number of elements, and , = 1,2, . .
Then the initial experts direct matrix is used to acquire the direct-relation matrix:
1
= =1[ ] = [ ] (4.25)
Step 2: Calculating a normalised direct relation matrix. Based on the direct relation
matrix, , the normalised direct relation matrix, , can be obtained through the following
equation:
= (4.26)
1
= , , = 1,2, . . ,
max1
=1
Step 3: Developing a total relation matrix. Once the normalised direct relation matrix, , is
obtained, the total relation matrix, , or as it is called, the dependency (direct/indirect
relation) matrix can be obtained from the following equation:
= ( )1 (4.27)
130
Where, is the identity matrix.
Step 4: Setting a threshold value. This step is needed to isolate minor effects presented in the
total relation matrix, , and then to obtain an appropriate cause-effect diagram. Therefore,
DMs must set a threshold value () for the influence level. Only some elements, whose
influence level in the total relation matrix, , are higher than the threshold value, can be
chosen and converted into the cause-effect diagram.
Step 5: Drawing out a cause-effect diagram. The sum of rows and the sum of columns are
denoted as vector and vector through the following equations:
= [ ] , , = 1,2, . . , , (4.28)
= [ ]1 = [=1 ] , (vector is the sum of rows from )

1
= [ ]`1 = [=1 ]1 , (vector is the sum of columns from ).
where superscript ` denotes transpose.
The cause-effect diagram, or impact relation map (IRM), can be obtained by mapping the
dataset of the ( + , ) . Indeed, the horizontal axis ( + ) is named Relation,
which deciphers how much importance the element has, whereas the vertical axis ( ) is
named Influence, which separates elements into a cause group and an effect group.
Generally, when the ( ) is positive, then the element is affecting other elements and
belongs to the cause group. Otherwise, if ( ) is negative, then the element is being
influenced by others and belongs to the effect group.
Step 6: Obtaining the dependency matrix. In this step, the sum of each column in =
[ ] , , = 1,2, . . , , is equal to one by the normalisation method, and thus the
dependency matrix can be obtained.
131
4.3.3.2 The Proposed Extended Fuzzy DEMATEL Method
Based on the existing Fuzzy DEMATEL method (Lin & Wu, 2008; Jassbi, et al., 2011), new
extended Fuzzy DEMATEL method is described as follows:
Step 1: Producing initial fuzzy direct relation matrices. In this step, a decision group of
experts/DMs are asked to make sets of pairwise comparisons in linguistic terms to measure
the relationships between each element, = {1 , 2 , . }. To deal with uncertainty in
human opinions and judgements, the crisp comparison scale used in the crisp version of
DEMATEL is rejected. Thus, to treat the ambiguities due to human feelings and evaluations,
the different degrees of influence are expressed with five linguistic terms, which are
Strong Influence, High Influence, Medium Influence, Low Influence, and No
Influence, which correspond to the triangular fuzzy numbers shown in Table 4.4 and Figure
4.5.
Table 4.4: Linguistic Variables for the New Extended Fuzzy DEMATEL Method
Triangular fuzzy numbers Linguistic terms Fuzzy scale

No Influence (No) (1,1,1)

Very Low Influence (VLI) (2,3,4)

Low Influence (LI) (4,5,6)

High Influence (HI) (6,7,8)

Very High Influence (VHI) (8,9,10)
NI LI MI HI SI
1
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0
1 2 3 4 5 6 7 8 9 10
Figure 4.5: Triangular Fuzzy Numbers for the New Extended Fuzzy DEMATEL Method
132
Hence, fuzzy matrices, 1 , 2 , , , each corresponding to an expert/DM, are
obtained. For simplicity, denote as:
1 2 ..
1 0 12 1

= [
] = .2
21 0 2 (4.29)

2 0
( 1 )

= 1,2, . ; and = ( , , ), denotes the degree to which the element
influences the element . Fuzzy matrix, , is called an initial fuzzy direct relation matrix
for expert .
Step 2: Computing a normalised fuzzy direct relation matrix. As soon as the initial fuzzy
direct relation matrices are obtained, the normalised fuzzy direct relation matrices can be
acquired by using the following formulas:

= =1 = (=1 , =1 , =1, ) (4.30)
= max1 (=1 ) = 1,2, . ;
Then we can obtain the direct relation matrix, :
11 12 1

22 2 ; = = ( ,

= 21 , ) (4.31)

( 1 2 )
In this method, we assume that at least one satisfies =1 < , as in the classical
DEMATEL method. The normalisation method mentioned above is to preserve the property
that the range of a normalised triangular fuzzy number, , belongs to the closed interval
[0,1].
133
Furthermore, an aggregation method is used to calculate the aggregated normalised fuzzy
direct relation matrix, , by taking into account the importance weights of the DMs. Here, the
Fuzzy WAM method is used for the aggregation, as follows:
11 12 1

22 2
= ( 21 ); = =1 (4.32)

1 2
where:
is the importance weight of expert , > 0 ; =1 = 1, and the number of experts/
DMs;
refers to the aggregated normalised (group) fuzzy assessments of the relation between
element and .
refers to the normalised fuzzy assessment between element and as assessed by
expert .
refers to the aggregated normalised fuzzy direct relation matrix.
Unlike the existing Fuzzy DEMATEL method, the Fuzzy WAM method is used in the
aggregation stage of the extended Fuzzy DEMATEL method instead of the arithmetic mean.
As a result, the Fuzzy WAM takes into account the DMs importance weights. In other
words, the significant feature of the Fuzzy WAM is its capability to consider the weights of
importance of the decision makers.
Step 3: Deriving a fuzzy total relation matrix. After obtaining the aggregated normalised
fuzzy direct relation matrix, , the fuzzy total relation matrix, , can be developed using the
formula below:
1
= ( ) (4.33)
We should ensure that the convergence of lim = 0
134

11
12
1

21 22 2
= ( ); where = ( , , ) , then

1 2
Matrix [ ] = ( )1 ,
Matrix [ ] = ( )1 ,
Matrix [ ] = ( )1.
where , and are crisp matrices, whose elements are elicited from , as follows:
0 12 1 0 12 1 0 12 1
2
21 0 2 21 0 21 0 2
= ( ) ; = ( ) ; = ( )

1 2 0 1 2 0 1 2 0
Step 4: Producing a cause-effect diagram. In order to map a cause-effect diagram, the sum of
rows and the sum of columns are denoted as vector and vector through the following
equations:
= [ ] , , = 1,2, . . , , (4.34)
= =1 ( = 1,2, . . , )
= =1 ( = 1,2, . . , )
To acquire the cause-effect diagram, a suitable fuzzy ranking method should be applied. In
this study, the CFCS (Converting Fuzzy data into Crisp Scores) fuzzy ranking method is
adopted. This is because the CFCS method can give a better crisp value than other fuzzy
ranking methods. Moreover, it may be used for converting fuzzy numbers within an MCDM
model with a mixed set of crisp and fuzzy criteria (Opricovic & Tzeng, 2003).
denotes their crisp values:

= ( , , ), = 1,2, , be TFNs and
Let
Computing = min( ); = max( ); = 1,2, and =
Then:
135
( )(+ )2 ( )+( )2 (+ )2
= +
2 2
(4.35)
(+ )(+ ) ( )+( )(+ ) (+ )
Then, the cause-effect diagram can be obtained by mapping the dataset of the ( ( +

) , ( ) )by using the CFCS method. Indeed, the horizontal axis ( + ) is

named Relation, whereas the vertical axis ( ) is named Influence, which
separates elements into a cause group and an effect group. According to the cause-effect
diagram, when ( ) is negative and ( + ) close to the zero (has a very small
value), this means that element is more independent and that is influenced by only a few
elements. When ( ) is positive and ( + ) is close to zero (has a very small
value), this means that element is also independent and that influences only a few
elements (Lin & Wu, 2008; Jassbi, et al., 2011).
Step 5: Setting the threshold. A threshold value for the influence level is needed to delete
unimportant relations and to structure the impact relation map (IRM). Only elements whose
influence value in matrix T is higher than the threshold value can be chosen and converted
into the SPCJM for calculating criteria relative weights.
The form of the SPCJM depends on the IRM. In order to demonstrate how the SPCJM can be
structured, Yu and Tseng (2006), and Liou et al. (2007) offer two simple cases that both
involve three clusters to illustrate how to form the SPCJM in accordance with different IRM
structures (see Figure (4.6)). Case 1 is much simpler than case 2 and, based on each IRM
structure, the SPCJMs are given under each. For example, in case 1, 13 is a matrix that
represents the influence of cluster 1 with respect to cluster 3, matrix 21 represents the
influence of cluster 2 with respect to cluster 1 and so on.
136
Figure 4.6: Two Simple Cases (source: adapted from Tseng, 2006 and Liou et al., 2007)
4.3.3.3 Numerical Example
A hypothetical example is designed here to demonstrate the calculation process for the
extended Fuzzy DEMATEL method proposed in the earlier section. Furthermore, this
example demonstrates how the importance weights of DMs affect the final result and the
cause-effect diagram.
Suppose that the proposed fuzzy DEMATEL method was employed for capturing the
complex relationships among three factors, , and , by a group of two DMs.
Through the fuzzy linguistic scale (see Table 4.4), the relationships between each pair of
factors are measured and each individual assessment of the two DMs is obtained. The
assessment data of 1 and 2 , represented as 1 and 2 respectively, are shown as
follows:

0 SI 0 (8,9,10) (6,7,8)
1 =
( 0 ) = ((1,1,1) 0 (1,1,1))
0 (2,3,4) (1,1,1) 0

0 SI 0 (1,1,1) (8,9,10)
2 =
( 0 ) = ((6,7,8) 0 (6,7,8) )
0 (2,3,4) (1,1,1) 0
137
In order to demonstrate the influence of the importance weights of the DMs on the final
result, two different scenarios are investigated, in which both DMs have different weights, as
follows:
First scenario: 1 = 0.2 , 2 = 0.8 , which means 2 is more important and powerful
than 1 .
Table 4.5 shows the final results of applying the extended Fuzzy DEMATEL method
when 2 is more important and powerful than 1 . From the initial fuzzy direct relation
matrices, 1 and 2 , the aggregated normalised fuzzy direct relation matrix, , was
obtained by formulas (4.30-4.32). Next, the fuzzy total relation matrix, , was acquired by
formulas (4.33-4.34). Then, the total relation matrix, () , was obtained by formula (4.35).
Finally, the cause-effect diagram (Figure 4.7) can be acquired by mapping a dataset of (( +
) , ( ) ) (Table 4.5). Figure 4.7 shows that factor has the highest value for its
interaction influence level ( 0.8946 ) on other factors. This is because 2 , the most
important of the two DMs, gave a high assessment in measuring the influence level for
factor on the other two factors. The factors and belong to the cause group and have
influence on each other as well as on . The factor is a purely influenced factor as
indicated by its value (1.0548).
Table 4.5: The Results of the Extended Fuzzy DEMATEL Method (First Scenario: = . , = . )
The aggregated normalised fuzzy direct relation matrix
A B C
A (0,0,0) (0.14, 0.15, 0.16) (0.47, 0.53, 0.59)
B (0.31, 0.36, 0.41) (0,0,0) (0.31, 0.36, 0.41)
C (0.12, 0.18, 0.24) (0.06, 0.06, 0.06) (0,0,0)

The fuzzy total relation matrix,
A B C
138
A (0.132,0.214,0.328) (0.193, 0.226, 0.269) (0.588, 0.723, 0.893)
B (0.403, 0.531, 0.6) (0.088,0.121,0.167) (0.527, 0.685, 0.890)
C (0.163, 0.255, 0.368) (0.090, 0.11, 0.137) (0.104,0.174,0.273)

)
The total relation matrix, (
A B C
A 0.2213 0.2283 0.7305
B 0.5392 0.1241 0.6954

C 0.2595 0.116 0.1805
)
+
( 2.2003 1.8226 2.1581
)

( 0.1602 0.8946 -1.0548
Figure 4.7: Cause-Effect Diagram (First Scenario: = . , = . )
Second scenario: 1 = 0.8 , 2 = 0.2 , which means 1 is more important and powerful
than 2 .
Table 4.6 and Figure 4.8 illustrate the final result and the cause-effect diagram for the second
scenario. As shown in Figure 4.8, the factors are divided into the cause group, which includes
(which is affecting other elements), and the effect group, including and (which are
being influenced by other elements). has the highest interaction influence level (0.6857) on
other factors and it belongs to the cause group. Thus, is the most influencing factor because
it has the highest intensity of relationships with other factors. This is because 1 , the most
139
important DM, provides the highest assessment (i.e. Strong Influence) in measuring the
influence level for factor .
Table 4.6: The Results of the Extended Fuzzy DEMATEL Method (Second Scenario: = . , = . )
The normalised fuzzy direct relation matrix
A B C
A (0,0,0) (0.37, 0.41, 0.46) (0.37, 0.42, 0.48)
B (0.12, 13, 0.14) (0,0,0) (0.12, 0.13, 0.14)
C (0.11, 0.17, 0.23) (0.06, 0.06, 0.06) (0,0,0)

The fuzzy total relation matrix,
A B C
A (0.1036,0.1632,0.243) (0.4322, 0.5117, 0.6074) (0.4563, 0.5603, 0.6855)
B (0.1478, 0.181, 0.222) (0.0647,0.0872,0.1169) (0.1814, 0.2202, 0.2682)
C (0.1341, 0.209, 0.296) (0.1098, 0.1493, 0.2020) (0.0623,0.1083,0.1714)
)
The total relation matrix, (
A B C
A 0.1679 0.5153 0.5650
B 0.1829 0.0888 0.2222

C 0.2117 0.1522 0.1121
)
+
( 1.8106 1.2503 1.3753
)

( 0.6857 -0.2625 -0.4232
Figure 4.8: Cause-Effect Diagram (Second Scenario: = . , = . )
140
From the two diagrams in Figure 4.7 and Figure 4.8, it can be argued that the cause-effect
diagram resulting from applying the extended Fuzzy DEMATEL is heavily influenced by the
importance weights of DMs in the group. Therefore, the approach presented here is much
closer to the real world than the existing Fuzzy DEMATEL method.
To recap, the proposed Fuzzy DEMATEL method has some attractive features. It represents
the degrees of direct influence between pairwise elements (which could be clusters, criteria,
or alternatives) as fuzzy numbers in order to model uncertainty and imprecise judgements by
members of the group. It takes into account the importance weights of each DM and presents
those these weights as crisp numbers, which are used in a fuzzy aggregation method. It
obtains the influence levels of each element with respect to the others, then adopts these
influence level values as the basis of the SPCJM to obtain the relative importance (weight)
for the criteria.
4.3.4 The New Group Fuzzy Prioritisation Method
In this section, a new group version of the non-linear FPP method (Mikhailov, 2003) is
proposed by introducing importance weights of DMs. It is named the new Fuzzy Group
Prioritisation (FGP) method. A paper has been published by the author to establish this
proposed method13 (Almulhim, et al., 2013).
The proposed method has some attractive features. It does not require any aggregation
procedures. Moreover, it does not require a fuzzy ranking procedure and derives crisp
priorities/weights from an incomplete set of fuzzy judgements and incomplete fuzzy PCJMs.
In the following sections, the representation of the fuzzy group prioritisation problem is
briefly explained first. Afterwards, the initial version of the FPP method is described. Then,
13
Please see APPENDIX A for more details.
141
the proposed method is presented. Finally, illustrative numerical examples are used to show
the proposed prioritisation method.
4.3.4.1 Representation of the Fuzzy Group Prioritisation Problem
Consider a group of DMs ( ; = 1,2, . . ) that evaluates elements, 1 , 2 , . ., (in
MCDM, these elements could be clusters, criteria, sub-criteria or alternatives). With respect
to some fixed preference scale, each DM assesses the relative importance of any two
elements ( , )(, = 1,2, . . , ) by providing a ratio judgement , specifying by how
much is preferred/not preferred to .
In a fuzzy environment, suppose that each DM provides a set, , of fuzzy comparison
(1)
judgements, = { }, , where = 1,2, . . , 1, > , = 1,2, . . , , =
2
1,2, . . , and those judgements are represented as triangular fuzzy numbers, =

( , , ) , where , and are the lower, the mode and the upper
bounds, respectively.
The set can be used to derive a Fuzzy PCJM in the form (4.36):

(1,1,1) (12

, 12 , 12 ) (1 , 1 , 1 )

(21 , 21 , 21 ) (1,1,1) (2

, 2 , 2 )
= (4.36)

( (1 , 1 , 1 ) (2 , 2 , 2 ) (1,1,1) )
Then, the fuzzy group prioritisation problem is to determine a crisp priority vector (crisp
weights), = (1 , 2 , . , ) , from such that ( = 1,2, . . ) represents the relative
importance weights of the elements.
142
4.3.4.2 The Non-linear Fuzzy Preference Programming (FPP) Method
The original Fuzzy Preference Programming (FPP) method, proposed by Mikhailov (2003),
utilises the concept of alpha-cuts (or -level sets) for the fuzzy judgements to obtain interval
judgements, and applies an interval prioritisation method to produce crisp priorities for each
interval. The judgements are represented by triangular fuzzy numbers, and the -level
expresses the degree of confidence of the DMs in the judgements they make. Then, the fuzzy
prioritisation problem is transformed into an optimisation problem that maximises the DMs
overall satisfaction with the final optimal solution. However, this method has some
drawbacks. Firstly, it needs a number of -levels, which transfer the fuzzy judgements into
an interval series. It then requires an additional aggregation technique to obtain the priority
vector at different -levels. Consequently, this process is time consuming due to the several
computation steps needed for applying the -cuts concept. In order to avoid some of these
steps, a non-linear FPP method has been proposed by Mikhailov (2003).
The non-linear FPP method derives a priority vector, = (1 , 2 , . , ) , which
satisfies:

(4.37)

denotes fuzzy less than or equal to. If is the overall number of fuzzy group
where
comparison judgements, then 2 fuzzy constraints of the type (4.38) are obtained.
0
+ (4.38)
For each fuzzy judgement, Mikhailov (2003) constructed a membership function, which
represents the DMs satisfaction with different crisp solution ratios, and which is linear with

respect to ( ):
143

( )
, ( )

( ) = (4.39)
( )
, ( )
{
The solution to the prioritisation problem using the FPP method is based on two assumptions
(Mikhailov, 2000).
The first one requires the existence of a non-empty fuzzy feasible area, on the ( 1)
dimensional simplex 1 ,
1 = {(1 , 2 , . , ), > 0, =1 = 1} (4.40)
This should be defined as an intersection of the membership function. The membership
function of the fuzzy feasible area is given by:
() = [min{1 (), 2 (), , 2 () } , =1 = 1] (4.41)
According to Mikhailov (2000), the second assumption identifies a selection rule, which
determines a priority vector, having the highest degree of membership in the aggregated
membership function as described in (4.41). Thus, there is a maximising solution, (a crisp
priority vector) that has a maximum degree of membership, (the consistency index), in ,
such that:
= ( ) = max[min{1 (), 2 (), , 2 () } , =1 = 1] (4.42)
A new decision variable, , is introduced which measures the maximum degree of
membership in the fuzzy feasible area, . Then, the optimisation problem (4.42) is
transformed into:
144
(4.43)
()
=1 = 1 , > 0, , = 1,2, . . , >
The above max-min optimisation problem (4.43) is transformed into the following non-linear
optimisation problem:
(4.44)
( ) + 0
( ) + 0
= 1,2, . . 1; = 1,2, . . ; >
=1 = 1 , > 0, = 1,2, . .
The non-linear FPP method can be extended for solving group prioritisation problems.
Mikhailov et al. (2011) propose a Weighted FPP method for the fuzzy group prioritisation
problem by introducing the importance weights of DMs. However, the Weighted FPP method
requires an additional aggregation technique to obtain the priority vector at different -levels.
Consequently, this process is time consuming due to the several computation steps needed for
applying the -cuts concept. Therefore, this study modifies the non-linear FPP method
(Mikhailov, 2003), which can derive crisp weights without using -level cuts and by
introducing the DMs importance weights.
145
4.3.4.3 The New Fuzzy Group Prioritisation (FGP) Method
When we have a group of DMs, the problem is to derive a crisp priority vector, such that

the priority ratios, , are approximately within the scope of the initial fuzzy judgements,

= ( , , ), provided by those DMs. For example:

(4.45)

The ratios, , can also express the satisfaction of the DMs, because the ratios describe
how similar the crisp solutions are to the initial judgements from the DMs.
The inequality (4.45) can be represented as two single-side fuzzy constraints of the type
(4.38):

0, = 1,2, . . , = 1,2, 2 (4.46)
The degree of the DMs satisfaction can be measured by a membership function with respect

to the unknown ratio, :

( )

, ( )

( ) = (4.47)

( )

, ( )

{
We can define fuzzy feasible areas, , as the intersection of the membership functions
(4.47), corresponding to the -th DMs fuzzy judgements, and define the group fuzzy feasible
area, = .
By introducing a new decision variable, , which measures the maximum degree of
146
membership of a given priority vector in the fuzzy feasible area, , we can formulate a
max-min optimisation problem of the type (4.43), which can be represented as:
(4.48)
( )
=1 = 1 , > 0, = 1,2, . . , = 1,2, , = 1,2, 2
In order to introduce the DMs importance weights, let us define as the importance weight
of ; = 1,2, . . . To aggregate all individual models of type (4.48) into a single group
model, a weighted additive goal-programming (WAGP) model (Tiwari, et al., 1987) is
applied.
The WAGP model transforms the multi-objective decision making problem into a single
objective problem. Therefore, it can be used to combine all individual models (4.48) into a
new single model by taking into account the DMs importance weights.
The WAGP model considers the different importance weights of goals and constraints. In this
approach a DM assigns differential weights as coefficients of the individual terms in the
simple additive fuzzy achievement function to reflect their relative importance (Tiwari, et al.,
1987). The WAGP model is formulated as:
() = =1 () + =1 () (4.49)

=1 + =1 = 1
where:
are membership functions for the -th fuzzy goal , = 1,2, . . , ;
147
are membership functions of the -th fuzzy constraints , = 1,2, . . , ;

is the vector of decision variables;
are weighting coefficients that show the relative importance of the fuzzy goals;
are weighting coefficients that show the relative importance of the fuzzy constraints.
A single objective model in WAMP is the maximisation of the weighted sum of the
membership functions, and .

By introducing new decision variables, and , the model (4.44) can be transformed into a
crisp single objective model, as follows:
=1 + =1 (4.50)
(), = 1,2,
(), = 1,2,

+ = 1
=1 =1
, [0,1], , 0
In order to derive a group model, where the DMs have different importance weights, we
exploit the similarity between the models (4.48) and (4.50).
However, the non-linear FPP model (4.48) does not deal with fuzzy goals; it just represents
the non-linear fuzzy constraints. In this case, the coefficients will be zero in the model
4.50.
Thus, by taking into account the specific form of

0 , and introducing the
importance weights of the DMs, the problem can be further presented as a non-linear
programme by utilising the WAGP model, as follows:
148
=
=1 (4.51)

( ) + 0

( ) + 0
= 1,2, . . 1; = 1,2, . . ; > ; = 1,2, . .
=1 = 1 ; > 0; = 1,2, . .
where the decision variable, , measures the degree of DM satisfaction with the final
priority vector, = (1 , 2 , . , ) , denotes the importance weight of the -th
DM, = 1,2, . . .
In (4.51), the value of can be considered as a consistency index, as it measures the overall
consistency of the initial set of fuzzy judgements. When the set of fuzzy judgements is
consistent, the optimal value of is greater or equal to one. For inconsistent fuzzy
judgements, the maximum value of takes a value less than one.
However, the proposed model requires a non-linear optimisation procedure which leads to
very complex computation process. Therefore, in this study two techniques were be used to
solve the proposed model. The first technique was using LINGO V13.0 software ( see section
4.3.4.4). Whereas the second technique was applying the optimization tool box in the Matlab
software (refer to section 5.5 in chapter five).
4.3.4.4 Illustrative Examples
In this section two numerical examples are used to explain the proposed approach. The first
example illustrates the solution to the fuzzy group prioritisation problem for obtaining a
priority vector and a final group ranking. The second example demonstrates how the
149
importance weights of DMs influence the final group ranking.
Example 1
This example is given to illustrate the proposed method and the final solution. We consider
the example in (Mikhailov, et al., 2011), where three DMs ( = 3) assess three elements
(1 , 2 , 3 ) and the importance weights of the DMs are given as: 1 = 0.3, 2 = 0.2, 3 =
0.5 .
The DMs provide an incomplete set of five fuzzy judgements, presented as triangular fuzzy
numbers:
1 : 12 1 = (1,2,3); 13 1 = (2,3,4);
2 : 12 2 = (1.5,2.5,3.5) ; 13 2 = (3,4,5);
3 : 12 3 = (2,3,4).
Thus, the incomplete fuzzy PCJMs can be written as follows:
1 2 3
(1,1,1) (1,2,3) (2,3,4)
1 1 1
1 = ( , , 1) (1,1,1)
2 3 2
3 1 1 1
( , , ) (1,1,1)
( 4 3 2 )
1 2 3
(1,1,1) (1.5,2.5,3.5) (3,4,5)
1 1 1 1
2 = ( , , ) (1,1,1)
2 3.5 2.5 1.5
3 1 1 1
( , , ) (1,1,1)
( 5 4 3 )
1 2 3
(1,1,1) (2,3,4)
1
3 = 1 1 1
2 (( , , ) (1,1,1) )
3 4 3 2
(1,1,1)
150
The group fuzzy prioritisation problem is to derive a crisp priority vector, = ( 1 ,
2 , 3 ) , that approximately satisfies the following fuzzy constraints:
1
For 1 : 1 1
3 ,2 4
2 3
1
For 2 : 1.5 1
3.5, 3 5
2 3
1
For 3 : 2 4
2
Using the above data and the non-linear model (4.51), the following formulation is obtained:
Max = 0.3 1 + 0.22 + 0.5 3 (4.52)
1 2 1 + 2 0
1 2 + 1 32 0
1 3 1 + 23 0
1 3 + 1 43 0
2 2 1 + 1.52 0
2 2 + 1 3.52 0
2 3 1 + 33 0
2 3 + 1 43 0
3 2 1 + 22 0
3 2 + 1 42 0
1 + 2 + 3 = 1
1 0 , 2 0, 3 0
Using LINGO V13.0 software, the solution to the above non-linear problem (4.52) is found
as:
1 = 0.623 , 2 = 0.216, 3 = 0.161

1 = 0.123 , 2 = 0.623, 3 = 0.876
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The maximum value of the objective function is = 0.600. Thus,
= (0.623 , 0.216, 0.161) is a crisp priority vector generated from the group fuzzy
judgements set by selecting the solution that has the highest degree of membership of the
fuzzy judgements set. Also, it can be seen that the consistency index value is = 0.600,
which means that the fuzzy judgements are slightly inconsistent, since the consistency index
is non-negative ( is less than one).
This solution can be compared with the crisp results from the example in (Mikhailov, et al.,
2011) as shown in Table 4.7. We may observe that we have the same final ranking, 1 >
2 > 3 , from applying the two different prioritisation methods. However, the Weighted
FPP method (Mikhailov, et al., 2011) applies an aggregation procedure for obtaining the crisp
vector from different values of priorities at different - threshold. The proposed FGP method
does not require an additional aggregation procedure.
Table 4.7: Results from the Two Prioritisation Methods
Method 1 2 3
Weighted FPP method* 0.615 0.205 0.179
FGP method** 0.623 0.216 0.161
* The method proposed by Mikhailov et al. (2011) with application of - cut

** The method proposed in this study without applying - cut
If the third DM, who has the highest importance weight, provides a new fuzzy comparison
judgement, 32 3 = (1,2,3), which means that the third element is about twice as important
as the second element, the weights obtained by using the proposed non-linear FFP method
are:
1 = 0.538 , 2 = 0.170, 3 = 0.292 and the final ranking is 1 > 3 > 2 .
Consequently, it can be observed that the third DMs judgements strongly influence the final
152
ranking. However, if the importance weight of the third DM is lower than the first two DMs
weights, then the new fuzzy comparison judgement does not change the final ranking. Thus,
we can see the significance of introducing importance weights of the DMs to the fuzzy group
prioritisation problem.
Example 2
This example shows that the importance weights of the DMs influence the final group
results. Consider that two DMs ( = 2) assess three elements ( = 3). The DMs provide an
incomplete set of four fuzzy judgements ( = 4) presented as TFNs:
1 : 12 1 = (1,2,3); 131 13 1 = (2,3,4);
2 : 212 21 2 = (3,4,5); 13 2 = (2,3,4) .
Two situations are investigated in which the DMs have the following different weights:
1. 1 = 0.2, 2 = 0.8
2. 1 = 0.8, 2 = 0.2
As a result, the incomplete fuzzy PCJMs can be written as follows:
1 2 3
(1,1,1) (1,2,3) (2,3,4)
1 1 1
1 = ( , , 1) (1,1,1)
2 3 2
3 1 1 1
( , , ) (1,1,1)
( 4 3 2 )
1 2 3
(1,1,1) (3,4,5) (2,3,4)
1 1 1 1
2 = ( , , ) (1,1,1)
2 5 4 3
3 1 1 1
( , , ) (1,1,1)
( 4 3 2 )
For both situations, the final rankings for both individual DMs are shown in Tables 4.8 and
4.9 respectively. The final group rankings are shown in Tables 4.8 and 4.9 (the third row for
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each table). The results are obtained by using LINGO V13. Each final group ranking is
obtained by solving a non-linear programme of type (4.52), which includes eight non-linear
inequality constraints corresponding to the fuzzy comparison judgements given by the
DMs.
It can be observed from Tables 4.8 and 4.9 that the final group ranking tends to be the
individual ranking of the DM who has the highest importance weight. In more detail, it can
be seen from Table 4.8 that the judgements of the second DM, with the highest importance
weight ( 2 = 0.8), influence the final group ranking more strongly. On the other hand, the
final group ranking in Table 4.9 depends on the first DM, who has the highest importance
weight ( 1 = 0.8).
Table 4.8: Individual and Group Results (when = . , = . )
DMs 1 2 3 Final ranking

1 0.545 0.273 0.182 1 > 2 > 3
2 0.117 0.530 0.353 2 > 3 > 1
Group 0.117 0.529 0.354 2 > 3 > 1
Table 4.9: Individual and Group Results (when = . , = . )
DMs 1 2 3 Final ranking

1 0.545 0.272 0.181 1 > 2 > 3
2 0.117 0.530 0.353 2 > 3 > 1
Group 0.402 0.397 0.201 1 > 2 > 3
From examples 1 and 2, we can observe the importance of introducing importance weights of
DMs to the fuzzy group prioritisation problem. It is seen that the final group ranking depends
on the DMs importance weights.
Characteristics of the Proposed Method
154
The proposed FGP method in this study has some beneficial aspects as follows:
(1) The proposed method derives crisp priorities/weights from group fuzzy pairwise
comparison judgements. The final results from the proposed method are non-fuzzy
numbers, so fuzzy ranking procedures are not required to be applied to convert the fuzzy
numbers to crisp numbers.
(2) The proposed method can deal with incomplete judgements. It is capable of deriving crisp
priorities from an incomplete set of DMs fuzzy judgements, including missing data from
the pairwise comparison.
(3) The proposed method takes into consideration the importance of the DMs, which affects
the derived group priorities.
(4) According to the computation time needed to solve the fuzzy group prioritisation
problem, the proposed method does not need an additional aggregation method to
aggregate the priorities at the different -levels. Therefore, the proposed method in this
paper demands less computation time than the Weighted FPP method (Mikhailov, et al.,
2011). The performance, in terms of computation time, of the proposed method has been
investigated by using LINGO V13. It was found that the proposed method performs
significantly faster compared to the Weighted FPP (Mikhailov, et al., 2011) with different
-levels ( = 0,0.2,0.5,0.8,1), as seen in Figure 4.9.
As shown in Figure 4.9, we can conclude that the average computation time (in minutes)
for the Weighted FPP method increases greatly as the number of decision elements, ,
increases, compared with the proposed method. Hence, these results show that the method
proposed in this study is more efficient, with respect to computation time. Therefore, the
proposed method in this paper demands less computation time than the Weighted FPP
method (Mikhailov, et al., 2011).
155
Figure 4.9: Average Computation Time (Minutes)
4.3.5 The Modified Fuzzy TOPSIS Method
TOPSIS is a multiple criteria method for identifying solutions from a finite set of alternatives
and was initially proposed by Chen and Hwang (1992). The underlying logic of TOPSIS,
proposed by Hwang and Yoon (1981), is to define the positive ideal solution (PIS) and
negative ideal solution (NIS). The final solution should be at the shortest distance from the
PIS and the greatest from the NIS. Human judgements usually rely on imprecision,
subjectivity and vagueness; therefore, they address fuzzy logic. Here, evaluations are
expressed by linguistic terms and then represented as fuzzy numbers. The Fuzzy TOPSIS
methodologies require preliminary information about the relative importance of the criteria.
However, although Fuzzy TOPSIS works in the group decision making field have increased
in recent years, there is no Fuzzy TOPSIS study that considers DMs importance weights.
Nevertheless, in real group decision making problems, sometimes some experts are more
experienced than others (Ramanathan & Ganesh, 1994; Van Den Honert, 2001). Therefore,
the final results should be influenced by the degree of importance of each DM. Thus, in order
156
to overcome that limitation, an extended Fuzzy TOPSIS method is proposed in this section
based on the original TOPSIS method, by introducing the importance weights of the
participants in the decision making group. The proposed method helps DMs to organise the
problems to be solved, and to carry out analysis, comparisons and rankings of the
alternatives.
The following section provides a simplified description of the original TOPSIS method.
Then, the steps of the proposed Fuzzy TOPSIS method are explained, followed by a
numerical example to highlight the procedure of applying the proposed method.
4.3.5.1 The TOPSIS Method
Suppose a MCDM problem has alternatives (1 , 2 , , ), criteria (1 , 2 , , ),
and a decision matrix represented as:
1 1 2 . . . .
2 11 12 1
= . 21 22 2 (4.53)
( )
1 2
The TOPSIS procedure consists of the following steps:
Step 1: Normalising the decision matrix.

= (4.54)

=1
2
Step 2: Calculating the weighted normalised decision matrix.
= , = 1,2, ; = 1,2, (4.55)
where is the relative weight of the -th criterion, and =1 = 1.
Step 3: Determining the positive ideal solution (PIS) and negative ideal solution (NIS).
+ = ( 1 + , 2 + , . , + ) = {max , = 1,2, . . } (4.56)
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= ( 1 , 2 , . , ) = {min , = 1,2, . . } (4.57)
Step 4: Calculating the distance of each alternative from PIS and NIS. By using the n-
dimensional Euclidean distance, the distance of each alternative from PIS is given as:
1
+ + 2 2
= {=1( ) } (4.58)
Similarly, the distance of each alternative from NIS is given as:
1
+ + 2 2
= {=1( ) } (4.59)
Step 5: Calculating a Closeness Coefficient ()/the ranking score. The is defined to
determine the ranking order for all alternatives. The of each alternative, , can be
computed as:

= ; = 1,2, . (4.60)
+
+
Step 6: Ranking the preference according to .
Nevertheless, the TOPSIS method is not a realistic way to model real life situations. Human
judgements, including preferences, are often vague, and each member in the group has
different power and importance. Consequently, it is proposed in this study to further extend
the TOPSIS concept to develop a methodology for solving group decision making problems
in a fuzzy environment and to consider the weights of each member in the group.
4.3.5.2 The New Proposed Fuzzy TOPSIS Method
A systematic approach is proposed in this section to extend the Fuzzy TOPSIS to the group
decision making problem by introducing the importance of each member/DM in the group.
This method is suitable for solving the group decision making problem in a fuzzy
environment.
158
Based on the Fuzzy TOPSIS technique proposed by Chen (2000) and Sun (2009), where the
basic principle is that the chosen alternative should have the shortest distance from the fuzzy
PIS and the longest distance from the fuzzy NIS, the new extended Fuzzy TOPSIS method is
represented as follows:
Step 1: Constructing fuzzy decision matrices. A decision group of experts is asked to rate
alternatives with respect to each criterion by using linguistic variables. Then, the linguistic
evaluation is converted to triangular fuzzy numbers, as shown in Table 4.10 and Figure 4.10.
With alternatives and criteria, fuzzy decision matrices can be expressed as (Chen, 2000):
1 2 . . . .
1
2 11 12 1

= . 21 22 2 (4.61)

( 1

2 )

where = ( , , ) is denoted as the rating of alternative with respect to
criterion , as evaluated by expert , ( = 1,2, . ), = 1,2, . , and = 1,2, . .
Table 4.10: Linguistic Variables for Rating the Alternatives
Triangular fuzzy numbers Linguistic terms Fuzzy scale

Very poor (VP) (1,1,1)

Poor (P) (2,3,4)

Fair (F) (4,5,6)

Good (G) (6,7,8)

Very Good (VG) (8,9,10)
VP P F G VG
1
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0
1 2 3 4 5 6 7 8 9 10
Figure 4.10 : Triangular Fuzzy Numbers for Rating the Alternatives
159
Step 2: Identifying the importance weights of criteria and of each member/DM in the group.
The weight of each criterion and the weight of each member/DM are computed by either
directly assigning them or indirectly using one of the PCPMs (Hsu and Chen, 1994; Choo and
Wedley, 2004).
)
Step 3: Calculating a fuzzy aggregated decision matrix. The fuzzy decision matrices (
have to be aggregated in order to determine the fuzzy aggregated decision matrix. An
aggregation method, which takes into consideration the importance weights of the
members/DMs in the group, is proposed to find the fuzzy aggregated decision matrix. Here,
the Fuzzy WAM method (Forman & Peniwati, 1998) is proposed for aggregation as follows:
11 12 1

= ( 21

22 2
); = =1 , = 1,2, . . , , = 1,2, . . , (4.62)

1 2
where:
is the importance weight of a member/DM , > 0 ; =1 = 1, and the number of
members/DMs in the decision making group.
refers to the group fuzzy rating value of alternative with respect to criterion .
refers to the fuzzy rating of alternative with respect to criterion given by expert .
refers to the fuzzy aggregated decision matrix.
Step 4: Normalising the fuzzy aggregated decision matrix. A normalisation method (Chen,
2000) is used to obtain a normalised fuzzy decision matrix. Hence, the normalised fuzzy
decision matrix, , is calculated by the following formula (Sun, 2009):
11 12 1

22 2
= ( 21 ) ; = 1,2, . , and = 1,2, . . (4.63)

1 2
Then, the normalisation process can be performed by the following formula (Chen, 2000):
160
( , , )
= ; = max , = 1,2, . . , , and = 1,2, . . , (4.64)

The normalisation process mentioned above is used to preserve the property that the ranges of
normalised triangular fuzzy numbers, , belong to the closed interval [0,1], as Chen (2000)
argued.
Step 5: Constructing a weighted normalised fuzzy decision matrix. By considering the
different crisp importance weights of criteria ( , = 1,2, . ), the weighted normalised
fuzzy decision matrix, , can be constructed as in the following matrix (Chen, 2000):
11 12 1

22 2
= ( 21 ) ; = , = 1,2, . , and = 1,2, . (4.65)

1 2
Step 6: Defining the fuzzy PIS (+ ) and the fuzzy NIS ( ). Since the triangular fuzzy
numbers, , belong to the closed interval [0,1], the Fuzzy PIS (+ ) and the Fuzzy NIS ( )
can be defined as follows (Chen, 2000):
+ = ( 1 + , 2 + , . , + ) (4.66)
= ( 1 , 2 , . , (4.67)
where + = (1,1,1) and = (0,0,0), = 1,2, . .
Step 7: Calculating the distance of each alternative from the fuzzy PIS and fuzzy NIS. The
distance ( + , ) of each alternative from + and respectively, can be calculated as:
+ = =1 ( , + ) , = 1,2, . , = 1,2, . (4.68)
= =1 ( , ) , = 1,2, . , = 1,2, . (4.69)
where ( . , . ), the measure of the distance between two fuzzy numbers, is defined in
definition 4 (see section 4.3.1.2).
Step 8: Calculating the Closeness Coefficient ()/the ranking score. The is defined to
determine the ranking order for all alternatives. Once the ( + , ) of each alternative,
( = 1,2, . ), has been calculated, the of each alternative, , can be computed as:
161

= ; = 1,2, . (4.70)
+ +
Step 9: Determining the ranking order of all alternatives. According to the , the ranking
order of the alternatives can be determined; if > , then > . Then, the best one
from among a set of feasible alternatives can be selected.
4.3.5.3 A Numerical Example
A hypothetical example is designed to demonstrate the computational process of fuzzy
TOPSIS algorithm proposed herein. In this example, let us assume that three alternatives, 1 ,
2 and 3 , are ranked using the linguistic variables in Table 4.8 by a team of two decision
makers, 1 , and 2 , with respect to three attributes/criteria, 1 , 2 and 3 , whose weight
vector is = (0.3,0.2,0.5).
The ranking data from 1 and 2 , represented as the fuzzy decision matrices by using
1 and
TFNs , 2, respectively, are shown as follows:
1 2 3 1 2 3
(1,1,1) (4,5,6) (1,1,1)
1 = 1

= 1
2 ( ) 2 ((1,1,1) (2,3,4) (2,3,4) )
3 3 (6,7,8) (1,1,1) (8,9,10)
1 2 3 1 2 3
(1,1,1) (2,3,4) (2,3,4)
2 = 1

= 1
2 ( ) 2 ((2,3,4) (4,5,6) (8,9,10))
3 3 (2,3,4) (6,7,8) (1,1,1)
To demonstrate the effect of the importance weights of the DMs on the final result, two
different scenarios are investigated, in which the DMs have different weights.
First scenario: 1 = 0.2 , 2 = 0.8 , which means 2 is more important and powerful
than 1 .
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By applying equations (4.62-4.70) using Microsoft Excel, the final results for the proposed
Fuzzy TOPSIS method are given in Table 4.11. The fuzzy aggregated, the normalised fuzzy,
and the weighted normalised fuzzy decision matrices are constructed and, together with the
closeness coefficient ( ) of each alternative, are shown in Table 4.11. According to the
closeness coefficient ( ) in Table 4.11, the ranking order of the three alternatives is 2, 3
and 1 . Obviously, the best selection is alternative 2 , with a equal to 0.25. In other
words, 2 is closer to the fuzzy PIS and farther from the fuzzy NIS.
Table 4.11: The Results of the Extended Fuzzy TOPSIS Method (First Scenario: = . , = . )
A fuzzy aggregated decision matrix

(1,1,1) (2.4,3.4,4.4) (1.8,2.6,3.4)
(1.8,2.6,3.4) (3.6,4.6,5.6) (6.8,7.8,8.8)
(2.8,3.8,4.8) (5,5.8,6.6) (2.4,2.6,2.8)
A normalised fuzzy decision matrix

(0.21,0.21, 0.21) (0.36,0.51,0.67) (0.20,0.30,0.39)
(0.38,0.54,0.7) (0.55,0.7,0.85) (0.76,0.89,1)
(0.58,0.8,1) (0.76,0.89,1) (0.27,0.30,0.32)
A weighted normalised fuzzy decision matrix

(0.06,0.06,0.06) (0.07,0.10,0.13) (0.10,0.15,0.20)
(0.11,0.16,0.21) (0.11,0.14,0.17) (0.39,0.44,0.50)
(0.18,0.24,0.30) (0.15,0.18,0.20) (0.14,0.15,0.16)
The distance measure and closeness coefficient
+ +
2.69 0.32 0.11
2.26 0.75 0.25
2.44 0.57 0.19
Second scenario: 1 = 0.8 , 2 = 0.2 , which means 1 is more important and powerful
than 2 .
Using the Microsoft Excel Solver, the final results for this scenario, applying equations (4.62-
4.70), are shown in Table 4.12. According to the closeness coefficient ( ) in Table 4.12,
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the ranking order of the three alternatives is 3 , 2 and 1 . That is to say, the best selection is
alternative 3 , with a equal to 0.26, followed by alternative 2 with a equal to 0.15.
Table 4.12: The Results of the Extended Fuzzy TOPSIS Method (Second Scenario: = . , = . )
A fuzzy aggregated decision matrix

(1,1,1) (3.6,4.6,5.6) (1.2,1.4,1.6)
(1.2,1.4,1.6) (2.4,3.4,4.4) (3.2,4.2,5.2)
(5.2,6.2,7.2) (2,2.2,2.4) (6.6,7.4,8.2)
A normalised fuzzy decision matrix

(0.14,0.14,0.14) (0.64,0.82,1) (0.14,0.17,0.20)
(0.17,0.19,0.22) (0.43,0.60,0.79) (0.39,0.51,0.63)
(0.72,0.86,1) (0.36,0.40,0.43) (0.81,0.90,1)
A weighted normalised fuzzy decision matrix

(0.04,0.04,0.04) (0.13,0.16,0.20) (0.07,0.09,0.10)
(0.05,0.06,0.10) (0.09,0.12,0.16) (0.19,0.25,0.31)
(0.22,0.26,0.30) (0.07,0.08,0.10) (0.40,0.45,050)
The distance measure and closeness coefficient
+ +
2.71 0.30 0.10
2.57 0.45 0.15
2.21 0.79 0.26
It can be observed from the above two scenarios that the final ranking order for the
alternatives is affected by the importance weights of the DMs in the group. In the first
scenario, the final ranking order is 2 > 3 > 1 , where the symbol > means superior
to. That is because the most important DM (who is 2 , with the weight 2 = 0.8)
provides the highest ranking for 2. On the other hand, in the second scenario, where 1
is more important than 2 , the final ranking order is 3 > 2 > 1 . Thus, 3 is a better
alternative than 2 , since 1 (1 = 0.8) gave the highest ranking to 3 .
Both of the above scenarios, show the significance of introducing the importance weights of
the DMs for ranking alternatives in group decision making. Thus, this proposed method is
much closer to the real world than the existing Fuzzy TOPSIS method.
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To sum up, an extension of the Fuzzy TOPSIS method for ranking alternatives in group
decision making using the importance weights of each DM within the group is proposed.
Since human judgements, including preferences, are often vague and cannot be expressed
by exact numerical values, the judgements of the group members in ranking alternatives are
presented as fuzzy numbers rather than exact numerical values, in order to model the
uncertainty and imprecision in the DMs judgements. Unlike the classical TOPSIS method,
the importance weights of individual members in the group are presented as crisp numbers,
and used in a fuzzy aggregation process. The capabilities of the proposed model are
demonstrated by using numerical examples.
In this chapter, a novel hybrid Fuzzy MCDM model was proposed to assist the DMs (i.e. the
employers) in the private sector to evaluate the process of selecting a good group health
insurance plan to insure and cover their employees. The proposed novel hybrid Fuzzy
MCDM model was developed based on several new extended methods: the extended FDE
method (used to select the critical criteria), the extended Fuzzy DEMATEL method (used to
measure dependency), the new FGP method (used to derive the relative weights of criteria),
and the modified Fuzzy TOPSIS method (used to rank the alternatives). The new extended
methods in the proposed model apply the five-level linguistic variables scale with TFNs (no
overlap between the TFNs). Nevertheless, the new extended methods are applicable to use
any linguistic variables scale by different type of fuzzy numbers (e.g. trapezoidal fuzzy
numbers) with or without overlapping.
To our knowledge, no previous work has investigated such a selection problem using an
approach that integrates the Delphi, DEMATEL, Prioritisation, and TOPSIS methods in a
fuzzy environment by taking into account the different importance of each DM in the group.
165
Unlike all of the existing hybrid Fuzzy MCDM models, the main contribution in the proposed
model is its consideration of the different importance weights of DMs in the group. As the
proposed approach is novel, it might be applied to other MCDM problems.
The new extended proposed methodologies, the extended Fuzzy Delphi, extended Fuzzy
DEMATEL, new FGP, and modified Fuzzy TOPSIS methods were detailed technically in
this chapter. Moreover, several numerical examples were presented to show the applicability
and performance of the proposed methodologies. However, these proposed new extended
methodologies have a huge number of equations, which lead to very difficult and extensive
computation processes. Thus, decision support tools are needed to overcome this difficulty.
In order to do that, in the next chapter, four prototype decision support tools, namely the
Fuzzy Delphi Solver, the Fuzzy DEMATEL Solver, the Fuzzy Group Prioritisation (FGP)
Solver, and the Fuzzy TOPSIS Solver, are developed. These decision support tools aim to
assist DMs to implement the proposed new extended methodologies for solving the MCDM
problem much more effectively and efficiently.
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5. CHAPTER FIVE: DEVELOPMENT OF THE DECISION SUPPORT TOOLS
IMPLEMENTATIONS
5.1 Introduction
In the previous chapter, the concepts of the new proposed methods: the modified FDE
method, the extended Fuzzy DEMATEL method, the new GFP method and the modified
Fuzzy TOPSIS method, were fully explained and discussed. In order to be practically applied
in the real world, decision support tools which support the new proposed methods need to be
developed. Therefore, in this chapter, four decision support tools/systems 14, termed the Fuzzy
Delphi Solver, the Fuzzy DEMATEL Solver, the Fuzzy Group Prioritisation Solver and the
Fuzzy TOPSIS Solver, will be introduced. So far, these decision support tools have been
developed as prototypes15; the future aim is to develop them, in an upcoming project, as part
of the full design of the Fuzzy MCDM system proposed in this study.
In the following section, prototype decision support tools that facilitate the application of the
new proposed methods are developed and their performances are illustrated. Before going
into detail, a starting point will be a brief introduction of the programming languages in
section 5.2. In section 5.3, the concept of applying the new modified FDE method to select
the critical criteria and reduce the number of criteria in any MCDM problem is developed as
a prototype decision support tool, which is called the Fuzzy Delphi Solver. Afterwards, a
prototype decision support tool, called the Fuzzy DEMATEL Solver, is developed in section
5.4, using the MATLAB Software, for studying dependency among attributes. This is
followed by the design and implementation of a prototype decision support tool, termed the
Fuzzy Group Prioritisation Solver, is presented in section 5.5, for deriving criteria weights.
14
All of the decision support tools are available on request.
15
A prototype is an early sample, model or release of a product built to test a concept or process, or to act as
something to be replicated or learned from. It is a term used in a variety of contexts, including semantics,
design, electronics and software programming.
167
Section 5.6 presents the design and implementation of a prototype decision support tool, the
Fuzzy TOPSIS Solver, for ranking alternatives. Finally, section 5.7 summarises the whole
chapter.
5.2 MATLAB as a Programming Language
A programming language is an artificial language designed to develop applications, scripts or
other sets of instructions for a computer to perform; it can also be used to express algorithms.
There have been over 200 higher level languages developed in the 20 years between 1952
and 1972 (Sammet, 1972), including but not limited to, APT, BASIC, C, C++, FORTRAN,
JAVA, MATLAB, etc. In recent years, compared with other programming languages,
MATLAB has become popular in prototyping algorithms because it is one of the easiest
programming languages for writing mathematical programmes (Venkataraman, 2009).
MATLAB is a high level language and interactive environment for numerical computation,
visualisation and programming. The name MATLAB stands for MATrix LABoratory and the
software is built up around vectors and matrices. It was developed by the company,
MathWorks, to allow matrix manipulation, plotting of functions and data, implementation of
algorithms, creation of user interfaces and interfacing with programmes written in other
languages, including C, C++, Java, etc. (Chapman, 2007). Because of MATLABs numerous
matrix and vector computation and manipulation algorithms, the software is mainly used for
the following (Venkataraman, 2009):
Producing solutions to complex systems of equations
Developing algorithms
Modelling, simulation and prototyping
Application development, including Graphical User Interface (GUI ) building
Data analysis, exploration and visualisation
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Scientific and engineering graphics
In addition to the standard functions offered by MATLAB, a series of application toolboxes
are available as part of the MATLAB package (Fowley, et al., 1995). These toolboxes add
specific functionality for applications, such as digital single processing, automatic control
system design, nonlinear simulation, parametric modelling, optimisation and spline analysis;
for more information refer to Fowley et al. (1995). The MATLAB family of toolboxes,
including the following:
Control System Toolbox.
System Identication Toolbox.
Neural Network Toolbox.
MMLE3 State-Space Identification Toolbox.
Optimisation Toolbox.
Mu-Analysis and Synthesis Toolbox.
Robust Control Toolbox.
Signal Processing Toolbox.
Spline Toolbox.
The MATLAB environment provides powerful numerical functions, optimisation procedures,
good visualisation capabilities, and efficient matrix and vector computation programming
interfaces. It can be utilised to translate algorithms into function code, in a fraction of the
time needed in other traditional languages, such as C or FORTRAN (Venkataraman, 2009).
In addition, the MATLAB environment allows for easy communication. Moreover,
MATLABs code is compact and it is intuitive to learn (Higham & Higham, 2005). In other
words, to make problems work MATLAB requires only a few lines of code compared with
the traditional languages. Besides, it is a globally applicable product (Venkataraman, 2009).
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Thus, this study adopted MATLAB Version R2013a as a development environment for
prototyping the new extended methods proposed in the previous chapter: the modified FDE
method, the extended Fuzzy DEMATEL method, the new GFP method and the modified
Fuzzy TOPSIS method.
5.3 Fuzzy Delphi Method Implementation
In this section, the idea of applying the new extended FDE method to select the critical
criteria and reduce the number of criteria in MCDM problems, as proposed earlier in section
4.3.2 in chapter four, is formulated as a group decision making tool and then developed as a
prototype decision support tool. The extended FDE method was proposed for collecting the
opinions of DMs in the group through a decision matrix. Thus, it needs a language which has
the ability to deal with matrix operations. MATLAB is a language, with a very good
performance, which is suitable for handling these operations. Therefore, a prototype decision
support tool, termed the Fuzzy Delphi Solver, is developed by using MATLAB in order to
implement the proposed FDE method. The development of this Solver will provide a user-
friendly interface to help the users to implement the proposed FDE method and obtain a list
of key criteria. The details of the design and implementation of the Fuzzy Delphi Solver are
given in the following sections.
5.3.1 Designing the Fuzzy Delphi System
The procedures for designing the decision support tool for the extended FDE method are
divided into four main steps as illustrated in Figure 5.1. The four steps are: descriptive data
input, judgement input, implementation of the proposed FDE method and display of the
results. In the first step, the data for initial parameters is required, including the name of the
criteria and the numbers of DMs in the group. Moreover, the DMs importance weights are
needed in this step, and these can be derived by using the non-linear FPP method, as
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discussed in section 3.5 in chapter three. These parameters are very important and must be
decided before implementing the procedures, because the whole system is operated based on
these parameters. Then, all the judgements from the DMs with regard to the level of
importance of each criterion are given in the second step. The third step includes application
of the extended FDE method by using equations (4.21-4.23), as proposed in chapter four,
section 4.3.2. Finally, all the results are to be displayed graphically as well as in a table in the
fourth step.
Start
Obtain the initial parameters (name of

Input descriptive data criteria and number of DMs, and the
importance of DMs)
Obtain the fuzzy judgment from the DMs

Input data judgment regarding the level of importance of each
criterion
Implement the proposed FDE method Obtain and screen the evaluation indexes
Present the final results and show the

Display results results graphically
End
Figure 5.1: The Fuzzy Delphi System Flow Chart
5.3.2 Interface Design The Fuzzy Delphi Solver
The interface is developed as a connected windows presentation where the users can interact
with the windows by clicking on buttons. In this study, the Fuzzy Delphi Solver interface was
developed using GUI prototyping in MATLAB. This was achieved through building screens
containing a variety of GUI components (e.g. windows, text boxes, drop-down lists, list
boxes, sliders and buttons). Behind each component are properties that provide some sort of
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functionality. A numerical example illustrates how the extended FDE method can be
implemented through using the Fuzzy Delphi Solver developed. The example given in
section 4.3.2.3 in chapter four is used here.
Consider two DMs who assess three criteria, 1 , 2 and 3 , who have the importance
weights, 1 = 0.2, 2 = 0.8 . It is assumed that the judgements measuring the level of
importance of each criterion that were given by the two DMs are shown in Table 5.1. The
goal here is to assess the level of importance of the criteria and obtain evaluation indices
which can be used to eliminate insignificant criteria.
Table 5.1: The DMs Fuzzy Judgements for Applying the FDE Method
Decision Makers
Criteria
1 2
1 (6,7,8) (4,5,6)
2 (1,1,1) (8,9,10)
3 (2,3,4) (1,1,1)
The following steps demonstrate the interface design and the process for solving the above
example through the developed Fuzzy Delphi Solver.
Step 1: Entering the descriptive data into the system. The first window that the user interacts
with when the Fuzzy Delphi Solver is running is the Welcome Window; the START button
is in the middle of the window, as displayed in Figure 5.2.
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Figure 5.2: Welcome Window for the Fuzzy Delphi Solver
Once the user clicks the START button, a new window, called the Descriptive Data
Window, replaces the previous one; this allows the user to input the descriptive data. The user
should enter the name of the criteria in the edit bar and then click the SET button to add the
criteria to the system, as shown in Figure 5.3. The entered criteria are stored and displayed in
the list-box on the left of the window; the user can delete the criteria by clicking the
DELETE button or clicking the RESET button to reopen a new blanket Descriptive Data
Window. The system automatically counts the total number of criteria, which are displayed in
the text box next to the text Total No. of Criteria. In the above given example, there are
three criteria, 1 , 2 and 3 , that were added into the system, as indicated in Figure 5.3.
Moreover, the user should also set the number of DMs in the edit bar beside the text No. of
Decision Makers; the purpose of using this function is to support the group decision
making. According to the example above, there are only two DMs; see Figure 5.3.
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Figure 5.3: Descriptive Data Window for the Fuzzy Delphi Solver
Step 2: Setting the DMs importance weights. After adding the name of criteria and the
numbers of DMs, the Descriptive Data Window asks the user if he/she wants to consider the
importance weights of the DMs or not. When the user clicks NO, the calculation functions,
the original FDE method, will run without considering the DMs importance weights. Once
the user clicks YES, the computation functions, the extended FDE method, will be run as
proposed in section 4.3.2. According to the given example, the importance weights of the
DMs are included. In this case, the user should click YES, then a new click button will be
displayed Set the importance of decision makers on the bottom of the Descriptive Data
Window; see Figure 5.3. When the user clicks on that button, a new window is displayed, the
DMs Weights Window, and the user is prompted to enter the importance weight for each DM,
as shown in Figure 5.4. In doing so, from the pull down menu on at the top of the window,
the system allows the user to select each DM in the group and assign his/her weights in the
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editing box in the centre of the window. By clicking on the SET button, the DMs weights
will be stored in the system and are shown in the display box at the bottom of the screen.
After setting the importance weights for all DMs in the system, the user then can click the
BACK button to go back to the Descriptive Data Window again and can then click on
Create Decision Matrix to add the fuzzy judgements.
Figure 5.4: The DMs Weights Window for the Fuzzy Delphi Solver
Step 3: Adding the fuzzy judgements. Once the user clicks Create Decision Matrix, a new
window, the Fuzzy Judgements Window, is displayed. This asks the user to input the fuzzy
judgements into the system. From the pull down menu, which is on the top left of the
window, the Fuzzy Delphi Solver allows the user to select each DM in the group to
respectively assign their fuzzy numbers.
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Figure 5.5: Fuzzy Judgements Window for the Fuzzy Delphi Solver
At the top of this window is the area for setting the fuzzy judgements. The user must select
one criterion from the pull down menu at the top left and then the fuzzy judgements can be
made. There are three edit boxes, L, M and U, in the middle; these represent the lower,
medium and upper, respectively. The user can directly input the triangular fuzzy number
in these spaces. In order to input the fuzzy judgements, the user can use the default settings
pop-up menu (fixed scale), the slider (which allows the user to slightly adjust the fuzzy
judgements) or the keyboard (to write the numbers into the three edit boxes). Once the three
numbers are entered in the edit boxes, the user must click the SET button to store these
numbers into the system. They will, simultaneously, be displayed in the table Decision
Matrix. The user can click the RESET button to clear the Decision Matrix table.
According to the data given in the example, the fuzzy judgements for the two DMs are
illustrated in Figure 5.5. After setting all of the given fuzzy judgements in the system, the
user then can click the CALCULATE button and the results will be displayed as numbers
and bar charts in the Results Window. Regarding the above example, the evaluation index for
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each criterion has been calculated, as shown in Figure 5.6, which are the same results as those
obtained by solving the example using Microsoft Excel. Once all solutions have been
obtained, the user can then close the Fuzzy Delphi Solver by clicking the FINISH button or
can click the RESTART button to return to the Descriptive Data Window to restart with a
new example. The user can also export the results to an Excel file by clicking EXPORT
RESULTS; see Figure 5.6.
Figure 5.6: Display Results Window for the Fuzzy Delphi Solver
To sum up, the Fuzzy Delphi Solver was developed, based on the application of the proposed
FDE method (chapter 4). It was developed by using the GUI function in MATLAB to build
an interface that can assist the users to apply the proposed FDE method to achieve consensus
in group decisions by selecting the key criteria and then reducing the number of criteria. The
development of the Fuzzy Delphi Solver provides a user-friendly environment in which to
exercise the proposed FDE in a short time. The user has the flexibility to run either the
traditional FDE method (without considering the importance weights of the DMs) or the
extended FDE method (which includes consideration of the importance weights of the DMs).
In addition, the system offers support for fuzzy judgements which can be added into the
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system in three very straightforward ways (fixed scale, slider or keyboard). Being able to
display the results in Microsoft Excel gives the user more flexibility for future analysis.
Thus, in this study, the final evaluation indices from applying the extended FDE method will
be obtained through the developed Fuzzy Delphi Solver. As a result, some criteria will be
eliminated by setting a threshold value in order to select the most significant and key criteria.
Next, these key criteria will be grouped into clusters and dependency among the clusters will
be studied by applying the extended Fuzzy DEMATEL method proposed in section 4.3.3 in
chapter four.
5.4 Fuzzy DEMATEL Method Implementation
Based on the extended Fuzzy DEMATEL method proposed in section 4.3.3 in chapter four, a
new user interface for the software programme, henceforth called the Fuzzy DEMATEL
Solver, was developed as a decision support tool. The Fuzzy DEMATEL Solver was
developed using GUI components in MATLAB, which provided a user-friendly and efficient
way to apply the proposed Fuzzy DEMATEL method. MATLAB was used for manipulation
of the input fuzzy judgements from the group of DMs and for implementing the procedure of
the proposed Fuzzy DEMATEL method. The Fuzzy DEMATEL Solver allows users to input
the fuzzy pairwise comparison judgements into the system to study the dependency
relationships between factors automatically and intelligently. The system design and
implementation are given in the following sections.
5.4.1 Designing the Fuzzy DEMATEL System
MATLAB was adopted as the development environment for prototyping the decision support
tool (the Fuzzy DEMATEL Solver) for the proposed Fuzzy DEMATEL method. The
architecture of the developed Fuzzy DEMATEL System is composed of four main phases, as
seen in Figure 5.7: input initial data, input fuzzy judgements, implement the proposed Fuzzy
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DEMATEL method and display results. The first phase involves establishing the parameters
involved in the decision making problem. This involves knowing the names of the factors and
numbers of the DMs in the group. In the second phase, the process then proceeds to
measuring the dependency relationships between factors by construction of fuzzy direct
relation matrices (refer to equation 4.29 in chapter four). In the third phase, once all the fuzzy
direct relation matrices have been processed, the total relation matrix and the cause-effect
diagram are determined through the proposed Fuzzy DEMATEL method (refer to equations
4.30-4.35 in chapter four). The last phase is representing the total relation matrix and
displaying the cause-effect diagram.
Start
Enter the initial parameters (number and

Input initial data name of factors and DMs)
Input fuzzy judgments Construct fuzzy direct-relation matrices
Derive a total-relation matrix and produce

Implement the proposed Fuzzy DEMATEL method a causal-effect diagram
Obtain the final results and show the

End
Figure 5.7: The Fuzzy DEMATEL System Flow Chart
5.4.2 Interface Design The Fuzzy DEMATEL Solver
The Fuzzy DEMATEL Solver interface is built as connected windows by using a range of
GUI components in MATLAB. The concept of the Fuzzy DEMATEL Solver interface design
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is illustrated and clarified by implementing the given example given in section 4.3.3.3 in
chapter four.
Suppose that the proposed Fuzzy DEMATEL method was employed for capturing the
complex relationships among three factors, , and , by a group of two DMs, who have the
importance weights,: 1 = 0.2, 2 = 0.8. The dependency relationships between each pair of
factors were measured and each individual assessment by the two DMs is obtained as
demonstrated in Table 5.2. The aim here is to measure the dependency relationships between
the factors, in terms of their influence on each other, and then obtain the total relation matrix
and the cause-effect diagram that can be used in further analysis.
Table 5.2: The DMs Fuzzy Judgements for Applying the Fuzzy DEMATEL Method
The initial fuzzy direct relation matrix for DM1

A B C
A - (8,9,10) (6,7,8)
B (1,1,1) - (1,1,1)
C (2,3,4) (1,1,1) -
The initial fuzzy direct relation matrix for DM2
A B C
A - (1,1,1) (8,9,10)
B (6,7,8) - (6,7,8)
C (2,3,4) (1,1,1) -
The following steps present the interface design and the process for solving the above
example, via the developed Fuzzy DEMATEL Solver.
Step 1: Adding the initial data into the system. Once the Fuzzy DEMATEL Solver is
running, the first page that the user interacts with is the Welcome Window; with the START
button at the middle of the window, as displayed in Figure 5.8.
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Figure 5.8: Welcome Window for the Fuzzy DEMATEL Solver
Following this page is the input data page, called the Initial Data Window, which asks the
user to enter the name of the factor in the edit bar and then click the SET button to add the
factor into the system, as shown in Figure 5.9. The entered factors are stored and displayed in
the list-box on the left of the window. The total number of factors will be counted
automatically and displayed in the text box next to the text Total No. of Factors. Based on
the data in the above example, we have three factors, , and , as demonstrated in Figure
5.9. Moreover, the user can click on the DELETE button or the RESET button to delete
one factor or clear the list-box, respectively.
In this window, the user can add the numbers of the DMs on the edit bar beside the text No.
of Decision Makers; in this case there are two DMs in the group, see Figure 5.9.
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Figure 5.9: Initial Data Window for the Fuzzy DEMATEL Solver
Step 2: Inputting the DMs importance weights. The main characteristic of the developed
Fuzzy DEMATEL Solver is its flexibility in allowing the user to select two different Fuzzy
DEMATEL methods: the classical Fuzzy DEMATEL method, which does not take into
account the DMs importance weights, or the extended Fuzzy DEMATEL method proposed
in this study which considers the importance weights of DMs in the group. Thus, the system
asks the user if he/she wants to consider the importance weights of the DMs or not. As
before, once the user clicks NO, the calculation functions of the classical Fuzzy DEMATEL
method will run. On the other hand, when the user clicks YES, the computation functions of
the extended Fuzzy DEMATEL method will be run. According to the current example, the
importance weights of the DMs are known. In this case, the user should click YES, then a
new click button will display Set the importance of decision makers at the bottom of the
window, as shown in Figure 5.9. A new window, termed the DMs Weights Window, in which
the importance weight for each DM is required to be added, as clarified in Figure 5.10. After
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storing the importance weights for all of the DMs in the system, the user can then click the
BACK button to go back to the previous window or click on Create Relation Pair-wise
Comparison Matrices to add the fuzzy judgements.
Figure 5.10: The DMs Weights Window for the Fuzzy DEMATEL Solver
Step 3: Entering the fuzzy judgements. The input page, called the Fuzzy Judgements
Window, is designed to accept the fuzzy judgements (the fuzzy triangular numbers) from each
of the DMs to measure the influence between the factors.
Located at the top left of the window, the system allows the user to select each DM in the
group and add his/her fuzzy judgements in turn. At the top of this window is the area for
setting the fuzzy judgements. The user must select the two factors from the pull down menu
at the top right and left, then the fuzzy judgements can be entered by using the edit boxes L,
M and U in the middle of the window, which represent the lower, medium and upper
respectively. The user can directly input the triangular fuzzy numbers in these spaces. In
order to input the fuzzy judgements, the user can use the default settings pop-up menu (fixed
scale), the slider or the keyboard to write the numbers into the three edit boxes. Once the
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numbers are entered in the edit boxes, the user must click the SET button to store these
numbers in the system and they will simultaneously be displayed in the table Initial Fuzzy
Direct Relation Matrices. The RESET button can be used by the user to clear the initial
fuzzy direct relation matrices table. From the data in the example, the fuzzy judgements for
the two DMs are illustrated in Figure 5.11 and Figure 5.12.
Figure 5.11: The DEMATEL Fuzzy Judgements Window for DM1
Figure 5.12: The DEMATEL Fuzzy Judgements Window for DM2
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Once all given fuzzy judgements have been submitted, the user can then click the
CALCULATE button and the Fuzzy DEMATEL Results Window will be displayed.
Regarding the data in the example, the total relation matrix and the cause-effect diagram are
shown in Figure 5.13, which are the same results as those obtained by solving the example
using the Microsoft Excel. Eventually, the user can click on the FINISH button to close the
Fuzzy DEMATEL Solver or click on the RESTART button to restart a new example.
Further, the user can export the results to an Excel file by clicking EXPORT RESULTS,
see Figure 5.13.
Figure 5.13: The First Display Results Window for the Fuzzy DEMATEL Solver
To conclude, the main part of the Fuzzy DEMATEL decision support tool is the
implementation of the extended Fuzzy DEMATEL method proposed in chapter four. The
Fuzzy DEMATEL Solver can run two options: the classical Fuzzy DEMATEL method
(ignoring the DMs weights) or the extended Fuzzy DEMATEL method (including the DMs
weights). Moreover, it offers different ways to input the fuzzy data by using fixed scale,
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slider or keyboard. In terms of computation difficulties, the developed Fuzzy DEMATEL
Solver can do the mathematical operations on the matrices (equations 4.30-4.35) in a short
time by using MATLAB functions for programming these equations. The only complexity is
in the input of the fuzzy judgements into the Fuzzy DEMATEL Solver. Moreover, the
developed solver has the ability to export the results to an Excel sheet for further analysis.
The final result is provided as a visual graphical representation that divides the factors into
the cause group and effect group, which assist the DMs to take productive actions based on
this analysis. In addition, the obtained total relation matrix (or, as it is called, the dependency
matrix) can be used to create the SPCJM for calculating criteria relative weights as discussed
and explained in section 4.3.3 in chapter four.
5.5 Fuzzy Group Prioritisation Method Implementation
The FGP method, proposed in chapter four in order to derive crisp criteria weights from
incomplete judgements and fuzzy PCJMs, is a matrix optimisation model. It needs language
which has lots of mathematical functions and good performance to support it. MATLAB
satisfies these requirements. Thus, MATLAB is applied for the solution of the non-linear
optimisation problem; see the model (4.51) in chapter four, based on the proposed FGP
method. Thus a user interface, namely the Fuzzy Group Prioritisation Solver, is designed,
based on the MATLAB GUI. The main goal of this user interface is to implement the
proposed FGP method for obtaining the criteria weights. It assists in creating a user friendly
interface to aid the user to input data and exhibit the results clearly in the form of tables and
graphs, therefore, overcoming the complexity of programming. In addition, it demonstrates
the feasibility and capability of the proposed FGP method. The details of the system design
and implementation are given in the following sections.
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5.5.1 Designing the New Fuzzy Group Prioritisation System
The Optimisation Toolbox in MATLAB is used to formulate and solve the proposed FGP
model (4.51). A prototype of the decision support tool is developed, based on the concept of
the proposed FGP method and the functions of MATLABs GUI. Essentially, there are four
steps for programming and developing the Fuzzy Group Prioritisation system: add the data
into the system, input judgements for constructing the fuzzy PCJMs, implement the proposed
FGP method and display the results; see Figure 5.14. The aim of the first step is to obtain the
input information. The input information which should be acquired, includes the name of the
decision elements (e.g. criteria), the number of DMs and the importance weights of the DMs.
Then, all the judgements from the fuzzy PCJMs are given in the second step. The techniques
of looping and the mathematical operations in MATLAB are considered to obtain the input
data and judgements. The third step includes solving the non-linear optimisation problem
(section 4.51) by coding the data into the system. A number of functions are available in
MATLAB to solve the non-linear programming problem with non-linear constraints (see
section 4.51, in chapter four). In this step, an appropriate function should be used to solve the
non-linear programme. All the judgements given by fuzzy PCJMs firstly need to be
transformed into non-linear programming formats in the system. In doing so, a series of
matrix operation functions in MATLAB can be used. According to the non-linear programme
(4.51), the function fmincon is used to code and solve the programme. The function
fmincon is a MATLAB implementation of the sequential quadratic programming method,
which is an iterative method for nonlinear optimisation. Finally, the details of the priorities
(the criteria weights) are to be displayed. The final results can provide not only numerical
results, but can also illustrate them graphically.
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Start
Obtain the initial data (number and name

Add the data into the system
of criteria and DMs)
Input judgements for constructing the fuzzy Obtain all the comparison judgements among
PCJMs criteria and construct the fuzzy PCJMs
Derive the local priorities/ weights by

Implement the proposed FGP method solving the non-linear optimization problem
Present the final results and show the

End
Figure 5.14: The FGP System Flow Chart
Thus, the Fuzzy Group Prioritisation Solver is a mathematical application based on the
MATLAB-GUI for solving the fuzzy prioritisation method proposed in this study. An
example of the process of implementing the proposed prioritisation method using the Fuzzy
Group Prioritisation Solver is described in the next section.
5.5.3 Interface Design The Fuzzy Group Prioritisation Solver
The interfaces can be presented in three steps. These three steps are explained as follows by
considering the example in Mikhailov, et al.(2011), presented in section 4.3.4.4, where three
DMs ( = 3) assess three criteria (1 , 2 , 3 ) and the importance weights of the DMs are
given as: 1 = 0.3, 2 = 0.2, 3 = 0.5. The DMs provide an incomplete set of five fuzzy
judgements, presented as triangular fuzzy numbers:
1 : 12 1 = (1,2,3); 13 1 = (2,3,4);
2 : 12 2 = (1.5,2.5,3.5) ; 13 2 = (3,4,5);
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3 : 12 3 = (2,3,4).
The following steps show the interface design and the process for solving the above
example through the developed Fuzzy Group Prioritisation Solver.
Step 1: Entering the data into the system. Figure 5.15 shows the Welcome Window of the
Fuzzy Group Prioritisation Solver. Once the user clicks the START button, a new window,
the Initial Data Window, replaces the previous one. This is the first important input interface
and includes the number of DMs and the name of criteria which must be decided upon. The
user will be allowed to add, change and remove criteria from the system by using a series of
buttons: SET, DELETE and RESET (see Figure 5.16). As before, the user should also
set the number of DMs in the edit bar beside the text No. of Decision Makers. According
to the example above, there are only three DMs and three criteria (see Figure 5.16).
Figure 5.15: Welcome Window for the Fuzzy Group Prioritisation Solver
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Figure 5.16: Initial Data Window for the Fuzzy Group Prioritisation Solver
Step 2: Setting the DMs importance weights. After the initial data, in which the numbers of
criteria and DMs are given, the importance of the DMs is decided. The user is asked if he/she
wants to consider the importance weights of the DMs or not. When the user clicks NO, the
calculation functions, the original FPP model, will run. Once the user clicks YES, the
computation functions for the proposed FGP model will be run. The calculation function is
based on the concept of the non-linear FPP, which was discussed in section 4.3.4. According
to the example given, the importance weights of the DMs are included. Hence, once the user
has clicked YES, a new click button will be displayed, 'Set the importance of decision
makers, at the bottom of the criteria window. The user can then submit the importance
weight for each DM as shown in Figure 5.17.
After inputting the importance weights for all of the DMs into the system, the user can then
click the BACK button to go back to the Initial Data Window and click on Create the
matrices of criteria comparisons to add the fuzzy PCJMs.
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Figure 5.17: The DMs Weights Window for the Fuzzy Group Prioritisation Solver
Step 3: Adding the fuzzy comparison judgements. All the judgements in the fuzzy pairwise
comparisons (the relative importance between criteria) are given by using the fixed scale,
slider or keyboard; see Figure 5.18, The Fuzzy Judgements Window.
Once a judgement is entered, the user must click the SET button to store such numbers in
the system. They will, simultaneously, be displayed in the Pairwise Comparisons table.
Since the pairwise comparisons matrix is a reciprocal one, only the upper half of the matrix
needs to be filled in; the lower half of the matrix will be filled in automatically. The user can
click the RESET button to clear the Pairwise Comparisons table. Furthermore, the Fuzzy
Group Prioritisation Solver deals with missing data/judgements. If the fuzzy judgements
between two elements are missing, the user can click the Missing Data button and the
system will temporarily put 1 for the comparison. The negative value is not a true
judgement in the real world; it just gives the system a command to not include such
judgements in the subsequent calculations. According to the data given in the example, the
fuzzy judgements for the three DMs are illustrated in Figures 5.18- 5.20.
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Figure 5.18: The Fuzzy Judgements Window for DM1 for Weighting Criteria
192
After the setting of all the judgements in the system, the user can then click the
CALCULATE button to run the FGP method and obtain the final criteria weights. As
before, the results can either be displayed in the Results Window (see Figure 5.21) or
exported to Excel sheet. The second option gives the user more flexibility in directly using
the results for further application.
Regarding the data in the above example, the weights calculated are shown in Figure 5.21
and are the same as those obtained by solving the example using the LINGO V13.0 software
(refer to section 4.3.4.4 in chapter four).
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Figure 5.21: Display Results Window for the Fuzzy Group Prioritisation Solver
In summary, the Fuzzy Group Prioritisation Solver is developed to solve the prioritisation
problem based on the proposed FGP method. The user interface of the software programme is
designed based on the MATLAB GUI. The Fuzzy Group Prioritisation Solver allows users to
input the fuzzy pairwise comparison judgements into the system to gain the solutions
automatically and intelligently. The programme can derive crisp priorities directly from the
input of data from fuzzy comparison judgements into the system. The user has flexibility in
solving the prioritisation problem by selecting either the original non-linear FPP (without
taking into account the DMs importance weights) or the proposed FGP method (which takes
into account the DMs importance weights). The programme also supports incomplete fuzzy
sets in group decision making problems. The Fuzzy Group Prioritisation Solver provides a
graphical view of the results and displays them in a bar chart. Finally, the criteria weights
obtained can be utilised for further analysis in MCDM problems, such as using them to
evaluate and rank different alternatives.
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5.6 Fuzzy TOPSIS Method Implementation
In chapter four, an extension of the Fuzzy TOPSIS technique for group decision making was
proposed (section 4.3.5), with the importance weights of each DM within a group being used
in the ranking of a list of available alternatives with respect to each criterion. In the proposed
method, the elements of the group decision matrices are presented as fuzzy numbers rather
than exact numerical values, in order to model uncertainty and imprecision in the DMs
judgements. In this section, a working prototype of a decision tool, termed the Fuzzy TOPSIS
Solver, is developed using MATLAB software for realising the proposed Fuzzy TOPSIS
method. The constructed Fuzzy TOPSIS Solver provides a user-friendly implementation of
the proposed method. This development prototype will assist DMs to apply the proposed
Fuzzy TOPSIS method and to overcome computational complexity. In the following sections,
the design and implementation of this decision support tool are presented. .
5.6.1 Designing the Fuzzy TOPSIS System
As decided earlier, MATLAB is adopted as suitable software in the development
environments for the prototyping of this decision support tool (the Fuzzy TOPSIS Solver).
As before, the architecture of the developed prototype system is composed of four main
steps: the initial parameters list, data judgements input, the proposed Fuzzy TOPSIS method
implementation and display of results (see Figure 5.22). The first step includes getting the
initial parameters: the name of criteria, alternatives, the weights of criteria and the number of
DMs involved in the problem. The second step then involves constructing all of the fuzzy
decision matrices for rating the alternatives with respect to each criterion. After that, the third
step involves applying the proposed Fuzzy TOPSIS method to the problem. This is followed
by displaying the final results in the final step.
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Start
Get the primary parameters (number and

List the input parameters name of alternatives, criteria and DMs)
Determine the data judgement Construct fuzzy decision matrices for rating
alternatives with respect of each criterion
Obtain the alternatives ranking

Implement the proposed Fuzzy TOPSIS method
Offer the final results and show the results

Display results graphically
End
Figure 5.22: The Fuzzy TOPSIS System Flow Chart
5.6.2 Interface Design The Fuzzy TOPSIS Solver
The interfaces of the developed Fuzzy TOPSIS Solver can be presented in three parts. They
are explained and displayed by using the hypothetical example given in chapter four, section
4.3.5.3. Assume that three alternatives, 1 , 2 and 3 , are ranked using the triangular fuzzy
numbers, as shown in Table 5.3, by a team of two decision makers, 1 and 2 (with
weight 1 = 0.2 , 2 = 0.8 ), with respect to three criteria, 1 , 2 and 3 , whose weight vector
is = (0.3,0.2,0.5). The goal here is to evaluate the ranking of the alternatives and to select
the best one. By using the developed Fuzzy TOPSIS Solver, the above example is handled as
explained in the following steps.
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Table 5.3: The DMs Fuzzy Judgements for Ranking Alternatives
The fuzzy decision matrix for DM1

1 2 3
1 (1,1,1) F (1,1,1)
2 (1,1,1) (2,3,4) (2,3,4)
3 (6,7,8) (1,1,1) (8,9,10)
The fuzzy decision matrix for DM2
1 2 3
1 (1,1,1) (2,3,4) (2,3,4)
2 (2,3,4) (4,5,6) (8,9,10)
3 (2,3,4) (6,7,8) (1,1,1)
Step 1: Adding the initial parameters into the system. The Welcome Window of the Fuzzy
TOPSIS Solver is the first window that the user interacts with, see Figure 5.23. The user then
interacts with the first important input interface, which is the Initial Parameters Window.
The data required includes the numbers of the criteria, alternatives, the weights of criteria and
DMs which must be decided upon. As previously stated, the user is allowed to add, change
and remove parameters from the system by using a series of buttons: SET, DELETE and
RESET. According to the example above, there are only two DMs, three criteria and three
alternatives (see Figure 5.24).
Figure 5.23: Welcome Window for the Fuzzy TOPSIS Solver
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Figure 5.24: Initial Parameters Window for the Fuzzy TOPSIS Solver
Step 2: Considering the DMs importance weights. The Initial Parameters Window offers
two types of situations: either the DMs weights are considered or the are ignored; see Figure
5.24. Thus, the Fuzzy TOPSIS Solver deals with the original Fuzzy TOPSIS method and the
new Fuzzy TOPSIS method proposed in this study. In the given example, the importance
weights of the DMs are included. Therefore, the DMs Weights Window is displayed and the
user is asked to submit the DMs importance weights, as illustrated in Figure 5.25.
Figure 5.25: The DMs Weights Window for the Fuzzy TOPSIS Solver
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Step 3: Entering the fuzzy judgements. All the fuzzy judgements for rating alternatives with
respect to each given criterion can be added into the system by using the fixed scale, slider or
keyboard in the Fuzzy Judgements Window. In order to enter the fuzzy matrices, a table view
will be offered to the user where judgements will be entered or changed, see Figure 5.26 and
Figure 5.27. Then, in the Results Window, two ways of displaying the results are given: the
final results can be shown either in the Results Window or they can be transferred to
Microsoft Excel. The final results window shows the Closeness Coefficient (CC)/the ranking
of the scores for each alternative and the final ranking, with the table and graph all shown in
the same window; see Figure 5.28. The final ranking order obtained by using the developed
Fuzzy TOPSIS Solver is 2 > 3 > 1 , which is the same result as achieved by solving the
same example using Microsoft Excel (refer to section 4.3.5.3 in chapter four).
Figure 5.26: The Fuzzy Judgements Window for DM1 for Ranking Alternatives
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Figure 5.27: The Fuzzy Judgements Window for DM2 for Ranking Alternatives
Figure 5.28: Display Results Window for the Fuzzy TOPSIS Solver
To recap, the Fuzzy TOPSIS Solver developed in this study was based on the application of
the proposed Fuzzy TOPSIS method (chapter 4). MATLAB was used in order to build
interfaces that can assist the user to apply the Fuzzy TOPSIS method for ranking alternatives
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with respect to a list of criteria. The Fuzzy TOPSIS Solver analyses the fuzzy judgements
given within seconds and provides a user-friendly interface. The Solver also offers flexibility
to the user to run either the traditional Fuzzy TOPSIS method (without considering the
importance weights of the DMs) or the extended Fuzzy TOPSIS method (considering the
importance weights of the DMs) for obtaining the ranking scores of the alternatives. The
Fuzzy TOPSIS Solver has the ability to accept fuzzy judgements and then display the final
results as a table and a graph, which can be exported to Microsoft Excel.
In this chapter, the Fuzzy Delphi Solver, the Fuzzy DEMATEL Solver, the Fuzzy Group
Prioritisation Solver and the Fuzzy TOPSIS Solver are developed as decision support tools,
with the intention of helping users to implement the proposed new methods, respectively the
modified FDE method, the extended Fuzzy DEMATEL method, the new FGP method and
the modified Fuzzy TOPSIS method. MATLAB software was used for programming these
methods, because MATLAB is a widely applied computing language in areas of mathematic
mathematics and is also a powerful and high-performance language for numerical
computations, programming, data analysis and visualisations with a user-friendly interface.
Moreover, it includes a number of interfaces to import and export data, as well as to manage
the available decision variables.
All of the decision support tools developed in this chapter were attempts to support the
analysis involved in the process of the hybrid Fuzzy MCDM model proposed in this study;
see section 4.2 in chapter four. The decision support tools developed have common features;
they accept the input of the judgements from DMs as triangular fuzzy numbers in three
different ways: by fixed scale, slider and keyboard. Moreover, they support individual/single
decision making problems as well as group decision making problems. They offer two
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different techniques for application. The first technique is to run the existing traditional
methods, which disregard the importance weights of the DM/s (e.g. the classical FDE
method, the traditional Fuzzy DEMATEL method, the non-liner FPP method and the
traditional Fuzzy TOPSIS method). On the other hand, the second technique involves running
the new methods proposed in this study, which take into account the DM/s importance
weights, for instance, the modified FDE method, the extended Fuzzy DEMATEL method, the
new FGP method and the modified Fuzzy TOPSIS method. They provide graphical views of
the results and display the final results in tables, allowing them to be exported to Microsoft
Excel giving users more flexibility for further analysis. Moreover, they are able to speed up
the processes associated with the proposed methods.
Finally, the solvers developed were validated by checking the correctness of the included
functions and testing the accuracy of the results obtained by comparing them to other results.
In other words, the results were checked against results generated using the Microsoft Excel
and the LINGO V13.0 software as illustrated in chapter four.
Finally, the four decision support tools have been developed as prototypes in this study.
However, these four tools possibly can be merged in order to design a new decision support
system for assisting the users/ DMs to apply the entire proposed model in one process. That
can be done by connecting the four developed decision support tool through using different
functions in the Matlab software.
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6. CHAPTER SIX: APPLICATION OF THE NEW HYBRID FUZZY MCDM
MODEL A CASE STUDY IN SAUDI ARABIA
6.1. Introduction
This chapter focuses on providing a practical validation of the proposed hybrid Fuzzy
MCDM model in the Saudi health insurance industry as case study. From a modelling
viewpoint, validation is the process of defining whether the model is a meaningful and
accurate representation of the real system in a particular problem area (Borenstein, 1998).
The main aim is to demonstrate the application and effectiveness of the proposed model in
achieving the research objectives. Testing and ensuring the accuracy of the proposed
developed model is essential for using the output of this research in practice in industry and
for ensuring that the model developed is not limited to use only in an academic environment.
This chapter explains the methods of data collection conducted during the case study,
including: setting selection criteria and identification of alternatives, deriving the DMs
importance weights, grouping of the selection criteria into clusters, identifying dependencies
among clusters, constructing pairwise comparisons, obtaining criteria weights and ranking
alternatives. At the end of this case study, a sensitivity analysis is conducted based on two
scenarios: changing the DMs weights and changing the criteria weights. This is followed by
a discussion of the analysis.
In this research, the case study is mainly used to demonstrate the application of the proposed
hybrid Fuzzy MCDM model, rather than support a practical decision making process.
Therefore, a group of DMs from different private companies in Saudi Arabia was selected to
participate in this case study. This will provide an overview of the DMs opinions regarding
purchasing group health insurance plans.
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This chapter is divided into three main sections. The introduction is given in the first section.
Section 6.2 then focuses on the group health insurance plan selection problem in Saudi
Arabia as a case study. It is separated into four sub-sections. Firstly, sections 6.2.1 and 6.2.2
provide the aim and background of the case study in this research. Next, in section 6.2.3, the
proposed hybrid Fuzzy MCDM and the developed decision support tools are applied to tackle
the problem of selecting a proper group health insurance plan in the Saudi insurance market.
The validation of the results from the proposed hybrid Fuzzy MCDM model, by applying
sensitivity analysis, is discussed in the following section, 6.2.4. Finally, section 6.3 provides a
summary of the chapter.
6.2. The Group Health Insurance Plan Selection Problem in Saudi Arabia A case
Study
6.2.1 Aim
The purpose of the case study is to demonstrate how the proposed hybrid Fuzzy MCDM
model may be used in the evaluation process for the selection of a proper group health
insurance plan to cover and ensure the employees in the private sector. As stated by Yin
(1994), a case study approach is generally used for the validation of a new proposed model. It
is expected to enable more effective knowledge and information regarding the phenomenon
under study based upon the experts viewpoints (Bryman, 2004).
The main objectives of the case study are:
Investigation of the evaluation process of selecting a group health insurance plan,
including identifying the selection criteria, studying the dependency issue, deriving
the criteria weights and ranking the available alternatives.
Application of the new developed decision support tools: the Fuzzy Delphi Solver,
the Fuzzy DEMATEL Solver, the Fuzzy Group Prioritisation Solver and the Fuzzy
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TOPSIS Solver. This is another way to validate the decision support tools developed
in this study.
6.2.2 Background
The challenges faced by governments, with regard to the economics of health care, have
made many countries in the world unable to continue to provide health services for free to
their citizens. This makes these countries resort to the application of different programmes
of health insurance to meet significantly high costs and to provide health services. Saudi
Arabia however, although it continues to provide free health services in hospitals, like
other countries, will not be able to continue in this direction because of the high and
continuously growing cost of providing health services. Accordingly, the Saudi
government has begun to search for new ways to manage expenditure on health and to
provide greater opportunities for the private sector to play a more effective role in the
health sector. Thus, the Saudi government has begun to open new resources in the Saudi
economy, such as the health insurance market in 2000 (Al-Omair, 2004).
In Saudi Arabia, the health insurance sector is a major challenge to the Saudi government,
private companies, insurance companies and citizens, due to the fact that health insurance
has been in operation for just over 14 years (Saati and Aloumeer, 2004). The health
insurance system in Saudi Arabia is controlled by the Cooperative Health Insurance
Council (CHIC), which is an independent government body established by the Council of
Ministers in 1999. This council aims to supervise and regulate the health insurance sector,
and to also organise and provide health care. Health insurance in Saudi Arabia is
compulsory for specific categories (e.g. Saudi and non-Saudi/foreign employees working
in the private sector and their family members) due to the natural increase in population on
one hand, and a sharp rise in the number of immigrant workers on the other hand
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(approximately 6.4 million foreign workers in Saudi Arabia), as well as the high cost of
medical treatment (Al-Omair, 2004; Saati, 2007). The enforcement of the health insurance
system in Saudi Arabia has several benefits. First of all, the health insurance system offers
an alternative way to hold down the growing costs of health services and of financing
these services (Al-Rabiah, 2000). Secondly, it achieves a balance between the high costs
of the health service in the private health care sector, which the average citizen cannot
afford, and the level of passivity in the health services sector as a result of a lack of
resources and increasing demand (Ben Said, 2000). Finally, the health insurance market
will help create new job opportunities. This will be through the entry into the health
services market of new insurance companies as well as providers of new health services,
which also contributes effectively to reducing the unemployment rate in Saudi society
which reflects positively on the Saudi economy in general (Saati, 2007).
Indeed, the employers (non-government or private sector) and owners of companies must
obtain a health insurance plan in order to insure and cover their employees. In 2008,
according to CHICs studies in Saudi Arabia, 65% of those insured with health insurance
received their coverage through their employers.
Today, the employers play a significant role in the health insurance industry in Saudi
Arabia. Looking forward, much study needs to be done in health insurance in Saudi
Arabia due to the increasing number of non-Saudi and Saudi workers within the private
sector. Thus, there is need for a process that will help companies within the private sector
to choose the best health insurance plan to provide a perfect health care environment for
their employees. This may raise the level of their performance and might meet the
employees needs. Meanwhile, it may also help private sector companies to reduce the
expense of purchasing health insurance. Moreover, interest in health insurance is growing
within the private sector because of the desire of these companies to shift financial losses
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and medical claims management to the insurance companies and to predict medical claims
in advance so they can be included within their budgets. Besides, understanding the
criteria for the selection of a group health insurance plan will aid policy makers in the
insurance companies to understand consumers behaviour. This will lead them to either
improve their plans or create new plans that meet consumers requirements.
In this study, a practical validation of the proposed hybrid Fuzzy MCDM model in the
private sector in Saudi Arabia is carried out. The aim is to reveal the application and
effectiveness of the proposed model and to measure the validity of the model with a real
life case study.
6.2.3 Application of the Proposed Model in the Saudi Insurance Market
In this section, the proposed hybrid Fuzzy MCDM and the developed decision support tools
are applied to tackle the problem of selecting a proper group health insurance plan in the
Saudi insurance market. One can refer to section 1.5 in chapter one for the reasons behind the
choice to specifically focus on the Saudi health insurance industry.
In this study, a group including nine DMs, who are HR managers from nine different private
companies in Saudi Arabia, were selected to participate. The DMs were previously contacted
in order to get their agreement to be a participant in the study. The DMs selected had the
most senior positions among their colleagues in the company and were equipped with various
backgrounds and experiences. They had experience related to purchasing health insurance
plans and were actually involved in making such critical selection decisions. At the
beginning, 15 HR managers in 15 different private companies in Saudi Arabia were contacted
by email from the author explaining the aims and objectives of the study. Finally, nine
companies agreed to take part in the case study.
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The main research method employed in the case study for collecting DMs opinions and
judgements is the questionnaire. A questionnaire is a pre-prepared set of questions aimed at
research participants to obtain their answers. It is the most common way of conducting a
survey. Questionnaires are often used to survey peoples beliefs, attitudes, feelings or
opinions regarding an issue under investigation (Oppenheim, 2000). As a data collection tool,
the questionnaire has the advantage of allowing researchers to reach a large number of
respondents for a relatively low cost (de Vaus, 2002). A questionnaire can also be distributed
and administered online. It needs to be validated in order to reflect whether a survey is
measuring what the researcher intends it to measure (Bryman, 2004). It is recommended to
discuss questionnaires with colleagues and expert researchers, and to pilot them in order to
revise them before their formal distribution.
After deciding the main data collection method and constructing the committee of DMs, the
case study can be conducted for this thesis in order to confirm the validity of the proposed
hybrid Fuzzy MCDM model. There are five main steps to applying the proposed model, as
explained and discussed in section 4.2 and Figure 4.1 in chapter four. Thus, the case study
commenced with defining a list of alternatives and criteria, which is the first step for applying
the proposed model. After that, the DMs importance weights should be obtained in order to
be used in the next steps. The second step involves setting the critical selection criteria and
then grouping them into clusters. Afterwards, the dependency relationships must be measured
between the clusters in the third step. The fourth step includes deriving local and global
weights of the criteria. The final step is reaching the final decision by ranking the
alternatives. These five steps are discussed and explained in detail in the following sections.
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6.2.3.1 Defining a List of Alternatives and Criteria
Creating a list of alternative group health insurance plans and a list of selection criteria is the
first step in applying the proposed hybrid Fuzzy MCDM model. This is the pre-research
phase (refer to section 4.2 and Figure 4.1 in chapter four). In this phase, a list of the
alternative group health insurance plans that are available in the Saudi health insurance
market should be defined. Then, a list of the criteria used to select a proper group health
insurance plan for covering the employees in a private company should be established.
The published literature, Al-Omair (2004) and Saati (2007), identified four forms of group
health insurance plan in Saudi Arabia. These plans were initially highlighted and adopted as
possible decision alternatives for this research. Indeed, the alternatives for selecting the
proper group health insurance policy will include one of the plans from each of the different
forms, which are listed below:
1. Social security insurance. This provides care in cases of work-related injuries
suffered by workers covered by this insurance, which is exercised through the General
Organisation for Social Insurance. This is the oldest type of health insurance known in
Saudi Arabia.
2. Direct health insurance. This is done through a direct contract between private
companies and hospitals to provide health care for the companys employees, or by
some hospitals providing programmes for the health care needs of a group of people
who pay the premium to the hospital directly.
3. Private health insurance. Where some insurance companies offer different types of
insurance policies that exceed the limits described in the original health insurance
policy.
4. Co-operative health insurance. Co-operative insurance is generally based on the
concept that the negative impact of a specific event is distributed between groups of
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people, instead of making just the one person who experienced the loss pay for the
result alone. In this type of insurance, the insured needs to seek a guarantee from a
group of people who are participating in the insurance. The difference between
commercial and co-operative insurance is that the members of the insuring
organisation are not seeking to make a profit, but only to reduce the losses which may
affect some of them.
For simplicity's sake, the names of the alternative plans have been concealed and are
represented as ( = 1,2,3,4): Social Security Insurance Plan (1 ), Direct Health Insurance
Plan (2 ), Private Health Insurance Plan (3 ) and Co-operative Health Insurance Plan (4 ).
The primary list of selection criteria was obtained from literature reviews and from
documentary analysis of the official rules and regulations documents and the insurance
companies web pages.
An intensive literature survey was conducted to seek information about potential selection
criteria. As discussed in section 2.3 in chapter two, previous studies and research on similar
insurance selection problems were used as sources and were reviewed in order to reveal
related selection criteria for the problem at hand. It has been found that the key criteria for
purchasing health insurance plans, such as the period of insurance, deductibles,
coinsurance,16 flexibility of the insurance contract for cancellation, premium, health benefits,
quality of health care providers and re-insurance (Goldstein & Pauly, 1976; Summers, 1989;
Danzon, 1989; Cutler & Zeckhauser, 1998; Bundorf, 2002).
The second resource used in this study for setting the selection criteria is documentary
analysis. The documentary analysis includes a wide variety of sources, including official
statistics, government documents, texts, newspapers, the media and visual documents (May,
2011). Moreover, Bryman (2004) added that documents such as newspapers, books,
16
In health insurance, coinsurance means that the insurance company covers a certain percentage of the losses
up to a certain level.
210
magazines and government minutes can be preserved, and so are available for analysis by the
social researcher. In the present research project, the secondary sources include government
regulation documents and insurance companies web pages. Like many other countries, Saudi
Arabia regularly produces crucial documents on health insurance reforms that can be easily
accessed. These documents can be found in the Ministry of Health website and the CHIC
website. Moreover, health insurance contracts from the insurance companies are used to
collect data regarding the selection criteria to define and understand some of the insurance
terminology. Analytical reading is used for analysing the above mentioned documents,
reports and web pages.
Finally, from the aforementioned activities, it was possible to consolidate a list of 29
selection criteria ( , = 1,2, ,29); a description of all of the selection criteria is given
below:
Health benefits (1 ): Refers to the type of health insurance coverage granted to the
insured, as described in the insurance policy, including all medical coverage, all costs
relating to medical consultation, diagnosis, treatment, obstetrics and medicines. Also,
it refers to all hospitalisation benefits, including surgery, same day surgery or
treatment.
Premiums prices (2 ): The amount to be paid by the policy holder/employer to the
insurance company for the insurance coverage provided by the policy during the
insurance term.
Availability of deductibles in the insurance plan (3 ): This means burden sharing and
is a part of most policies covering losses. It is the amount that is not covered by the
insurance company and must be paid by the policy holder. In health insurance, for
example, the deductibles do not cover the cost of regular visits or repeat prescriptions.
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Availability of co-insurance ( 4 ): Refers to a co-sharing agreement between the
insured and the insurer under a health insurance policy which provides that the
insured will cover a set percentage of the covered costs after the deductibles have
been paid.
Availability of re-insurance (5 ): This is an insurance agreement that is purchased by
an insurance company (insurer) from another insurance company (re-insurer) that has
high insurance abilities, in order to transfer risk from the insurer to the re-insurer and
to distribute the risk between the two companies.
Efficiency of the panel of re-insurers (6 ): Refers to the eligibility of all the parties for
the reinsurance treaties of the insurance company.
Flexibility of the insurance contract (7 ): Refers to the ability to cancel the selected
health contract or conversion to any form of insurance.
Period of insurance (8 ): This is the period shown on the insurance contract, during
which insurance is valid.
Geographical scope of coverage worldwide ( 9 ): Refers to the geographical
boundaries for health care benefits and health service providers around the world.
Availability of the health service providers (10 ): Refers to a wide and comprehensive
network of health providers or hospitals/clinics in the Kingdom of Saudi Arabia.
Accessibility of the health service providers (11 ): Refers to ease of access to the
health service providers, such as hospital, diagnostic centre, clinic, pharmacy,
laboratory, physiotherapy centre or radiological treatment centre.
Exceptions in the insurance contract (12 ): This means the exceptions that the health
insurance contract does not cover, such as cosmetic surgery and cosmetic treatments,
diseases caused by alcohol and drug abuse, and hospitals and clinics outside the health
service providers network.
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Legitimacy and Shariah compliance (13 ): Refers to the legality of the contract in
accordance with Islamic rules, which means following Shariah law.
Availability of additional health benefits ( 14 ): Some health insurance policies
provide additional health benefits and significant features: delivery, dental and optical
treatment, treatment of sports and leisure activity injuries.
Services (15 ): These are provided by the insurance company in order to help the
clients using the health insurance plan. For example, personalised membership cards,
health service providers network booklets and websites.
Communication channel availability ( 16 ): This means facilities provided by the
insurance company for easy communication with their clients: customer services,
service hot-line, email-address, on-line access etc.
Ease of negotiation ( 17 ): To what extent the insurance company is flexible in
providing a policy based on the provision of the needs of each employer according to
direct negotiation between the insurance company and employer.
Types of medical treatment (18 ): Refers to the kind of medical treatment that the
insurance company covers under the contract, such as in-hospital cover or out-of-
hospital cover, regional coverage or international coverage.
Emergency expenses (19 ): To what extent the insurance company is able to cover
repatriation of remains to the home country and to cover emergency work injuries.
Moreover, it refers to the medical treatment required for an insured person as a result
of an accident, or a case requiring prompt medical attention.
Work injuries (20 ): This means that the health insurance contract covers the risk to
workers at their work sites.
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The quality of health service providers (21 ): Refers to the quality of hospital care,
which has many dimensions: outcomes, processes of care, focus on patients,
customers, markets and others.
Clarity of insurance policy terms (22 ): This criterion includes all rights of the insured
persons under the insurance policy, such as receiving health benefits and handling
settlements; all rules, conditions, limitations and exclusions under the policy; and all
terms and conditions regarding the eligibility of the policy (persons eligible for cover,
for example, all employees below 65 years, spouses, sons (up to 18 years of age),
unmarried/divorced/widowed daughters, and so on).
Eligibility standards (23 ): This means who is eligible for cover. For example, all
employees below 65 years, their spouses, sons up to 18 years of age, unmarried/
divorced/widowed daughters, and so on.
Specialised team availability ( 24 ): This is a service feature from the insurance
company. These teams help monitor critical cases and provide some consultation for
the policyholder/employers. They also offer internal training programmes to introduce
clients to the policys plan and to clarify the insurance plan.
Quality of the insurance company (25 ): The best way to determine an insurance
companys overall quality is to check its accreditation. This means that the health
insurance plan might be operated by cooperative insurance companies authorised to
operate in the Kingdom of Saudi Arabia in accordance with the Cooperative Health
Insurance (CCHI) Companies Control Law and its implementing regulations.
According to CCHI, accreditation shall be limited to a period of three years,
renewable for similar periods.
Efficiency of the health service providers network (26 ): Refers to the health service
providers accredited by the CHIC and specified by the insurance company to provide
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health care to the employer. Also, it means the quality of hospital/clinic care, which
has many dimensions such as, outcomes, processes of care, focus on patients,
customers, markets and others.
Financial benefits (27 ): Refers to the overall maximum coverage amount per member
per policy period.
Reliability of the insurance company (28 ): This means that the insurance company
has a good financial stability score.
The insurance company reputation (29 ): Refers to the opinions and emotional beliefs
of stakeholders in the health insurance market about the insurance companys
finances.
It should be noted that to cover all the criteria for selecting a group health insurance plan is
impossible. Nevertheless, the set of criteria identified here appears to capture all the
important aspects of the selection problem.
6.2.3.2 Setting the Critical Selection Criteria and Grouping them into Clusters
The second phase in the proposed hybrid Fuzzy MCDM model involves applying the new
extended FDE method by introducing the DMs importance weights for setting the critical
selection criteria and then grouping them into clusters.
Before starting to apply the new extended FDE method to reduce the number of selection
criteria and set a list of the critical selection criteria, the importance weight of each DM/HR
manager in the selected group should be obtained. The selected group consists of nine
DMs/HR managers (1 , 2 , 3 and 9 ). As decided in section 3.5 in chapter three,
the SDM method and the non-linear FPP method are adopted to derive the DMs importance
weights.
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Therefore, the SDM assigned is a HR specialist with over 20 years experience in the field of
HR and is the Head of the HR department at BAE Systems in Saudi Arabia. For the problem
of selecting a health insurance plan, the SDM defined two factors to measure the different
weights of the DMs in the group. The first factor was years of experience, which determines
the DMs experience in the purchase of group health insurance plans to cover the companys
employees. The second factor was role/position in the company. This factor indicates the
DMs skill level and ability in the purchasing task.
In this phase, a setting critical criteria questionnaire was designed, the objectives of which
are to:
Investigate the importance of each respondent (each DM/HR manager) in the selected
group.
Collect the DMs/HR managers opinions regarding the level of importance of each
criterion.
In order to respond to these two objectives, the questionnaire was divided into two parts.
Each part is briefly described below:
Part 1: aims to elicit respondents background information, such as work position and years
of experience.
Part 2: responds to the second objective, which directly relates to the FDE method. In this
part, one question is given for each criterion and asks the respondents to choose one linguistic
variable (Table 4.2) that he/she believes best describes the level of importance of each
selection criterion.
MBS Surveys, powered by Qualtrics, which was created by Scott M. Smith in 1997, was
utilised in order to create, edit and distribute the setting critical criteria questionnaire online.
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Qualtrics is web-based survey software available to all Manchester Business School students
and staff. This software allows users with no advanced computer training to create and
administer surveys to collect responses from a large group of participants. It gives those with
limited experience access to computer-oriented research capabilities and better availability to
their intended audience.
The setting critical criteria questionnaire was distributed by using Qualtrics; see the
following link:
http://mbs.qualtrics.com/SE/?SID=SV_7NUava9tjpv1RNG
To ensure the reliability of the questionnaire and to avoid any ambiguity, a pilot test was
conducted before posting the questionnaire online. The pilot test for the questionnaire was
performed with four experts, who work in the area of decision making. The response
suggested only minor changes and no statements were removed. Based on the input and
feedback received, the questionnaire was modified and distributed by Qualtrics to the
selected group.
Based on the responses to the first part of the setting critical criteria questionnaire, which
are shown in Table 6.1, the SDM was asked to objectively assess each DMs importance
according to their respective levels of expertise and their position, and to make a pairwise
comparison between the DMs (1 , 2 , 3 and 9 ) on a five level linguistic scale
basis. The linguistic assessments were then converted into triangular fuzzy numbers, using
the transformation procedure in Table 4.1; refer to chapter four. In doing so, a DM weights
questionnaire was designed and once more the questionnaire was distributed using Qualtrics;
see the link below:
http://mbs.qualtrics.com/SE/?SID=SV_eLpXFxiQ8dGjzRG
217
In order to avoid any ambiguity in filling in the DM weights questionnaire, an example was
incorporated into the questionnaire, as shown in Figure 6.1.
Figure 6.1: An Example Incorporated into the DM Weights Questionnaire
Table 6.1: Participants Responses Regarding their Background Information
DM position / job Years of experience

1 HR head manager 9-12 Years
2 HR manager 9-12 Years
3 HR general manager 5-8 Years
4 HR director 9-12 Years
5 Chief HR Officer 17-20 Years
6 HR manager 1-4Years
7 HR manager Less than one year
8 HR manager 13-16 Years
9 HR director 13-16 Years
The data collected from the SDM were entered in a reciprocal matrix in order to form the
corresponding fuzzy PCJM, as shown in Table 6.2.
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Table 6.2: The Reciprocal Fuzzy PCJM for Deriving the DMs Importance Weights
1 2 3 4 5 6 7 8 9
1 (1,1,1) (2,3,4) (4,5,6) 1 1 1 1 1 1 (4,5,6) (6,7,8) (1,1,1) 1 1 1
( , , ) ( , , ) ( , , )
4 3 2 8 7 6 4 3 2
2 (1,1,1) (2,3,4) 1 1 1 1 1 1 (4,5,6) (6,7,8) 1 1 1 1 1 1

( , , ) ( , , ) ( , , ) ( , , )
4 3 2 10 9 8 4 3 2 6 5 4
3 (1,1,1) 1 1 1 1 1 1 (1,1,1) (2,3,4) 1 1 1 1 1 1

( , , ) ( , , ) ( , , ) ( , , )
6 5 4 10 9 8 6 5 4 8 7 6
4 (1,1,1) 1 1 1 (4,5,6) (6,7,8) 1 1 1 1 1 1

( , , ) ( , , ) ( , , )
6 5 4 4 3 2 4 3 2
5 (1,1,1) (6,7,8) (8,9,10) (6,7,8) (4,5,6)
6 (1,1,1) (2,3,4) 1 1 1 1 1 1
( , , ) ( , , )
6 5 4 8 7 6
7 (1,1,1) 1 1 1 1 1 1
( , , ) ( , , )
8 7 6 8 7 6
8 (1,1,1) 1 1 1
( , , )
4 3 2
9 (1,1,1)
The non-linear FPP method was then applied in order to derive the DMs importance weights
from the obtained fuzzy PCJM, as described in chapter three. By using the developed Fuzzy
Group Prioritisation Solver to apply the non-linear FPP method, the different weights of the
DMs in the evaluation process were obtained, as shown in Table 6.3 and Figure 6.2.
However, many steps were needed leading up to this final result in order to achieve the
required consistency. Essentially, when the SDM was first asked to provide a fuzzy PCJM to
assess the DMs importance, the DM weights obtained had a consistency/satisfaction index=
7.851. As Mikhailov (2003) discussed in his paper, the optimal value of the consistency
index, , is positive, indicating that all solution ratios completely satisfy the initial fuzzy

judgements, e.g. , while a negative value for means the fuzzy judgements

are inconsistent and the solution ratios approximately satisfy the initial fuzzy judgements. In
this case, the first fuzzy judgements provided were strongly inconsistent. Therefore, the SDM
was asked to revise his inconsistent judgements by offering new judgements in order to
219
improve the fuzzy PCJM consistency. This procedure was repeated seven times until the final
result, illustrated in Table 6.3 and Figure 6.2, was reached. According to the crisp weights
calculated by the Fuzzy Group Prioritisation Solver, the consistency index was calculated as
shown in figure 6.2. The negative value of the consistency index = 1.428 indicates that the
initial fuzzy judgements are slightly inconsistent, and also show that the solution ratios
approximately satisfy them (which means some of the judgements are not completely
satisfied, whereas the others are satisfied). For example, according to the comparison ratio
between 2 and 3 , the fuzzy initial judgement given by SDM was (2, 3, 4), and the
2 0.06
solution ratio obtained was = 0.02 = 3 , which is consistent with the given fuzzy
3
judgement because it lies in the range of the fuzzy judgement given and satisfies the

inequality, 2 2 4. From another example, it can been seen that the fuzzy comparison
3
4 0.18
ratio given for 4 and 6 was (4, 5, 6), and the solution ratio obtained is = = 4.5
6 0.04
lies in the given initial fuzzy judgement. On the other hand, the desired comparison ratios
1 1 1
between 8 and 9 should lie in the desired range ( 4 , 3 , 2 ), but the obtained ratio
8 0.10
= 0.17 = 0.588 does not satisfy the desired ratios. Although the consistency index is still
9
negative, it can be pointed out that the final weights were acceptable to the SDM after
conducting an in-depth discussion with him.
Thus, the results obtained in Table 6.3 and Figure 6.2 were adopted as the importance
weights of the DMs in the selected group. In this case, 5 has almost a third of the decision
importance in the evaluation process with a weight equal to 0.33. Thus, 5 is the most
important expert in the group, followed by 4 , then 9 , with weights equal to 0.18
and 0.17 respectively.
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Table 6.3: Final Weights of the DMs
DM position / job Years of experience Importance Weights

1 HR head manager 9-12 Years 0.08
2 HR manager 9-12 Years 0.06
3 HR general manager 5-8 Years 0.02
4 HR director 9-12 Years 0.18
5 Chief HR Officer 17-20 Years 0.33
6 HR manager 1-4Years 0.04
7 HR manager Less than 1 0.02
8 HR manager 13-16 Years 0.10
9 HR director 13-16 Years 0.17
Figure 6.2: The DMs Weights by Applying the Fuzzy Group Prioritisation Solver
As mentioned previously, this research adopted the extended FDE method by taking into
account the DMs importance weights to reduce the number of selection criteria. Therefore,
Table 6.4 shows the judgements of the DMs regarding the level of importance of each
criterion that was obtained from the second part of the setting critical criteria questionnaire.
The final results, for the extended FDE method are gained by using the developed Fuzzy
Delphi Solver, as shown in Table 6.5 and Figure 6.3. Afterwards, the modified Mean De-
Entropy algorithm for determining a threshold value (See Appendix B), was used to eliminate
unimportant criteria. Following the steps of the modified Mean De-Entropy algorithm
(Appendix B), the threshold value was set as = 5. This was used to select the critical
221
criteria based on DMs judgements. It can be seen from Table 6.5 that, by applying the FDE
method, the initial 29 criteria for the selection of a health insurance policy, were reduced to
19 after deleting 10 less significant criteria.
Table 6.4: The Judgements of the DMs for Setting Critical Criteria
1 2 3 4 5 6 7 8 9
1 I N N N VI VI VI VI VI
2 VI U VI VU I I U VI I
3 VI U N I I N N VI VI
4 U VU I VU VU U N U VU
5 UI VU I VU N VU I U VU
6 N VU I VU N U I VU VU
7 I N VI N I I VI VI VI
8 I N VI U I N I VI VI
9 N VI VI N VI N N VI U
10 VI VI VI VI VI VI VI VI I
11 I VI VI I I VI VI VI I
12 I VI N N VU I VU U VU
13 UI U N VU VU VU U VU U
14 UI I N N I I VI VI I
15 N I N U VU N N N VU
16 I VI I I VI VI VI VI U
17 UI I I N I I VI VI U
18 I VI I I VI I VI VI N
19 VU VI VI N VI VI VI VI N
20 I N N VU U N VU U VU
21 N N N U VU N U U U
22 I VI VI VI VI N VI VI VI
23 U U N N VU VU N VU U
24 I N VI I VI VI VI VI VI
25 I N VI I I I VI VI VI
26 I N VI N VI VI VI VI VI
27 VI VI I VI I I I VI VI
28 VI VI I VI I VI VI VI VI
29 VI VI VI VI VI I VI VI VI
222
Figure 6.3: Final Results for Setting the Critical Criteria by Applying the Fuzzy Delphi Solver
223
Table 6.5: The Final Results for Setting the Critical Criteria (selection criteria: evaluation indices )
Evaluation Select or
Label Criteria
indices Reject
1 Health benefits 5.16 S
2 Premium prices 6 S
3 Availability of deductibles in the insurance plan 7.3 S
4 Availability of co-insurance . R
5 Availability of re-insurance . R
6 Efficiency of the panel of re-insurers . R
7 Flexibility of the insurance contract 7.14 S
8 Period of insurance 6.66 S
9 Geographical scope of coverage worldwide 6.7 S
10 Availability of the health service providers 8.02 S
11 Accessibility of the health service providers 7.48 S
12 Exceptions in the insurance contract . R
13 Legitimacy and Shariah compliance . R
14 Availability of additional health benefits 6.52 S
15 Services . R
16 Communication channels availability 7.26 S
17 Ease of negotiation . R
18 Types of medical treatment 7.68 S
19 Emergency expenses 6.96 S
20 Work injuries . R
21 The quality of health service providers . R
22 Clarity of insurance policy terms 7.78 S
23 Eligibility standards . R
24 Specialised team availability 7.44 S
25 Quality of the insurance company 8.16 S
26 Efficiency of the health service providers network 7.88 S
27 Financial benefits 8.18 S
28 Reliability of the insurance company 8.3 S
29 The insurance company reputation 7.39 S
After obtaining a list of critical and key selection criteria, the criteria gained were grouped
into clusters for the sake of simplicity. In this study, the grouping of the criteria into clusters
is based on: (1) similar features among the criteria; (2) the evaluation indices, which have
been obtained from the extended FDE method. In other words, the criteria were clustered by
grouping those that are comparable or similar into clusters. Additionally, the evaluation
indices (Table 6.5) were used as a reference to classify the criteria. Thus, the criteria were
clustered so that each cluster only includes criteria that are comparable or do not differ in
their order of importance (Gasiea, et al., 2010).
224
All clusters are coded from A to E, according to relevance, in this order: Strength of the
insurer/the insurance company (A), Regulatory aspects (B), Medical aspects (C), Policy
features (D) and Services features (E). The nodes in each cluster were numbered starting with
the cluster code, e.g. company reputation (A1) and reliability of the insurance company (A2).
Indeed, a similar process was carried out on all other clusters. Table 6.6 shows the coding for
the criteria of all clusters.
Table 6.6: Grouping of selection criteria
Cluster Criteria
(A) Strength of the insurer/ (A1) Insurance company reputation
the insurance
company) (A2) Reliability of the insurance company
(B1) Clarity of insurance policy terms

(B) Regulatory aspects (B2) Quality of the insurance company
(B3) Efficiency of the health service providers network
(C1) Health benefits
(C2) Types of medical treatment
(C) Medical aspects
(C3) Emergency expenses
(C4) Availability of additional health benefits
(D1) Financial benefits
(D2) Period of insurance
(D3) Geographical scope of coverage worldwide
(D) Policy features
(D4) Flexibility of the insurance contract
(D5) Availability of deductibles in the insurance plan
(D6) Premium prices
(E1) Availability of the health service providers
(E2) Accessibility of the health service providers
(E) Services features
(E3) Specialised team availability
(E4) Communication channel availability
225
6.2.3.3 Identifying Dependencies among Clusters
Since the selection process of the health insurance policy is complex, it is not appropriate to
assume the decision elements within the process are independent. Therefore, the third phase
in the proposed model is measuring the relationships among the clusters by following the
extended Fuzzy DEMATEL method proposed in section 4.3.3 in chapter four. The outputs of
the extended fuzzy DEMATEL are then used to construct the SPCJM for calculating relative
weights of the criteria as discussed in section 4.2.
HR managers from nine different private companies in Saudi Arabia (the same selected group
of DMs as in the previous investigation), were asked to score the relationships among the
clusters in terms of their influence by using the linguistic scale as shown in Table 4.4 and
Figure 4.5 (refer to chapter four). For this purpose, a new dependency questionnaire was
designed and distributed using Qualtrics. The link is:
http://mbs.az1.qualtrics.com/SE/?SID=SV_doLiTtXwdRKa66U
Prior to sending out the questionnaire, a review and pilot version of the questionnaire were
conducted to refine the questions, before deciding on the format of the actual questionnaire,
based on the feedback given.
Nine initial fuzzy direct relation matrices were obtained by pairwise comparison in terms of
influence between five clusters: Strength of the insurer/the insurance company (A),
Regulatory aspects (B), Medical aspects (C), Policy features (D) and Services features (E), as
shown Table 6.7. Using the data from Table 6.7 and the developed Fuzzy DEMATEL Solver
(see section 5.4 in chapter five), the influence values of the clusters are found by introducing
the importance weights of the DMs and the results are shown in Tables 6.8 and 6.9, and in
Figure 6.4.
226
Table 6.7: Initial Fuzzy Direct Relation Matrices
The initial fuzzy direct relation matrix for 1

A B C D E
A - LI VHI HI VHI
B LI - HI VLI VHI
C NI NI - VHI VHI
D VLI LI HI - VHI
E VHI VHI VHI VHI -
A B C D E
A - HI HI LI LI
B LI - HI HI LI
C HI LI - HI LI
D HI HI LI - LI
E LI VLI VLI NI -
A B C D E
A - VHI VHI VHI HI
B HI - LI LI LI
C HI LI - HI LI
D VHI LI VHI - NI
E HI NI HI LI -
A B C D E
A - VLI LI LI LI
B HI - VHI VHI VHI
C HI LI - LI HI
D LI LI HI - LI
E HI NI HI HI -
A B C D E
A - NI VHI VHI VHI
B VHI - VHI VHI VHI
C VHI NI - VHI VHI
D HI NI VHI - VHI
E VHI NI VHI VHI -
A B C D E
A - VLI HI HI HI
B LI - VLI HI HI
C LI VLI - HI NI
D HI LI LI - HI
E HI VHI HI LI -
A B C D E
A - VLI LI HI LI
B LI - HI VHI LI
C VLI HI - LI VHI
D VLI HI HI - VHI
E VHI LI HI VHI -
A B C D E
A - HI VHI VHI VHI
B VHI - LI LI LI
C HI HI - LI VLI
D VHI NI VLI - LI
E VHI NI LI LI -
A B C D E
A - NI HI HI VHI
B HI - VLI NI NI
C VHI VLI - LI LI
D VHI NI LI - LI
E VHI NI VLI LI -
227
Table 6.8: The Fuzzy Total Relation Matrix from the Extended Fuzzy DEMATEL Result.
A B C D E
A (0.2469,0.4303,0.8141) (0.1652,0.2613,0.4523) (0.3857,0.5788,0.9616) (0.3842,0.5766,0.970) (0.3723,0.5608,0.9336)
B (0.4102,0.6185,1.0313) (0.1025,0.1887,0.3726) (0.3719,0.5702,0.9631) (0.3536,0.5470,0.9333) (0.3492,0.5383,0.9164)
C (0.3917,0.5872,0.9760) (0.1635,0.2595,0.4473) (0.2093,0.3758,0.7270) (0.3572,0.5437,0.9122) (0.3318,0.5143,0.8752)
D (0.3651,0.5614,0.9494) (0.1607,0.2553,0.4411) (0.3454,0.5314,0.9000) (0.2065,0.3706,0.7164) (0.3403,0.5212,0.8793)
E (0.4051,0.5944,0.9686) (0.1469,0.2309,0.4034) (0.3314,0.5135,0.8713) (0.3540,0.5330,0.8864) (0.2027,0.3584,0.6858)
Table 6.9: The Total Relation Matrix from the Extended Fuzzy DEMATEL Result
A B C D E
A 0.4736 0.2819 0.6199* 0.6173* 0.6008*
B 0.6629* 0.2097 0.6124* 0.5888 0.5792
C 0.6291* 0.2794 0.4156 0.5831 0.553
D 0.6029* 0.2751 0.571 0.4098 0.5596
E 0.6345* 0.25 0.5516 0.5708 0.3955
*Note: threshold value of MMDE algorithm: 0.6000
Figure 6.4: Extended Fuzzy DEMATEL Results by Using the Fuzzy DEMATEL Solver
Looking at the cause-effect diagram in Figure 6.4, the selection clusters were visually divided
into the cause group (implies influencing clusters), which included cluster B, and the effect
228
group (implies influenced clusters), which was composed of clusters A, C, D, and E. From
the cause-effect diagram, we can see that Regulatory aspects (cluster B) is an independent
cluster.
In this study, a threshold value was obtained by applying the Maximum Mean De-Entropy
(MMDE) algorithm, in order to screen out the significant effects that explain the relationship
structure of the clusters and to obtain an appropriate IRM. The MMDE algorithm can easily
be used to set an appropriate threshold value and obtain adequate information to delineate the
influence network for further analysis and decision making. Following the steps of the
MMDE algorithm (see APPENDIX C), the threshold value can be determined as 0.600.
Therefore, there is no causal relationship when the degree of influence is less than 0.600.
Based on this threshold value, the IRM was derived, shown in Figure 6.5.
Medical Strength of the Policy

aspects (C) insurer (A) features (D)
Regulatory Services
aspects (B) features (E)
Figure 6.5: Impact Relation Map (IRM)
The IRM displays the final influence result. For example, in Fig. 6.5, an arrow from cluster B
to cluster A represents the fact that cluster B affects A, and a double headed arrow between
cluster C and cluster A indicates that clusters C and A influence each other, whereas cluster B
is not influenced by any other cluster.
After determining the relationship structure among the five clusters for the selection of the
most suitable group health insurance plan, the SPCJM can be formulated based on the IRM as
follows:
229
0 12 13 14 15
0 0 0 0 0
SPCJM = 31 32 0 0 0
41 0 0 0 0
[51 0 0 0 0 ]
Table 6.10 presents the initial SPCJM of the study by applying equations 4.1 and 4.2. The
typical entry, , in the SPCJM is called a block of the SPCJM and represents the
relationship between the -th cluster and the -th cluster. Each column of is a local
priority vector for each criterion, which is derived from fuzzy PCJMs by applying a
prioritisation method. For instance, in this study the grey-shaded block in Table 6.10
represents the relationship between cluster A and cluster B. Each column of the grey-shaded
block is a local priority vector for each of the criteria, 1 and 2 , with respect to criteria, 1
and 2, which is derived from fuzzy PCJMs by applying the new proposed FGP method.
230
Table 6.10: Initial SPCJM for the Group Health Insurance Plan Selection Problem
A1 A2 B1 B2 B3 C1 C2 C3 C4 D1 D2 D3 D4 D5 D6 E1 E2 E3 E4
A1 0 0 () () () WA1 (C1) WA1 (C2) WA1 (C3) WA1 (C4) WA1 (D1) WA1 (D2) WA1 (D3) WA1 (D4) WA1 (D5) WA1 (D6) WA1 (E1) WA1 (E2) WA1 (E3) WA1 (E4)
A2 0 0 () () () WA2 (C1) WA2 (C2) WA2 (C3) WA2 (C4) WA2 (D1) WA2 (D2) WA2 (D3) WA2 (D4) WA2 (D5) WA2 (D6) WA2 (E1) WA2 (E2) WA2 (E3) WA2 (E4)
B1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C1 WC1 (A1) WC1 (A2) WC1 (B1) WC1 (B2) WC1 (B3) 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D1 WD1 (A1) WD1 (A2) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D2 WD2 (A1) WD2 (A2) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D3 WD3 (A1) WD3 (A2) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D4 WD4 (A1) WD4 (A2) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D5 WD5 (A1) WD5 (A2) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D6 WD6 (A1) WD6 (A2) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E1 WE1 (A1) WE1 (A2) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E2 WE2 (A1) WE2 (A2) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E3 WE3 (A1) WE3 (A2) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E4 WE4 (A1) WE4 (A2) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
231
6.2.3.4 Weighting of Criteria
After constructing the IRM and the initial SPCJM, the next phase is asking the DMs to
provide fuzzy PCJMs by using a new pairwise questionnaire developed in order to obtain
criteria weights, based on the primary structure of the SPCJM. The proposed new FGP
method is then utilised for deriving a local priority vector. The local priority vector for each
fuzzy PCJM will be needed to complete the initial SPCJM in Table 6.10.
The columns in Table 6.10 present the parent criteria, while the rows present the child
criteria. For example, A1 is a parent criterion and C1 through to E4 are its child criteria. The
criteria that are to be pairwise compared are always in the same cluster. In this model, there
are a number of fuzzy PCJMs for every parent criterion and one fuzzy PCJM for criteria in
the same cluster originating from the same parent criterion. To derive local priorities of the
child criteria with respect to the parent criteria, it is only necessary to make (( 1)) 2
comparisons to establish the full set of fuzzy PCJMs, where denotes the number of criteria
in one cluster. For example, six fuzzy PCJMs are required for cluster A and B; while for
cluster C, four fuzzy PCJMs are needed (see Appendix D). The comparisons among all other
criteria were done in the same way and produced a total of 26 fuzzy PCJMs which include 89
pairwise comparison questions. Appendix D presents the relevant tables showing how these
numbers of fuzzy PCJMs and pairwise questions were determined. In order to collect answers
to pairwise questions, new pairwise questionnaires were developed and distributed using
Qualtrics. The new pairwise questionnaires can be viewed by clicking the links shown below:
http://mbs.az1.qualtrics.com/SE/?SID=SV_07e2rXf20kSuIeh
http://mbs.az1.qualtrics.com/SE/?SID=SV_daspsn3Tvxgje5v
http://mbs.az1.qualtrics.com/SE/?SID=SV_8jiZJWLaAGB4YSx
232
As before, a pilot test was conducted to revise the pairwise questionnaires before their formal
distribution, in order to enhance their reliability by eliminating ambiguity. The pairwise
questionnaire links were then e-mailed to the selected group of HR manager. The data was
collected and used to derive the local priority vectors by using the developed Fuzzy Group
Prioritisation Solver and introducing the DMs importance weights. Appendix E presents all
of the reciprocal fuzzy PCJMs for all criteria, including their local weights. In Table 6.11, an
example is provided of the reciprocal fuzzy PCJMs for criteria D1-D6 with respect to
criterion A1, and the local priority vector is calculated via the proposed FGP method by
introducing the DMs importance weights. Figure 6.6 shows the local priority vector for
criteria D1-D6 with respect to criterion A1 by using the Fuzzy Group Prioritisation Solver. In
Table 6.11, one can see that there are missing judgements, which can be handled by the
proposed FGP method.
Table 6.11: Examples of Reciprocal Fuzzy PCJMs for Criteria D1-D6 With Respect to Criterion A1 and
their Local Weights
The pairwise comparison matrix for 1

WRT A 1 D1 D2 D3 D4 D5 D6
D1 (1,1,1) (2,3,4) (4,5,6) (2,3,4) (8,9,10) 1 1 1
( , , )
4 3 2
D2 (1,1,1) (4,5,6) (4,5,6) (8,9,10) 1 1 1
( , , )
6 5 4
D3 (1,1,1) (2,3,4) - 1 1 1
( , , )
6 5 4
D4 (1,1,1) - 1 1 1
( , , )
10 9 8
D5 (1,1,1) 1 1 1
( , , )
10 9 8
D6 (1,1,1)

D1 (1,1,1) 1 1 1 (4,5,6) (6,7,8) (8,9,10) 1 1 1
( , , ) ( , , )
4 3 2 6 5 4
D2 (1,1,1) (2,3,4) (4,5,6) (6,7,8) 1 1 1
( , , )
8 7 6
D3 (1,1,1) (2,3,4) (6,7,8) 1 1 1
( , , )
8 7 6
D4 (1,1,1) (6,7,8) 1 1 1
( , , )
6 5 4
D5 (1,1,1) 1 1 1
( , , )
10 9 8
D6 (1,1,1)

D1 (1,1,1) (2,3,4) (4,5,6) (2,3,4) (6,7,8) 1 1 1
( , , )
6 5 4
D2 (1,1,1) 1 1 1 (2,3,4) (6,7,8) 1 1 1
( , , ) ( , , )
4 3 2 6 5 4
233
D3 (1,1,1) (2,3,4) (6,7,8) 1 1 1
( , , )
8 7 6
D4 (1,1,1) (6,7,8) 1 1 1
( , , )
8 7 6
D5 (1,1,1) 1 1 1
( , , )
8 7 6
D6 (1,1,1)

D1 (1,1,1) (4,5,6) (2,3,4) (2,3,4) (8,9,10) (4,5,6)
D2 (1,1,1) (4,5,6) (4,5,6) - -
D3 (1,1,1) 1 1 1 (6,7,8) 1 1 1
( , , ) ( , , )
4 3 2 8 7 6
D4 (1,1,1) (4,5,6) 1 1 1
( , , )
8 7 6
D5 (1,1,1) 1 1 1
( , , )
10 9 8
D6 (1,1,1)

D1 (1,1,1) (4,5,6) (4,5,6) (4,5,6) (6,7,8) 1 1 1
( , , )
10 9 8
D2 (1,1,1) 1 1 1 1 1 1 (6,7,8) 1 1 1
( , , ) ( , , ) ( , , )
6 5 4 4 3 2 10 9 8
D3 (1,1,1) 1 1 1 (6,7,8) 1 1 1
( , , ) ( , , )
4 3 2 10 9 8
D4 (1,1,1) (4,5,6) 1 1 1
( , , )
6 5 4
D5 (1,1,1) 1 1 1
( , , )
10 9 8
D6 (1,1,1)

D1 (1,1,1) (4,5,6) (2,3,4) (6,7,8) - 1 1 1
( , , )
6 5 4
D2 (1,1,1) 1 1 1 (6,7,8) - 1 1 1
( , , ) ( , , )
8 7 6 8 7 6
D3 (1,1,1) (2,3,4) (6,7,8) 1 1 1
( , , )
8 7 6
D4 (1,1,1) - 1 1 1
( , , )
6 5 4
D5 (1,1,1) 1 1 1
( , , )
10 9 8
D6 (1,1,1)

D1 (1,1,1) (4,5,6) (2,3,4) - (6,7,8) 1 1 1
( , , )
4 3 2
D2 (1,1,1) 1 1 1 1 1 1 (6,7,8) 1 1 1
( , , ) ( , , ) ( , , )
6 5 4 4 3 2 6 5 4
D3 (1,1,1) 1 1 1 (6,7,8) 1 1 1
( , , ) ( , , )
4 3 2 6 5 4
D4 (1,1,1) (8,9,10) 1 1 1
( , , )
8 7 6
D5 (1,1,1) 1 1 1
( , , )
10 9 8
D6 (1,1,1)

D1 (1,1,1) (6,7,8) (2,3,4) (2,3,4) (8,9,10) 1 1 1
( , , )
6 5 4
D2 (1,1,1) 1 1 1 1 1 1 (4,5,6) 1 1 1
( , , ) ( , , ) ( , , )
4 3 2 6 5 4 8 7 6
D3 (1,1,1) 1 1 1 (4,5,6) 1 1 1
( , , ) ( , , )
4 3 2 8 7 6
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D4 (1,1,1) (4,5,6) 1 1 1
( , , )
8 7 6
D5 (1,1,1) 1 1 1
( , , )
10 9 8
D6 (1,1,1)

D1 (1,1,1) (4,5,6) (2,3,4) (2,3,4) (6,7,8) 1 1 1
( , , )
4 3 2
D2 (1,1,1) 1 1 1 1 1 1 (2,3,4) 1 1 1
( , , ) ( , , ) ( , , )
6 5 4 6 5 4 6 5 4
D3 (1,1,1) (2,3,4) (6,7,8) 1 1 1
( , , )
6 5 4
D4 (1,1,1) (6,7,8) 1 1 1
( , , )
6 5 4
D5 (1,1,1) 1 1 1
( , , )
10 9 8
D6 (1,1,1)
Local weights
0.12 0.14 0.09 0.07 0.05 0.53
Figure 6.6: Local Weights for Criteria D1-D6 with Respect to Criterion A1 by Using the Fuzzy Group
Prioritisation Solver
In this way, the local priority vectors are then entered as a part of one of the columns of the
initial SPCJM. The complete result is an un-weighted SPCJM, shown in Table 6.12. Table
6.12 illustrates the un-weighted SPCJM that contains the local priorities derived from the
pairwise comparison of fuzzy PCJMs. After that, a normalised SPCJM is produced by
adjusting the un-weighted SPCJM to column stochastic so that the sum of the elements in
each column is equal to one. The normalised SPCJM is shown in Table 6.13. Finally, to
235
derive the global priorities of criteria the limit SPCJM is obtained by raising the normalised
SPCJM by powers until the row elements converge to the same value for each column of the
matrix (i.e. to allow for convergence of the interdependent relationships) (Saaty, 2010). In
this case, the normalised SPCJM was raised to the power 20. This limit SPCJM is shown in
Table 6.14. Each row in Table 6.14 represents the weight of each criterion. The different
criteria, global weights and their ranking are illustrated in Table 6.15. As can be found in
Table 6.15, the top five priorities in the selection process are: Reliability of the insurance
company (29.8 %), Availability of the health service providers (10.25%), followed very
closely by Insurance company reputation (9.77% ), Health benefits (9.33%) and Premium
prices (9.08% ). The selected group of HR managers chose criterion A2 (Reliability of the
insurance company) to be the most important criterion among a set of criteria. This choice is
in a sense, due to the financial score being of critical importance for the insurance company
to encourage employers to purchase group health insurance for their employees. These results
can help the employers when they plan the purchase of a group health plan. That means they
might take these five important criteria into consideration when they compare among the
different available plans.
It is observed from Table 6.15, that Reliability of the insurance company is the most
important criterion in the selection and purchase of a group health insurance plan, the highest
priority of 0.298. As inferred from Table 6.15, the criteria in cluster B (Regulatory aspects)
including: Quality of the insurance company, Clarity of insurance policy terms and
Efficiency of the health service providers network, are the lowest importance criteria
compared with other criteria.
236
Table 6.12: The Un-weighted SPCJM
A1 0 0 0.167 0.2 0.167 0.1 0.178 0.256 0.5 0.167 0.184 0.125 0.180 0.215 0.025 0.167 0.794 0.5 0.747
A2 0 0 0.833 0.8 0.833 0.9 0.822 0.744 0.5 0.833 0.816 0.875 0.820 0.785 0.975 0.833 0.206 0.5 0.253
B1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C1 0.034 0.561 0.604 0.519 0.162 0 0 0 0 0 0 0 0 0 0 0 0 0 0

C2 0.322 0.252 0.112 0.071 0.514 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C3 0.322 0.077 0.078 0.160 0.119 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C4 0.322 0.110 0.206 0.250 0.205 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D1 0.12 0.17 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D2 0.14 0.11 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D3 0.09 0.04 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D4 0.07 0.15 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D5 0.05 0.10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D6 0.53 0.43 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E1 0.416 0.585 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E2 0.305 0.206 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E3 0.079 0.062 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E4 0.200 0.147 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
237
Table 6.13: The Normalised SPCJM
A1 0 0 0.06 0.07 0.06 0.05 0.1 0.13 0.25 0.08 0.09 0.06 0.09 0.11 0.01 0.08 0.4 0.25 0.4
A2 0 0 0.28 0.27 0.28 0.45 0.4 0.37 0.25 0.42 0.41 0.44 0.41 0.39 0.49 0.42 0.1 0.25 0.1
B1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C1 0.009 0.14 0.2 0.17 0.05 0 0 0 0 0 0 0 0 0 0 0 0 0 0

C2 0.08 0.06 0.04 0.02 0.17 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C3 0.08 0.02 0.03 0.05 0.04 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C4 0.08 0.03 0.06 0.08 0.07 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D1 0.03 0.04 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D2 0.04 0.03 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D3 0.02 0.01 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D4 0.02 0.04 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D5 0.01 0.04 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D6 0.13 0.12 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E1 0.1 0.15 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E2 0.08 0.05 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E3 0.02 0.02 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E4 0.05 0.04 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
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Table 6.14: The Limit SPCJM
A1 0.0977 0.0977 0.0977 0.0977 0.0977 0.0977 0.0977 0.0977 0.0977 0.0977 0.0977 0.0977 0.0977 0.0977 0.0977 0.0977 0.0977 0.0977 0.0977
A2 0.2980 0.2980 0.2980 0.2980 0.2980 0.2980 0.2980 0.2980 0.2980 0.2980 0.2980 0.2980 0.2980 0.2980 0.2980 0.2980 0.2980 0.2980 0.2980
B1 0.0005 0.0005 0.0005 0.0005 0.0005 0.0005 0.0005 0.0005 0.0005 0.0005 0.0005 0.0005 0.0005 0.0005 0.0005 0.0005 0.0005 0.0005 0.0005
B2 0.0007 0.0007 0.0007 0.0007 0.0007 0.0007 0.0007 0.0007 0.0007 0.0007 0.0007 0.0007 0.0007 0.0007 0.0007 0.0007 0.0007 0.0007 0.0007
B3 0.0003 0.0003 0.0003 0.0003 0.0003 0.0003 0.0003 0.0003 0.0003 0.0003 0.0003 0.0003 0.0003 0.0003 0.0003 0.0003 0.0003 0.0003 0.0003
C1 0.0933 0.0933 0.0933 0.0933 0.0933 0.0933 0.0933 0.0933 0.0933 0.0933 0.0933 0.0933 0.0933 0.0933 0.0933 0.0933 0.0933 0.0933 0.0933
C2 0.0496 0.0496 0.0496 0.0496 0.0496 0.0496 0.0496 0.0496 0.0496 0.0496 0.0496 0.0496 0.0496 0.0496 0.0496 0.0496 0.0496 0.0496 0.0496
C3 0.0292 0.0292 0.0292 0.0292 0.0292 0.0292 0.0292 0.0292 0.0292 0.0292 0.0292 0.0292 0.0292 0.0292 0.0292 0.0292 0.0292 0.0292 0.0292
C4 0.0371 0.0371 0.0371 0.0371 0.0371 0.0371 0.0371 0.0371 0.0371 0.0371 0.0371 0.0371 0.0371 0.0371 0.0371 0.0371 0.0371 0.0371 0.0371
D1 0.0279 0.0279 0.0279 0.0279 0.0279 0.0279 0.0279 0.0279 0.0279 0.0279 0.0279 0.0279 0.0279 0.0279 0.0279 0.0279 0.0279 0.0279 0.0279
D2 0.0240 0.0240 0.0240 0.0240 0.0240 0.0240 0.0240 0.0240 0.0240 0.0240 0.0240 0.0240 0.0240 0.0240 0.0240 0.0240 0.0240 0.0240 0.0240
D3 0.0092 0.0092 0.0092 0.0092 0.0092 0.0092 0.0092 0.0092 0.0092 0.0092 0.0092 0.0092 0.0092 0.0092 0.0092 0.0092 0.0092 0.0092 0.0092
D4 0.0261 0.0261 0.0261 0.0261 0.0261 0.0261 0.0261 0.0261 0.0261 0.0261 0.0261 0.0261 0.0261 0.0261 0.0261 0.0261 0.0261 0.0261 0.0261
D5 0.0244 0.0244 0.0244 0.0244 0.0244 0.0244 0.0244 0.0244 0.0244 0.0244 0.0244 0.0244 0.0244 0.0244 0.0244 0.0244 0.0244 0.0244 0.0244
D6 0.0908 0.0908 0.0908 0.0908 0.0908 0.0908 0.0908 0.0908 0.0908 0.0908 0.0908 0.0908 0.0908 0.0908 0.0908 0.0908 0.0908 0.0908 0.0908
E1 0.1025 0.1025 0.1025 0.1025 0.1025 0.1025 0.1025 0.1025 0.1025 0.1025 0.1025 0.1025 0.1025 0.1025 0.1025 0.1025 0.1025 0.1025 0.1025
E2 0.0424 0.0424 0.0424 0.0424 0.0424 0.0424 0.0424 0.0424 0.0424 0.0424 0.0424 0.0424 0.0424 0.0424 0.0424 0.0424 0.0424 0.0424 0.0424
E3 0.0148 0.0148 0.0148 0.0148 0.0148 0.0148 0.0148 0.0148 0.0148 0.0148 0.0148 0.0148 0.0148 0.0148 0.0148 0.0148 0.0148 0.0148 0.0148
E4 0.0315 0.0315 0.0315 0.0315 0.0315 0.0315 0.0315 0.0315 0.0315 0.0315 0.0315 0.0315 0.0315 0.0315 0.0315 0.0315 0.0315 0.0315 0.0315
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Table 6.15: The Relative Importance Weights / Global Weights of the Criteria
Global weights Ranking

A1 0.0977 A2 Reliability of the insurance company 0.298
A2 0.2980 E1 Availability of the health service providers 0.1025
B1 0.0005 A1 The insurance company reputation 0.0977
B2 0.0007 C1 Health benefits 0.0933
B3 0.0003 D6 Premium prices 0.0908
C1 0.0933 C2 Types of medical treatment 0.0496
C2 0.0496 E2 Accessibility of the health service providers 0.0424
C3 0.0292 C4 Availability of additional health benefits 0.0371
C4 0.0371 E4 Communication channel availability 0.0315
D1 0.0279 C3 Emergency expenses 0.0292
D2 0.0240 D1 Financial benefits 0.0279
D3 0.0092 D4 Flexibility of the insurance contract 0.0261
D4 0.0261 D5 Availability of deductibles in the insurance plan 0.0244
D5 0.0244 D2 Period of Insurance 0.024
D6 0.0908 E3 Specialised team availability 0.0148
E1 0.1025 D3 Geographical scope of coverage worldwide 0.0092

E2 0.0424 B2 Quality of the insurance company 0.0007
E3 0.0148 B1 Clarity of insurance policy terms 0.0005
E4 0.0315 B3 Efficiency of the health service providers network 0.0003
6.2.3.5 Ranking Alternatives
The final phase in the proposed hybrid Fuzzy MCDM model is the ranking phase (see section
4.2). In this case study, the ranking phase consists of the evaluation of the four alternative
plans ( = 1,2,3,4) by each DM in the selected group according to the 19 criteria. For this
evaluation, the fuzzy linguistic variables shown in Table 4.10 are used. In doing so, a
ranking questionnaire was developed and distributed to the DMs, to obtain their opinions
and judgements for rating the alternatives with respect to each criterion. For ranking the
alternatives and reaching the final solution, the extension of Fuzzy TOPSIS, proposed in
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section 4.3.5, is utilised in this stage. The obtained weights obtained for each criterion and for
each DM in the group are involved in this step, in order to reach the final ranking by using
the Fuzzy TOPSIS Solver, as developed in section 5.6.
As before, the ranking questionnaire was designed and distributed by Qualtrics. In addition, a
pilot test was conducted before posting the questionnaire online to ensure that the questions
are understood by the respondents and that there are no problems with the wording or
measurement. The online ranking questionnaire can be viewed by clicking the link shown
below:
http://mbs.az1.qualtrics.com/SE/?SID=SV_38ezeaN6yr83Q7r
In the ranking questionnaire, the DMs/HR managers were asked to rate each alternative plan
with respect to each criterion. All of the judgements for rating the alternative plans with
respect to each criterion given by each DM in the group are represented in Appendix E. An
example of the rating of the four alternatives by 1 according to all of the criteria is
summarised in Table 6.16.
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Table 6.16: Ratings of the Four Alternatives by under All Criteria
P1 (2,3,4) (0,1,2) (4,5,6) (2,3,4) (4,5,6) (2,3,4) (0,1,2) (4,5,6) (2,3,4) (4,5,6) (4,5,6) (2,3,4) (4,5,6) (0,1,2) (4,5,6) (0,1,2) (4,5,6) (2,3,4) (2,3,4)
P2 (0,1,2) (0,1,2) (2,3,4) (0,1,2) (2,3,4) (4,5,6) (2,3,4) (0,1,2) (2,3,4) (2,3,4) (4,5,6) (2,3,4) (0,1,2) (0,1,2) (2,3,4) (0,1,2) (4,5,6) (0,1,2) (2,3,4)
P3 (4,5,6) (4,5,6) (6,7,8) (8,9,10) (6,7,8) (6,7,8) (4,5,6) (6,7,8) (4,5,6) (4,5,6) (8,9,10) (6,7,8) (4,5,6) (6,7,8) (2,3,4) (4,5,6) (6,7,8) (6,7,8) (6,7,8)
P4 (6,7,8) (8,9,10) (8,9,10) (8,9,10) (8,9,10) (8,9,10) (8,9,10) (8,9,10) (6,7,8) (8,9,10) (8,9,10) (8,9,10) (8,9,10) (8,9,10) (6,7,8) (8,9,10) (8,9,10) (8,9,10) (6,7,8)
242
Using the rating data obtained in Appendix E, criterion weights in Table 6.15, and DM
importance weights in Table 6.3, the final ranking for selecting a group health insurance plan
are obtained and shown in Table 6.17. The final ranking, see Figure 6.7, was reached by
applying the modified Fuzzy TOPSIS method (section 4.3.5) using the developed Fuzzy
TOPSIS Solver (section 5.6).
Table 6.17: Final Ranking of the Alternative Group Health Insurance Plans
Alternatives closeness coefficients ranking
1 : Social Security Insurance 0.0208 3

2 : Direct Health Insurance 0.0126 4
3 : Private Health Insurance 0.0404 2
4 : Co-operative Health Insurance 0.0468 1
Final ranking 4 > 3 > 1 > 2
Figure 6.7: Final Ranking of the Alternative Group Health Insurance Plans Obtained by the Fuzzy
TOPSIS Solver
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The highest value for relative closeness to the ideal solution defines the best plan for covering
employees, taking into account all of the criteria weights, DM importance weights and
evaluations of the DMs. According to the value for relative closeness to the ideal solution, the
alternative plans are ranked as shown in Table 6.17. The best plan is the Co-operative Health
Insurance plan ( 4 ) with a closeness coefficient equal to 0.0468, followed by the Private
Health Insurance plan ( 3 ) with a closeness coefficient equal to 0.0404. Note as well that 4
and 3 are far from plan 1 (Security Insurance Plan) and 2 , ranked third and fourth, which
have the closest coefficients equal to 0.0208 and 0.0126, respectively. Hence the ranking
order for the alternatives is 4 > 3 > 1 > 2 .
It is also apparent that the correlation coefficients for the Co-operative Health Insurance plan
( 4 ) and Private Health Insurance plan ( 3 ) only differ by 0.006. However, although the
difference is very small, the result is significant for the decision makers in determining the
order of the ranking. In other words, the alternatives 4 and 3 can both meet and include
the first four importance criteria: Reliability of the insurance company, Availability of the
health service providers, Insurance company reputation and Health benefits. However, the
fifth ranking criterion, Premium prices, is not taken into account in the purchase of the
Private Health Insurance plan ( 3 ). That is because the premium price of the Private Health
Insurance plan is more expansive than for the Co-operative Health Insurance plan. Moreover,
the Reliability of the insurance company criterion and the Availability of the health service
providers criterion did not usually feature properly in health coverage with the Social
Security Insurance plan ( 1 ) and the Direct Health Insurance plan ( 2 ). Therefore, there are
sufficient reasons to believe that the ranking order 4 > 3 > 1 > 2 is reliable.
244
6.2.4 Validation of the Model Results Sensitivity Analysis
Validation is a vital part of the model development process, which increases confidence in
the model and makes it more valuable (Kennedy, et al., 2005). However, it is often too costly
and time consuming to determine that a model is absolutely valid over the complete area of
its intended applicability (Borenstein, 1998). This is because models are essentially unable to
totally reproduce or predict the real environment (Gass, 1983). Accordingly, the validation
process is often not to aim for achieving absolute validity, but rather to check that the
models output performance has sufficient accuracy for the models intended purpose over
the area of the models intended applicability. There are various techniques for validating a
models results (Gass, 1983; Kennedy, et al., 2005), such as animation, comparison to other
models, face validity, historical data validation and sensitivity analysis.
It is well-known that sensitivity analysis is crucial to the validation and calibration of the
results of MCDM models (Crosetto, et al., 2000). To analyse the quality of the proposed
hybrid Fuzzy MCDM in reaching a good solution under different conditions, a sensitivity
analysis is conducted (Qureshi, et al., 1999). It can be used as a tool to check the robustness
of the final outcome against slight changes in the input data (Evans, 2001). It is a special case
of stability analysis. Hence, sensitivity analysis helps determine the robustness of a model.
Sensitivity analysis is performed by changing the specific input parameters in the model to
determine the impact of such changes on evaluation of the outcomes and to test the strength
of the results of the proposed model. It therefore provides information on the stability of the
final ranking in MCDM models. If the ranking is highly sensitivity to small changes in the
parameter values, a careful review of those parameters is recommended. Therefore,
sensitivity analysis after problem solving can effectively contribute to making accurate
decisions.
245
In this study, two different scenarios were investigated to study the stability of the final
ranking under varying weights of attributes: the DM weights and criteria weights. In this
sensitivity analysis, when a change occurs in the weight of one attribute, the change in the
score and final ranking of alternatives is calculated.
In doing so, a method proposed by Alinezhad and Amini (2011) is applied here, where
varying the weight of one attribute is accompanied by decreasing the weights of the other
attributes by certain amounts such that the total of all attribute weights is equal to one.
Assume that the vector for the weights of attributes is = (1 , 2 , , ), where weights
are normalised to sum to one, =1 = 1. Therefore, if the weight of one attribute changes,
then the weight of the other attributes change accordingly, and the weights vector is
transformed to = ( 1 , 2 , , ). If the weight of the th attribute changes by and
the new weight obtained is = + , then the weights of the other attributes can be
obtained:
1
= , = 1,2, , (6.1)
1
Sensitivity analysis is performed, based on two scenarios: changing the DMs weights and
changing the criteria weights. For this purpose, the weight of the individual attribute, DM
weight or criterion weight, is increased by 50%, 100% and 200%; accordingly, the weights
of the other attributes are decreased by amounts such that the sum of the weights has to add
up to 1.
6.2.4.1 Sensitivity Analysis under Varying DM Weights
In this investigation, the focus is to test the effect of the DM weights on the ranking of the
results. The tests proceed by increasing each original DM weight by 50%, 100% and 200%.
While one DMs weight is increased, the values for the remaining DMs are decreased by
246
certain amounts, such that the total DM weights are equal to one. A series of evaluation runs
is conducted where each DMs weight is altered by 50%, 100% and 200%. This scenario
consists of 27 evaluation runs.
Figure 6.8 shows the results of this test. The horizontal axis represents the percentage
increases in the DM weights ( , = 1,2, 9) and the vertical axis represents the new
closeness coefficient values, , of the alternative policies, ( = 1,2,3,4) by applying the
proposed Fuzzy TOPSIS method. As shown in Figure 6.8, the final ranking orders of the
alternatives (4 > 3 > 1 > 2 ) does not change and alternative 4 remains the best group
health insurance policy for employers to purchase. Even if there are very small deviations in
the values, the final results are still consistent in this case and are not sensitivity to
changes in the weights of the decision makers.
In this test, 4 has the highest 4 value in all of the investigations performed, which
is 0.049, when the weight of 5 (who has the highest importance weight) is increased by
200% . Moreover, the lowest 4 value of 4 , 0.0461 , is when the weight of 4 is
increased by 200%.
The second best alternative is 3, with the highest 3 value of 0.0425 being reached when
the weight of 4 rises by 200%, whereas the smallest 3 value, 0.0388, is obtained when
the weight of 5 is increased by 200%.
Alternative 1 is the third best policy with the peak 1value of 0.0225 being gained when
the weight of 9 is increased by 200% , while its lowest value is 0.019, obtained by
increasing the weight of 5 by 200%.
247
The last alternative is 2 ; this reached its highest 2 value of 0.0148 when the weight of
9 was increased by 200% and has the lowest 2 value of 0.0115 when the weight of
5 was increased by 200%.
Although it can be seen that the final ranking for all of the alternatives does not change under
this scenario, it is possible that 4 , who has the second highest importance weight, might
influence and change the final ranking enabling 3 to be highest ranked instead of 4 . This is
due to the fact that the difference between for 4 and 3 is very small when the weight of
4 is increased by 50%, 100% and 200%. As a consequence, one can argue that the
importance weight of the DMs might influence the final ranking. Thus, careful evaluation of
the importance weights of the DMs is recommended.
248
Figure 6.8: Sensitivity Analysis Results Caused by Varying the Weights of the DMs
249
6.2.4.2 Sensitivity Analysis under Varying Criteria Weights
Investigating the effect of criteria weights on the ranking of alternatives is the focus here. The
experiments are based on increasing each original criterion weight by 50%, 100% and 200%
respectively. While one criterions value is increased, the priorities of the remaining criteria
must decrease proportionately such that the total of the criteria weight is equal to one. In this
analysis, three evaluations were run for each criterion; in total, 57 evaluations were required.
Figure 6.9 shows the results of the analysis under the scenario of changing the criteria
weights. The horizontal axis represents the percentage increases in the criteria weights (19
criteria for the selection and purchase of a group health insurance policy are listed in Table
6.15) and the vertical axis represents the new values for the closeness coefficients of the
alternative police ( = 1,2,3,4).
Figure 6.9 illustrates that when the weights of the criteria change, the values of the vary
slightly. According to the sensitivity analysis results under this scenario, 4 is determined to
be the most appropriate alternative plan, because it always has a maximum 4 value after
the weight changes are applied.
Alternative 4 has the highest 4 value of 0.0483 when criterion 2 (Reliability of the
insurance company) is increased by 200%, whereas it has its lowest value of 0.0462 when
criterion 3 is raised by 50%. Moreover, it can be observed that the 4 values of 4 show an
upward tendency when the weight of 2 (which has the highest importance weight, see Table
6.15) is increased by50%, 100% and 200%.
The second best policy in this analysis is alternative 3 , with the maximum 3 value,
0.041 , obtained when criterion 1 is increased by 200% ; it has the smallest 3 value,
0.0363, when criterion 2 is increased by 200%. Furthermore, the 3 values of 3 show a
250
slight upward trend when the weights of criteria 1 and 6 (which are the fourth and fifth
most important criteria, see Table 6.15) are increased by 50%, 100% and 200%.
Plan 1 is the third best alternative and has the maximum 1 value, 0.0206, when criterion
1 is increased by 200%, while its lowest value is 0.0163 when criterion 6 (which is the
fifth most important criterion; refer to Table 6.15) is increased by 200%. Additionally, it can
be noted that when criterion 6 is increased by 50%, 100% and 200%, the 1 value of the
alternative 1 shows a downward tendency. However, this plan drops to last place when the
weight of criterion 6 is increased by 200%.
Alternative 2 has the maximum 2 value, 0.0164, when criterion 6 is increased by
200%, while its lowest value, 0.0089, is when criterion 2 is increased by 200%. It can be
concluded that the 2 values of 2 show an upward tendency when the weight of criterion
6 is increased by 50%, 100% and 200%. Moreover, it is possible to observe that when
criterion 6 is increased by 200%, alternative 2 (originally in last position) rises to third
position ahead of policy 1 .
As a result, the proposed approach is robust and stable, since changes in the criteria weights
do not significantly affect the final ranking order of the first two alternative policies.
The above situations illustrate that the weights of criteria 2 (Reliability of the insurance
company), 6 (Premium prices) and 1 (Health benefits) might influence the final preference
in purchasing a group health insurance policy. Therefore, these criteria can be considered as
critical criteria and the most sensitivity criteria in the model. Meanwhile, care should be
given to the weighting of these sensitivity criteria, since this step may affect the final ranking.
In addition, this analysis may also assist the insurance companies to improve their group
health insurance plans by taking into account these critical criteria in order to meet the
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consumers needs. New group health insurance plans can be designed by taking into
consideration the results of this analysis.
From the above results, the following recommendations can hopefully provide insurance
companies ways of improving their group health insurance plans. First of all, it can be noted
that the reliability of the insurance company is a sensitivity and important criterion for
employers when purchasing a group health insurance plan. This is rational, because the
employers desire to decrease the financial risk of healthcare expenditure, while needing to
allocate their health budget appropriately. Thus, the insurance companies should be aware of
their reliability level in order to guarantee the stability of their financial resources. Moreover,
the insurance companies must modify their group health insurance plans or design new group
health insurance plans by making premiums affordable for consumers since premium prices
are a very important criterion for the selection of a group health insurance plan. In addition,
the insurance companies could encourage employers to purchase their insurance plans by
expanding the range of health benefits, since one of the most important criteria for the
selection of a group health insurance plan is its health benefits. In other words, the insurance
companies can add new health benefits, which are not included in previous insurance
contracts, for instance including mental health cover, unlimited cancer treatment, cover for
work injuries, cosmetic treatment, cover for sports injuries, etc. Finally, a recommendation
could be made to the Saudi government that improving the regulation of the health insurance
market should be based on these selection criteria used by employers for purchasing
insurance plans.
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Figure 6.9: Sensitivity Analysis Results Caused by Varying the Weights of the Criteria
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The main contribution of this chapter is to apply the proposed hybrid Fuzzy MCDM model to
a real group health insurance selection problem in the Saudi insurance industry. The case
study helps to verify that the proposed model is an effective and efficient decision making
tool.
This chapter started by providing the aim and the background of the issue of selecting a group
health insurance plan in Saudi Arabia in order to understand the problem under study. This
case study involved a group of nine DMs, who are HR managers selected from nine different
private companies in Saudi Arabia. Four alternatives and various selection criteria were then
identified through the published literature and the documentary analysis. An online
questionnaire was then designed and conducted to obtain judgements from the selected group
in order to derive the importance weights of the DMs and to set the critical selection criteria
via the modified FDE method. The list of 19 critical selection criteria was reached. After this,
the critical selection criteria were grouped into clusters and the dependency relationships
between these clusters were measured through an online questionnaire. The Fuzzy
DEMATEL method was then applied, taking into account the importance weights of the
DMs. Another questionnaire, to collect data for deriving the selection criteria local weights,
was designed in order to apply the new proposed FGP method and eventually to construct the
SPCJM to obtain the global weights of the selection criteria. Subsequently, an online survey
questionnaire was conducted to rank the identified alternatives by using the proposed Fuzzy
TOPSIS method. Finally, a sensitivity analysis was conducted to validate the proposed
models results by investigating two different scenarios: changing the DMs weights and
changing the criteria weights. The final results for the above mentioned activities were
achieved by using four decision support tools: the Fuzzy Delphi Solver, the Fuzzy
DEMATEL Solver, the Fuzzy Group Prioritisation Solver and the Fuzzy TOPSIS Solver.
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The final results obtained indicate that the Co-operative Health Insurance plan is the
preferred alternative for covering employees, followed by the Private Health Insurance plan
and the Social Security Insurance plan, with the least preferred of the four plans being the
Direct Health Insurance plan. Regarding the importance of all of the selection criteria
considered in the model, the top five criteria were: Reliability of the insurance company,
Availability of the health service providers, Insurance company reputation, Health benefits
and Premium prices.
The process of changing the DM and selection criteria weights in the sensitivity analysis left
the ranking of the alternatives unchanged, indicating the robustness of the proposed model
and the reliability of its results. Another observation from the sensitivity analysis results was
that a huge change in the importance weight of the DMs might influence the final ranking of
the alternatives. Moreover, the sensitivity analysis illustrates that the three selection criteria,
Reliability of the insurance company, Premium prices and Health benefits, were considered
as critical criteria and the most sensitivity criteria in the model.
As mentioned earlier, the questionnaire was the main research method employed in the case
study for collecting DMs opinions and judgements independently. All of the questionnaires
used in this study were designed and distributed online by Qualtrics. Pilot tests were
conducted to refine the questions, before deciding on the final format of the actual
questionnaires, based on the feedback given. The questionnaires designed in this study have
good features. To avoid any ambiguity on the part of the respondents in answering the
questions, an illustrative example was incorporated into each questionnaire. Besides,
assuming that some of the selection criteria included in the questionnaires might be
misunderstood or might not be clear to some respondents, instructions were incorporated into
the questionnaires to inform respondents to place his/her mouse pointer over the text in blue
in order to read more information; see one of the questionnaire links.
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Based on the results of this case study, it can be concluded that the application of the
proposed hybrid Fuzzy MCDM model to the selection of a group health insurance plan, is
indeed beneficial. Besides, although this study was based on the Saudi insurance industry, it
is believed that the proposed model could be utilised for solving any selection problem.
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7. CHAPTER SEVEN: CONCLUSIONS
7.1 Introduction
This final chapter is devoted to summarising the study in four main sections. First of all, in
section 7.2 there is a review of the research gaps in the literature and an outline of the work
done in this thesis in order to fill these gaps. Next, section 7.3 highlights how the objectives
of this study were achieved and how the research conducted has answered the research
questions. Following this, the limitations of this research are presented in section 7.4. Finally,
recommendations for future research are presented in section 7.5.
7.2 Recalling Research Gaps and the Responses in this Thesis
This section summarises, below, how this thesis responds to the main research gaps which
were described in section 2.4.
There are a relatively small number of insurance studies which address the uncertainty issue
that can occur in any selection problem, due to vagueness of information and the subjective
nature of human judgements. Therefore, this thesis has investigated different methods to
tackle the uncertainty issue. As stated in chapter three, the FST approach was considered as
the most appropriate and practical method to handle uncertainty.
Some existing frameworks discuss the selection of an insurance plan as a group decision
making problem. However, these studies ignore the fact that each expert in the group has a
different level of expertise, which might have an influence on the final results and decision.
Thus, the importance of each expert in the group has been considered in this research study.
In the existing published research on the selection of insurance plans, the study of the
relationships/dependency among the decision attributes is neglected. However, it can be
argued that dependency is a crucial issue that should be addressed in the decision making
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problem. Thus, this thesis responds to these points by extending the Fuzzy DEMATEL
method to measure dependency in a fuzzy environment, which takes into account the
importance weights of DMs; refer to section 4.3.3.
Most prior studies in health insurance are not detailed enough with regards to the selection
criteria and the derivation of their importance, as discussed in chapter two. Accordingly, this
thesis has investigated and analysed various prioritisation methods to generate the importance
weights of the decision elements. As concluded in section 4.3.4, the non-linear versions of the
FPP method were adopted for additional investigation in order to propose a new prioritisation
method in this research. Subsequently, the new FGP method was proposed for deriving the
criteria weights and for considering the importance of each member in the decision making
group.
It seems, from the literature review in chapter two, that there are no studies that deal with
the problem of evaluating the selection of group health insurance plans. Thus, this study
proposes a model for evaluating alternative group health insurance plans in order to select an
appropriate plan that can be purchased by employers to cover their employees. In doing so,
the new integrated Fuzzy MCDM model, proposed in this study combines the extended
Fuzzy Delphi, extended Fuzzy DEMATEL, new Fuzzy Group Prioritisation and modified
Fuzzy TOPSIS methods.
The majority of the insurance literature pays greater attention to the cases of developed
countries and less attention to developing countries. Furthermore, there is still a lack of
research in the health insurance industry. For this thesis, the focus was on applying the
proposed model in a developing country (Saudi Arabia).
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7.3 Meeting the Aim of the Research and Addressing the Research Questions
This section explains how this thesis has satisfied the aim and answered the research
questions of this research, as outlined at the beginning of the introduction chapter. The aim of
this research was to propose an evaluation methodology for alternative group health
insurance plans, in order to select an appropriate plan for purchase by employers in the
private sector to cover and insure their employees against financial losses or large health care
expenses. This aim was achieved through developing the proposed model based on the
literature reviews (section 4.2, in chapter four). Indeed, the new hybrid Fuzzy MCDM model,
an integrated model combining the extended Fuzzy Delphi, extended Fuzzy DEMATEL, new
FGP and modified Fuzzy TOPSIS methods, was designed and proposed for the selection
problem in this research study. In the literature, there are some works on some of these
methods, but there is no research that combines these four methods together. Thereby, this
study proposes a new integrated approach which can cope with the interdependencies among
various criteria in a fuzzy environment and can consider the importance weights of DMs. The
new hybrid model is based on five phases, as discussed in detail in section 4.2: Pre-research
phase for defining the initial lists of alternatives and criteria; Extended FDE method phase for
setting the critical selection criteria and grouping them into clusters; Extended Fuzzy
DEMATEL method phase to measure dependency among clusters; New FGP method phase
for deriving the weights of the criteria; and Extended Fuzzy TOPSIS method phase for
ranking the alternatives and reaching the final decision. As the proposed model is novel, it
might be applied to other MCDM selection problems.
Moreover, this section has restated the research questions, the research objectives and the
methodology employed to respond to each question is summarised below. The research
questions were made explicit in section 1.4 of this thesis.
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The first research question was What is the gap in existing studies used in the insurance
plan selection problem and how can selection be improved.
A traditional literature survey method was used to address the first research question. The
research began with the literature review, which defined the basic information about the
health insurance industry in order to understand concepts and terms in this area (section 2.2).
Moreover, the various issues and challenges related to insurance modelling and selection
problems were reviewed in sections 2.3. The findings of this review showed that the selection
problem in this study is a decision making problem under conditions of uncertainty and that
the DMs in this selection process are likely to deal with a number of dependent and correlated
selection criteria. Based on the review, the gap or incompleteness in this research area was
defined in section 4.1.
These foregoing activities, furthermore, meet the first objective of the research, which was
To analyse the issues involved in the selection of group health insurance plans in the private
sector in order to address the gap or incompleteness in this research area and to decide the
direction of this study.
The second research question was Which tools and methods are valuable and applicable to
tackling the issues associated with the evaluation process for selecting a group health
insurance plan
In order to decide the direction of this study and adopt the main approach for this research,
the literature related to health insurance studies was explored in the second half of chapter
two. Particular emphasis was given to the methods used for the selection and choice of an
insurance plan for covering employees. Although this thesis specifically focuses on the case
of health insurance, it is necessary to also review the selection problems in the insurance
sector in general, in order to consider general thoughts of the topic. Thus, previous works
260
regarding the methods that have been used for insurance policy selection and purchasing have
been reviewed. The review of the existing literature on insurance selection studies, in chapter
two, indicates that the MCDM approach was adopted to be the dominant research
methodology. In addition, the conclusion from chapter two was that the nature of group
health insurance plan selection was considered as a complex group MCDM problem under
conditions of uncertainty and with dependency relationships among the decision criteria.
Moreover, the importance weights of the DMs, in affecting the priorities of criteria, the
ranking of alternatives and the final decision, were taken into account.
Thus, the focus in chapter three was on the investigation and analysis of suitable
methodologies and techniques from the field of MCDM, which could be used to improve the
current selection process for group health insurance. Consequently, the most frequently used
theories and tools in group MCDM for modelling uncertainty, generating decision criteria
weights, studying dependency, deriving the importance of DMs in a group and ranking
alternatives were reviewed and analysed to gain an in-depth understanding of the limitations
and advantages of these theories and tools. To conclude chapter three, the adopted techniques
were the SDM method, the non-linear FPP method, the Fuzzy DEMATEL method and the
Fuzzy TOPSIS method for obtaining the importance of DMs, deriving criteria weights,
studying dependency and ranking the alternatives, respectively. One may refer to chapter
three for further clarification with respect to the adopted techniques suitable for the selection
problem. The abovementioned tasks also addressed the following objectives of this research:
To investigate existing methods in literature, such as the MCDM methods and other
operational research techniques, that have been used to handle the insurance plan selection
problem. Moreover, to explore and analyse suitable existing methods, that can be applied in
capturing the group health insurance plan selection problem and to investigate their
extension to modelling the uncertainty aspect in the selection problem.
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To explore a proper method to analyse the relationships/dependence among the criteria in
the selection process for group health insurance plans.
The third research question was How can those tools and methods be used to propose a
novel model to evaluate the group health insurance plan selection problem?
In this thesis, a new hybrid Fuzzy MCDM model, an integrated model which combines the
extended Fuzzy Delphi (used to select the critical criteria), extended Fuzzy DEMATEL (used
to measure dependency), new FGP (used to derive the relative weights of criteria) and
modified Fuzzy TOPSIS (used to rank the alternatives) methods, was proposed for the
selection problem in chapter four. To our knowledge, no prior work has investigated such a
selection problem using an integrated model with Delphi, DEMATEL, Prioritisation and
TOPSIS methods in a fuzzy environment, taking into account the different importance of
each DM in the group. The main contribution of the proposed model is consideration of the
different importance weights of DMs in the group, unlike all existing hybrid Fuzzy MCDM
models.
In order to assist DMs to implement the proposed new extended methodologies for solving
the MCDM problem much more effectively and efficiently, and to provide user-friendly
interfaces, four decision support tools, termed the Fuzzy Delphi Solver, the Fuzzy
DEMATEL Solver, the Fuzzy Group Prioritisation Solver and the Fuzzy TOPSIS Solver,
were developed in chapter five by using MATLAB software.
The activities in chapters four and five address the following research objectives:
To propose an evaluation model to assist employers in private sector companies, in
choosing the ideal plan in order to provide a health environment for their employees under
the complexity of the various criteria and uncertainty in the judgement process.
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To design prototype decision support tools to assist the DMs in applying the proposed
model in this study.
The fourth research question in this study was How efficient and useful are the multi
criteria decision making (MCDM) tools in the evaluation process for selecting a group health
insurance plan?
To respond to this research question, the applicability of the proposed hybrid Fuzzy MCDM
model was demonstrated using actual data from a case study. The case study of the practical
implementation of the developed model was conducted in Saudi Arabia, specifically
involving nine HR managers/DMs, in terms of modelling such a selection process for health
insurance purchasing. The main purpose for conducting this case study was to verify the
proposed model and to meet the sixth research objective, which was To implement the
proposed model in a real life case study in order to test the empirical validity of the model.
From the case study, the key selection criteria and feasible alternatives which are applicable
for the purchase of a group health insurance plan were defined; refer to section 6.2.3.
Dependency between the selection criteria was measured and their relative importance was
derived by considering the importance of the DMs who were involved in this case study. The
main goal, to select the most beneficial alternative, was thus achieved after ranking the
defined alternatives with respect to the importance of the selection criteria and the importance
of the DMs. Moreover, a sensitivity analysis was used in chapter six as a tool to check the
robustness of the final outcomes of implementing the proposed model. Based on the results of
this case study, some recommendations were provided to insurance companies for improving
their group health insurance plans.
Finally, it has been concluded that the implementation of the proposed hybrid Fuzzy MCDM
model in the selection of a group health insurance plan, is indeed valuable. Moreover,
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although this study was applied to the Saudi insurance industry, it is believed that the
proposed model might be utilised for solving other selection problems.
7.4 Limitations of this Research
This study, like any other study, has its logical limitations. The limitations associated with
this study are summarised as follows:
1. There is a lack of literature on the insurance industry in Saudi Arabia, especially in the
adoption of health insurance, since it is a new and developing field. Thus, there are a
limited number of studies that describe and explain the Saudi health insurance industry.
Most available literature relates to developed countries.
2. This research was a challenge since it was a female who conducted it. As a female living
in Saudi Arabia, I am bound by the system and rules of the society. Therefore, I had to
respect the culture and follow the accepted system. Gathering data was the most
challenging; in other words, there were issues such as the restrictions that prevented the
researcher from conducting face to face interviews with the HR managers. Thus, the
questionnaire was adopted as a research method for collecting DMs opinions and
judgements independently.
3. The proposed model was validated based on the data collected from Saudi Arabia. Thus,
generalising the findings to other countries may be difficult, due to the different
environments and contexts.
4. The proposed model was examined by involving nine HR managers from nine different
companies. Further testing and enrolment of the model, in practice, was required to prove
its validity. Moreover, a larger sample size in the case study would have been preferable.
This would have offered a wider perspective, providing further views and emphases
within the particular context.
264
5. Defining the list of selection criteria and generating their importance weights were based
on the HR managers opinions only. Hence, they are limited in that they cannot be
generalised straightaway to the employees viewpoints. More research is required to
investigate the feasibility of achieving research findings from employees perspectives.
6. Due to the large number of decision criteria that are involved when dealing with the issue
of the selection of a group health insurance plan, reviews and discussion of each
particular aspect may not be very in-depth.
7.5 Recommendations for Possible Future Research
This section suggests some recommendations for further investigation and study.
Obviously, the proposed model is not restricted to the health insurance industry. It is
devised to handle the uncertainty issue, to study the concept of dependency, to consider
the importance of each participant in a design making group, to assess criteria weights
and to rank available alternatives accordingly. Hence, it is worth investigating the
practicality and suitability of the proposed model in other domains.
Conducting competitive studies is suggested to expand the proposed model by testing it in
different regions and industries.
In response to the concept of uncertainty, a possible future research direction is to present
the importance weights of the DMs in the decision making group as fuzzy weights, not
just as crisp weights, in order to model uncertainty in the importance weights of DMs.
The different DMs importance weights have been evaluated by assigning a unique
decision maker with a prior knowledge of the expertise and skills of all other DMs.
However, it is not always possible to find such a situation. Thus, future research may
investigate or develop new techniques to define the importance of each group member.
265
In further work, other methods can be utilised in order to build other new hybrid MCDM
models for future investigation. For instance, utilising the ER approach (Yang and Singh,
1994; Yang and Sen, 1997) instead of FST for modelling uncertainty, or applying Fuzzy
Ordered Weighted Averaging (FOWA) (Chang, et al., 2006; Merig & Casanovas, 2008)
for aggregation of DMs judgements rather than the WAM. The results obtained from the
newly built models could then be compared with the results obtained from the model
proposed in this study.
In this research, the decision support tools, named the Fuzzy Delphi Solver, Fuzzy
DEMATEL Solver, Fuzzy Group Prioritisation Solver and Fuzzy TOPSIS Solver, have
been developed as prototypes. Consequently, future studies are needed to integrate them
together and to develop a decision support system based on the proposed model in this
study. Moreover, some enhancements are needed to improve the quality of the system by
interviewing potential users and updating the requirements accordingly. For example,
sensitivity analysis should be incorporated into the system to see how results vary when
judgements are slightly changed. Additionally, new fuzzy scales can be used such as
Trapezoidal Fuzzy Numbers.
7.6 Final Words
The thesis was a useful journey and valuable for the researcher. It provided the researcher
with knowledge and skills to conduct academic research, including a range of knowledge
about carrying out the related literature review, adopting suitable research methodology,
collecting data and analysing the final results, using different software for programming and
more.
During this journey, the researcher presented at several conferences: Manchester Business
School Annual Doctoral Conference, Manchester, UK, 2011; 3rd Student Conference on
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Operational Research, Nottingham, UK, 2012; International Conference on Fuzzy Systems
and Neural Computing (ICFSNC), Paris, France, 2012; The World Conference on
Information Systems and Technologies (WorldCIST13), Algarve, Portugal, 2013; the 22nd
International Conference on Multiple Criteria Decision Making (MCDM2013), Malaga,
Spain, 2013; the 6th European Conference of the International Federation for Medical and
Biological Engineering (MBEC2014), Dubrovnik, Croatia on September 7 -11, 2014 and a
paper published in the International Journal of Artificial Intelligence and Interactive
Multimedia, vol. 2, Special Issue on Improvements in Information Systems and
Technologies, 2013.
267
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9. APPENDICES
Appendix A: Journal Publication
Almulhim, T., Mikhailov, L. & Xu, D.-L., 2013. A Fuzzy Group Prioritization Method for Deriving
Weights and its Software Implementation. International Journal of Interactive Multimedia and
Artificial Intelligence, Special Issue on Improvements in Information Systems and Technologies, 2(3),
pp. 7-14.
285
286
287
288
289
290
291
292
293
Appendix B: The Modified Mean De-Entropy Algorithm for Determining a Threshold
Value
A method to select an appropriate threshold value is needed in order to select the critical
selection criteria and reduce the number of selection criteria. In the existing literature, the
threshold value has been determined through interviews and discussions with experts or
chosen by the researchers. Determining the threshold value by asking experts is time
consuming. As well as this, it can be difficult to achieve a consensus for finding a unique
threshold, especially if there are too many experts to aggregate at the same time. If the
threshold is determined by the researcher alone, it is important to clarify how to choose the
specific value. The Mean De-Entropy Algorithm proposed by Li & Tzeng (2009) is a proper
way to choose the cut point. Therefore, the Mean De-Entropy algorithm was modified and
adopted in this study to determine a threshold value for the extended FDE method.
Information Entropy was developed by Shannon (1948); he defined information entropy to
measure uncertainty in a random variable. It is a criterion for the amount of uncertainty
represented by a discrete probability distribution. Let a random variable with elements be
denoted as = {1 , 2 , . , }, with a corresponding probability, = {1 , 2 , . , }, then
we define the entropy, , of as follows:
(1 , 2 , . , ) = =1 log 2
Subject to: =1 = 1 and =1 log 2 = 0 = 0
The decreased level of entropy was defined by Li and Tzeng (2009) for a given finite discrete
scheme of . The de-entropy of is denoted as and defined as:
1 1 1
= ( , , . , ) (1 , 2 , . , ) = log 2 (1 , 2 , . , )
The value of is equal to or larger than 0. Unlike entropy, which is used for the measure of
uncertainty, the can explain the amount of useful information derived from a specific
dataset, which reduces the uncertainty of information.
294
The steps of the modified Mean De-Entropy algorithm for determining the threshold value
are described as follows (Quinlan, 1986; Li & Tzeng, 2009):
Step 1: Transforming the = {1 , 2 , . , } into an ordered set by rearranging the element
order in set from small to large. If there is no frequency in the data set, then round the value
down to some simple value (like 2 instead of 2.43 or 5 instead of 5.26) to obtain .
Step 2: Dividing the set to establish new subsets with different cases ( = 1,2, , , ,

1). For each case, two new ordered subsets can be established, 1 and2 , = 1,2, , , , 1,

where for = , 1 = {1 , . . , } and2 = {+1 , . . , }.
For example, if = {2,2,5}, so we have two different cases ( = 1,2) as follows:

First case: = 1 1 1 = {2 } and 2 1 = {2,5 }

Second case: = 2 1 2 = {2,2} and 2 1 = {5}

Step 3: Calculating the mean de-entropy of each subset in each case. Calculate the 1 and

2 of the subsets, 1 and 2 , then calculate the mean de-entropy for each subset as
follows:

1
1 =
( 1 )

2
2 =
( 2 )
where () denotes the cardinal number of different elements in set .
Step 4: Calculating the Information Gain (IG) of the mean de-entropy for different
cases ( = 1,2, , , , 1) (Quinlan, 1986):

| | | |
= [( 1 ) 1 + ( 2 ) 2 ]

295
where the cardinality || of a set is the number of elements of .
Step 5: Finding the threshold level. The case with the minimum value of is selected to be
the cut level.
Table 9.1 shows the results obtained by using the Modified Mean De-Entropy Algorithm for
determining the cut level for screening out the selection criteria in the extended FDE method
as explained in section 6.2.3.2. From Table 9.1 one can conclude that the cut level is case 10:

1 10 = {2,2,3,3,3,3,3,3,3,4} ; 2 10 = {5,6,7,7,7,7,7,7,7,7,7,7,8,8,8,8,8,8,8} . Thus, the
selected threshold value is 5.
Table 9.1: Results Derived from Steps 1 to 5 Using the Modified Mean De-entropy Algorithm
Item Data
Step 1: The ordered = {1.64,1.94,2.74,2.76,2.82,2.92,2.96,3.02,3.04,4.32,5.16,6,6.52,6.66,6.7,6.96,7.14,
set 7.26,7.3,7.39,7.44,7.48,7.68,7.78,7.88,8.02,8.16,8.18,8.3}

= {2,2,3,3,3,3,3,3,3,4,5,6,7,7,7,7,7,7,7,7,7,7,8,8,8,8,8,8,8}

Step 2: Establishing Case 1: 1 1 = {2}; 2 1 = {2,3,3,3,3,3,3,3,4,5,6,7,7,7,7,7,7,7,7,7,7,8,8,8,8,8,8,8}
28 different cases
Case 2: 1 2 = {2,2}; 2 2 = {3,3,3,3,3,3,3,4,5,6,7,7,7,7,7,7,7,7,7,7,8,8,8,8,8,8,8}

Case 3: 1 3 = {2,2,3}; 2 3 = {3,3,3,3,3,3,4,5,6,7,7,7,7,7,7,7,7,7,7,8,8,8,8,8,8,8}

Case 4: 1 4 = {2,2,3,3}; 2 4 = {3,3,3,3,3,4,5,6,7,7,7,7,7,7,7,7,7,7,8,8,8,8,8,8,8}

Case 5: 1 5 = {2,2,3,3,3}; 2 5 = {3,3,3,3,4,5,6,7,7,7,7,7,7,7,7,7,7,8,8,8,8,8,8,8}

Case 6: 1 6 = {2,2,3,3,3,3}; 2 6 = {3,3,3,4,5,6,7,7,7,7,7,7,7,7,7,7,8,8,8,8,8,8,8}

Case 7: 1 7 = {2,2,3,3,3,3,3}; 2 7 = {3,3,4,5,6,7,7,7,7,7,7,7,7,7,7,8,8,8,8,8,8,8}

Case 8: 1 8 = {2,2,3,3,3,3,3,3}; 2 8 = {3,4,5,6,7,7,7,7,7,7,7,7,7,7,8,8,8,8,8,8,8}

Case 9: 1 9 = {2,2,3,3,3,3,3,3,3}; 2 9 = {4,5,6,7,7,7,7,7,7,7,7,7,7,8,8,8,8,8,8,8}

Case 10: 1 10 = {2,2,3,3,3,3,3,3,3,4}; 2 10 = {5,6,7,7,7,7,7,7,7,7,7,7,8,8,8,8,8,8,8}

Case 11: 1 11 = {2,2,3,3,3,3,3,3,3,4,5}; 2 11 = {6,7,7,7,7,7,7,7,7,7,7,8,8,8,8,8,8,8}

Case 12: 1 12 = {2,2,3,3,3,3,3,3,3,4,5,6}; 2 12 = {7,7,7,7,7,7,7,7,7,7,8,8,8,8,8,8,8}

Case 13: 1 13 = {2,2,3,3,3,3,3,3,3,4,5,6,7}; 2 13 = {7,7,7,7,7,7,7,7,7,8,8,8,8,8,8,8}

Case 14: 1 14 = {2,2,3,3,3,3,3,3,3,4,5,6,7,7}; 2 14 = {7,7,7,7,7,7,7,7,8,8,8,8,8,8,8}

Case 15: 1 15 = {2,2,3,3,3,3,3,3,3,4,5,6,7,7,7}; 2 15 = {7,7,7,7,7,7,7,8,8,8,8,8,8,8}

Case 16: 1 16 = {2,2,3,3,3,3,3,3,3,4,5,6,7,7,7,7}; 2 16 = {7,7,7,7,7,7,8,8,8,8,8,8,8}

Case 17: 1 17 = {2,2,3,3,3,3,3,3,3,4,5,6,7,7,7,7,7}; 2 17 = {7,7,7,7,7,8,8,8,8,8,8,8}

Case 18: 1 18 = {2,2,3,3,3,3,3,3,3,4,5,6,7,7,7,7,7,7}; 2 18 = {7,7,7,7,8,8,8,8,8,8,8}

Case 19: 1 19 = {2,2,3,3,3,3,3,3,3,4,5,6,7,7,7,7,7,7,7}; 2 19 = {7,7,7,8,8,8,8,8,8,8}
296

Case 20: 1 20 = {2,2,3,3,3,3,3,3,3,4,5,6,7,7,7,7,7,7,7,7}; 2 20 = {7,7,8,8,8,8,8,8,8}

Case 21: 1 21 = {2,2,3,3,3,3,3,3,3,4,5,6,7,7,7,7,7,7,7,7,7}; 2 21 = {7,8,8,8,8,8,8,8}

Case 22: 1 22 = {2,2,3,3,3,3,3,3,3,4,5,6,7,7,7,7,7,7,7,7,7,7}; 2 22 = {8,8,8,8,8,8,8}

Case 23: 1 23 = {2,2,3,3,3,3,3,3,3,4,5,6,7,7,7,7,7,7,7,7,7,7,8}; 2 23 = {8,8,8,8,8,8}

Case 24: 1 24 = {2,2,3,3,3,3,3,3,3,4,5,6,7,7,7,7,7,7,7,7,7,7,8,8}; 2 24 = {8,8,8,8,8}

Case 25: 1 25 = {2,2,3,3,3,3,3,3,3,4,5,6,7,7,7,7,7,7,7,7,7,7,8,8,8}; 2 25 = {8,8,8,8}

Case 26: 1 26 = {2,2,3,3,3,3,3,3,3,4,5,6,7,7,7,7,7,7,7,7,7,7,8,8,8,8}; 2 26 = {8,8,8}

Case 27: 1 27 = {2,2,3,3,3,3,3,3,3,4,5,6,7,7,7,7,7,7,7,7,7,7,8,8,8,8,8}; 2 27 = {8,8}

Case 28: 1 28 = {2,2,3,3,3,3,3,3,3,4,5,6,7,7,7,7,7,7,7,7,7,7,8,8,8,8,8,8}; 2 28 = {8}

Step 3: Calculating the Case 1: 1 1 = 0 ; 2 1 = 0.718
mean de-entropy
Case 2: 1 2 = 0.5 ; 2 2 = 0.775

Case 3: 1 3 = 0.959 ; 2 3 = 0.776

Case 4: 1 4 = 0.594 ; 2 4 = 0.774

Case 5: 1 5 = 0.603 ; 2 5 = 0.772

Case 6: 1 6 = 0.606 ; 2 6 = 0.767

Case 7: 1 7 = 0.605 ; 2 7 = 0.758

Case 8: 1 8 = 0.603 ; 2 8 = 0.742

Case 9: 1 9 = 0.993 ; 2 9 = 0.756

Case 10: 1 10 = 0.980 ; 2 10 = 0.810

Case 11: 1 11 = 0.918 ; 2 11 = 0.958

Case 12: 1 12 = 0.854 ; 2 12 = 0.943

Case 13: 1 13 = 0.769 ; 2 13 = 0.997

Case 14: 1 14 = 0.775 ; 2 14 = 0.995

Case 15: 1 15 = 0.774 ; 2 15 = 0.993

Case 16: 1 16 = 0.772 ; 2 16 = 0.991

Case 17: 1 17 = 0.767 ; 2 17 = 0.990

Case 18: 1 18 = 0.762 ; 2 18 = 0.912

Case 19: 1 19 = 0.756 ; 2 19 = 0.817

Case 20: 1 20 = 0.749 ; 2 20 = 0.771

Case 21: 1 21 = 0.745 ; 2 21 = 0.5

Case 22: 1 22 = 0.773 ; 2 22 = 0

Case 23: 1 23 = 0.685 ; 2 23 = 0

Case 24: 1 24 = 0.702 ; 2 24 = 0

Case 25: 1 25 = 0.708; 2 25 = 0

Case 26: 1 26 = 0.712 ; 2 62 = 0
297

Case 27: 1 27 = 0.714 ; 2 27 = 0

Case 28: 1 28 = 0.684 ; 2 28 = 0
Step 4: Calculating the Case 1: 1 = 0.717
Case 2: 2 = 0.756
Case 3: 3 = 0.794
Case 4: 4 = 0.750
Case 5: 5 = 0.743
Case 6: 6 = 0.733
Case 7: 7 = 0.721
Case 8: 8 = 0.704
Case 9: 9 = 0.830
Case 10: 10 = 0.953
Case 11: 11 = 0.942
Case 12: 12 = 0.943
Case 13: 13 = 0.902
Case 14: 14 = 0.898
Case 15: 15 = 0.889
Case 16: 16 = 0.876
Case 17: 17 = 0.859
Case 18: 18 = 0.838
Case 19: 19 = 0.809
Case 20: 20 = 0.770
Case 21: 21 = 0.752
Case 22: 22 = 0.707
Case 23: 23 = 0.542
Case 24: 24 = 0.581
Case 25: 25 = 0.610
Case 26: 26 = 0.638
Case 27: 27 = 0.664
Case 28: 28 = 0.689
Step 5: Finding the Case 10: 10 = 0.953

threshold level Case 10: 1 10 = {2,2,3,3,3,3,3,3,3,4}; 2 10 = {5,6,7,7,7,7,7,7,7,7,7,7,8,8,8,8,8,8,8}
298
Appendix C: The Maximum Mean De-Entropy Algorithm (MMDE)
In the past, it was the experts who determined the threshold when applying Fuzzy
DEMATEL. Therefore, obtaining the threshold value is different for each researcher. The
Maximum Mean De-Entropy Algorithm (MMDE) can obtain a unique threshold value. The
MMDE proposed by Li & Tzeng (2009) is a way to choose the cut point to obtain a
suitable impact relations map. The MMDE algorithm based on the information entropy
approach, can be used to derive a set of dispatch nodes, the factors which strongly dispatch
influence to others, and a set of receive nodes, which are easily influenced by other factors
(Li & Tzeng, 2009). According to these two sets, a unique threshold value can be obtained
for solving the problems that a researcher may face regarding the selection of a consistent
threshold value and creation of a suitable impact relations map in the Fuzzy DEMATEL
method.
Information Entropy was developed by Shannon (1948); he defined information entropy to
measure uncertainty in a random variable. It is a criterion for the amount of uncertainty
represented by a discrete probability distribution. Let a random variable with elements be
denoted as = {1 , 2 , . , }, with a corresponding probability, = {1 , 2 , . , }, then
we define the entropy, , of as follows:

(1 , 2 , . , ) = log 2
=1
Subject to: =1 = 1 and =1 log 2 = 0 = 0
The decreased level of entropy, or de-entropy (Li and Tzeng, 2009), of is denoted as
and defined as:
1 1 1
= ( , , . , ) (1 , 2 , . , ) = log 2 (1 , 2 , . , )
In the Fuzzy DEMATEL method, the total relation matrix is the matrix used to delineate the
final output of the Fuzzy DEMATEL method, the impact relations map, after the threshold
299
value is determined. A n n total relation matrix is denoted as . The (, ) element of the
matrix is denoted as and directly affects the influence of factor on factor . For
each , the factor is defined as a dispatch-node and factor is defined as a receive-node
with respect to .
From the definition of , a full relation matrix, , can be considered as a collection
(set ) with 2 pair ordered elements. Each subset of the set can be divided into two sets:
an ordered dispatch-node set and an ordered receive-node set. For an ordered dispatch-node
set (or an ordered receive-node set), we can count the frequency of the different elements of
the set. If the finite cardinality of an ordered dispatch-node set (or an ordered receive-node set)
is and the frequency of element is , we assign the corresponding probability of as:

= .
Based on a calculated total relation matrix, , Li and Tzeng (2009) described the MMDE
algorithm; the steps of the MMDE are summarised as follows:
Step 1: Transforming the relation matrix into a set of ordered triplets. Transforming the
total relation matrix, , into an ordered set, , {11 , 12 , . , 21 , 22 , . } ,
rearranging the element order in set from large to small, and transforming to a
corresponding set of ordered triplets ( , , ), , = 1,2, denotes . Each element of
set , , can also be seen as an ordered triplet, ( , , ), respectively denoting the
influence value, dispatch-node and receive-node that denote .
Step 2: Taking the second element from the ordered triplets set, , to establish a new
ordered dispatch-node set, .
Step 3: Calculating the mean de-entropy of the dispatch-node set. Taking the first elements

of as a new set, , assigning the probability of different elements, = , then
300
calculating the of the set , , allows us to calculate the mean de-entropy by

= ( ) (where () denotes the cardinal number of different elements in set ).

Step 4: Finding the maximum mean de-entropy. Considering the mean de-entropy values
( ), we choose the maximum mean de-entropy and its corresponding . This dispatch-

node set, with the maximum mean de-entropy, is denoted as .
Step 5: Similar to steps 2 to 4, an ordered receive-node set and a maximum mean de-

entropy receive-node set can be derived. The elements of provide information
that is easily influenced.
Step 6: Finding the threshold value. Taking the first elements in as the subset, ,

which includes all elements of in the dispatch-node and all elements of in the
receive-node, the minimum influence value in is the threshold value.
301
Table 9.2: The Results Derived from Steps 1 to 6 Using the MMDE Algorithm
Item Data
Step 1: The ordered = {(0.6629,2,1), (0.6345,5,1), (0.6291,3,1), (0.6199,1,3), (0.6173,1,4), (0.6124,2,3),
triplets set (0.6029,4,1), (0.6008,1,5), (0.5888,2,4), (0.5831,3,4), (0.5792,2,5), (0.571,4,3), (0.5708,5,4)
, (0.5596,4,5), (0.553,3,5), (0.5516,5,3), (0.4736,1,1), (0.4156,3,3), (0.4098,4,4),
(0.3955,5,5), (0.2819,1,2), (0.2794,3,2), (0.2751,4,2), (0.25,5,2), (0.2097,2,2)}
Step 2: Dispatch-node = {2,5,1,3,1,2,2,1,2,4,3,3,5,5,4,4,1,3,5,4,1,3,4,5,2}
set,
Step 3.1: sets and 1 = {2}, 1 = 0 ; 2 = {2,5}, 2 = 0 ; 3 = {2,5,3}, 3 =
values
0; 4 = {2,5,3,1}, 4 =0; 5 = {2,5,3,1,1}, 5 = 0.01951;;

25 = {2,5,1,3,1,2,2,1,2,4,3,3,5,5,4,4,1,3,5,4,1,3,4,5,2}, 25 = 0;
Step 3.2: Set of 25 = {0,0,0,0,0.0195,0.02042,0.01720,0.03325,0.0417,0.03019,0.040769,
values 0.0188,0.01283,0.010197,0.00653,0.002129,0.002947,0.002731,0.00169,0,
0.00125,0.00176,0.00166,0.001047,0}
Step 4.1: Maximum 0.04172
Step 4.2: Dispatch {2,5,3,1,1,2,4,1,2} = {1,2,3,4,5}

node set of
maximum
Step 5.1: Receive-node = {1,1,5,1,3,3,5,4,4,1,4,5,4,3,3,5,1,3,5,4,2,2,2,2,2}
set,
Step 5.2: Set of 25 = {0,0,0,0.09436,0.07133,0.4193,0.06872,0.0625,0.0408,0.03839,
values
0.01593,0.010213,0.01248,0.00369,0.002525,0,0.00180,0.00223,0.001556
0,0.02819,0.012849,0.004833,0.001047,0}
Step 5.3: Maximum 0.09436

Step 5.4: Receive node {1,1,1,3} = {1,3}
set of
maximum
{(0.6629, , 1), (0.6345, , 1), (0.6291, , 1), (0.6199, , 3), (0.6029, , 1)}
Step 6.1:

Step 6.2: {(0.6629,2, ), (0.6199,1, )}
Step 6.3: {(0.6629, , ), (0.6345, , 1), (0.6291, , 1), (0.6199, , ), (0.6029, , 1)}
Step 6.4: Threshold 0.6029

value
302
Appendix D: Number of Fuzzy PCJMs
Table 9.3: Number of Fuzzy PCJMs and Questions for Cluster A Criteria
Criteria No. of comparison No. of criteria in each matrix No. of pairwise

matrix questions
A1 3 4,6,4 6+15+6=27
A2 3 4,6,4 6+15+6=27
sum 6 -- 54
Table 9.4: Number of Fuzzy PCJMs and Questions for Cluster B Criteria
Criteria No. of comparison No. of criteria in each matrix No. of pair-

matrix wise questions
B1 2 2,4 1+6=7
B2 2 2,4 1+6=7
B3 2 2,4 1+6=7
sum 6 -- 21
Table 9.5: Number of Fuzzy PCJMs and Questions for Cluster C Criteria

C1 1 2 1
C2 1 2 1
C3 1 2 1
C4 1 2 1
sum 4 -- 4
Table 9.6: Number of Fuzzy PCJMs and Questions for Cluster D Criteria

D1 1 2 1
D2 1 2 1
D3 1 2 1
D4 1 2 1
D5 1 2 1
D6 1 2 1
sum 6 -- 6
303
Table 9.7: Number of Fuzzy PCJMs and Questions for Cluster E Criteria

E1 1 2 1
E2 1 2 1
E3 1 2 1
E4 1 2 1
sum 4 -- 4
Table 9.8: Total Number of Required Fuzzy PCJMs and Questions
No. of comparison matrix No. of pair-wise questions

Total 26 89
304
Appendix E: Comparison Matrices of Decision Criteria and their Local Weights
Table 9.9: Reciprocal Fuzzy PCJMs for Criteria A1 and A2 with Respect to Criterion B1 and their Local
Weights
The pair-wise comparison matrix for

WRT B 1 A1 A2
A1 (1,1,1) 1 1 1
( , , )
6 5 4
A2 (1,1,1)
WRT B 1 A1 A2
A1 (1,1,1) 1 1 1
( , , )
8 7 6
A2 (1,1,1)
WRT B 1 A1 A2
A1 (1,1,1) (4,5,6)
A2 (1,1,1)
WRT B 1 A1 A2
A1 (1,1,1) 1 1 1
( , , )
6 5 4
A2 (1,1,1)
WRT B 1 A1 A2
A1 (1,1,1) 1 1 1
( , , )
6 5 4
A2 (1,1,1)
WRT B 1 A1 A2
A1 (1,1,1) 1 1 1
( , , )
6 5 4
A2 (1,1,1)
WRT B 1 A1 A2
A1 (1,1,1) 1 1 1
( , , )
6 5 4
A2 (1,1,1)
WRT B 1 A1 A2
A1 (1,1,1) 1 1 1
( , , )
6 5 4
A2 (1,1,1)
WRT B 1 A1 A2
A1 (1,1,1) 1 1 1
( , , )
8 7 6
A2 (1,1,1)
Local weights
A1 A2
WRT B1
0.167 0.833
305
Figure 9.1: Local Weights for Criteria A1 and A2 with Respect to Criterion B1 by Using the Fuzzy Group
Table 9.10: Reciprocal Fuzzy PCJMs for Criteria A1 and A2 with Respect to Criterion B2 and their
Local Weights

WRT B 2 A1 A2
A1 (1,1,1) 1 1 1
( , , )
8 7 6
A2 (1,1,1)
WRT B 2 A1 A2
A1 (1,1,1) (1,1,1)
A2 (1,1,1)
WRT B 2 A1 A2
A1 (1,1,1) (1,1,1)
A2 (1,1,1)
WRT B 2 A1 A2
A1 (1,1,1) 1 1 1
( , , )
4 3 2
A2 (1,1,1)
WRT B 2 A1 A2
A1 (1,1,1) 1 1 1
( , , )
6 5 4
A2 (1,1,1)
WRT B 2 A1 A2
A1 (1,1,1) 1 1 1
( , , )
10 9 8
A2 (1,1,1)
WRT B 2 A1 A2
306
A1 (1,1,1) 1 1 1
( , , )
6 5 4
A2 (1,1,1)
WRT B 2 A1 A2
A1 (1,1,1) 1 1 1
( , , )
6 5 4
A2 (1,1,1)
WRT B 2 A1 A2
A1 (1,1,1) 1 1 1
( , , )
6 5 4
A2 (1,1,1)
Local weights
A1 A2
WRT B 2
0.2 0.8
307
Table 9.11: Reciprocal Fuzzy PCJMs for Criteria A1 and A2 with Respect to Criterion B3 and their
Local Weights

WRT B 3 A1 A2
A1 (1,1,1) (6,7,8)
A2 (1,1,1)
WRT B 3 A1 A2
A1 (1,1,1) 1 1 1
( , , )
8 7 6
A2 (1,1,1)
WRT B 3 A1 A2
A1 (1,1,1) 1 1 1
( , , )
6 5 4
A2 (1,1,1)
WRT B 3 A1 A2
A1 (1,1,1) 1 1 1
( , , )
6 5 4
A2 (1,1,1)
WRT B 3 A1 A2
A1 (1,1,1) 1 1 1
( , , )
6 5 4
A2 (1,1,1)
WRT B 3 A1 A2
A1 (1,1,1) 1 1 1
( , , )
8 7 6
A2 (1,1,1)
WRT B 3 A1 A2
A1 (1,1,1) (2,3,4)
A2 (1,1,1)

WRT B 3 A1 A2
A1 (1,1,1) 1 1 1
( , , )
4 3 2
A2 (1,1,1)
The pair-wise comparison matrix for the
WRT B 3 A1 A2
A1 (1,1,1) 1 1 1
( , , )
4 3 2
A2 (1,1,1)
Local weights
A1 A2
WRT B 3
0.167 0.833
308
Table 9.12: Reciprocal Fuzzy PCJMs for Criteria A1 and A2 with Respect to Criterion C1 and their
Local Weights

WRT C 1 A1 A2
A1 (1,1,1) 1 1 1
( , , )
8 7 6
A2 (1,1,1)
WRT C 1 A1 A2
A1 (1,1,1) 1 1 1
( , , )
8 7 6
A2 (1,1,1)
WRT C 1 A1 A2
A1 (1,1,1) 1 1 1
( , , )
6 5 4
A2 (1,1,1)
WRT C 1 A1 A2
A1 (1,1,1) 1 1 1
( , , )
8 7 6
A2 (1,1,1)
WRT C 1 A1 A2
A1 (1,1,1) 1 1 1
( , , )
10 9 8
A2 (1,1,1)
WRT C 1 A1 A2
A1 (1,1,1) 1 1 1
( , , )
6 5 4
A2 (1,1,1)
WRT C 1 A1 A2
309
A1 (1,1,1) -
A2 (1,1,1)
WRT C 1 A1 A2
A1 (1,1,1) 1 1 1
( , , )
8 7 6
A2 (1,1,1)
WRT C 1 A1 A2
A1 (1,1,1) 1 1 1
( , , )
4 3 2
A2 (1,1,1)
Local weights
A1 A2
WRT C 1
0.1 0.9
Figure 9.4: Local Weights for Criteria A1 and A2 with Respect to Criterion C1 by Using the Fuzzy Group
Local Weights

WRT C 2 A1 A2
A1 (1,1,1) 1 1 1
( , , )
4 3 2
A2 (1,1,1)
WRT C 2 A1 A2
A1 (1,1,1) 1 1 1
( , , )
6 5 4
A2 (1,1,1)
WRT C 2 A1 A2
A1 (1,1,1) 1 1 1
( , , )
6 5 4
310
A2 (1,1,1)
WRT C 2 A1 A2
A1 (1,1,1) 1 1 1
( , , )
8 7 6
A2 (1,1,1)
WRT C 2 A1 A2
A1 (1,1,1) 1 1 1
( , , )
8 7 6
A2 (1,1,1)
WRT C 2 A1 A2
A1 (1,1,1) 1 1 1
( , , )
8 7 6
A2 (1,1,1)
WRT C 2 A1 A2
A1 (1,1,1) -
A2 (1,1,1)
WRT C 2 A1 A2
A1 (1,1,1) 1 1 1
( , , )
8 7 6
A2 (1,1,1)
WRT C 2 A1 A2
A1 (1,1,1) 1 1 1
( , , )
4 3 2
A2 (1,1,1)
Local weights
A1 A2
WRT C 2
0.178 0.822
311
Local Weights

WRT C 3 A1 A2
A1 (1,1,1) 1 1 1
( , , )
4 3 2
A2 (1,1,1)
WRT C 3 A1 A2
A1 (1,1,1) 1 1 1
( , , )
4 3 2
A2 (1,1,1)
WRT C 3 A1 A2
A1 (1,1,1) (2,3,4)
A2 (1,1,1)
WRT C 3 A1 A2
A1 (1,1,1) 1 1 1
( , , )
4 3 2
A2 (1,1,1)
WRT C 3 A1 A2
A1 (1,1,1) 1 1 1
( , , )
8 7 6
A2 (1,1,1)
WRT C 3 A1 A2
A1 (1,1,1) 1 1 1
( , , )
8 7 6
A2 (1,1,1)
WRT C 3 A1 A2
A1 1 -
A2 (1,1,1)
WRT C 3 A1 A2
A1 (1,1,1) 1 1 1
( , , )
10 9 8
A2 1
WRT C 3 A1 A2
A1 (1,1,1) 1 1 1
( , , )
4 3 2
A2 (1,1,1)
Local weights
A1 A2
WRT C 3
0.256 0.744
312
Local Weights

WRT C 4 A1 A2
A1 (1,1,1) 1 1 1
( , , )
6 5 4
A2 (1,1,1)
WRT C 4 A1 A2
A1 (1,1,1) (2,3,4)
A2 (1,1,1)
WRT C 4 A1 A2
A1 (1,1,1) (2,3,4)
A2 (1,1,1)
WRT C 4 A1 A2
A1 (1,1,1) (1,1,1)
A2 (1,1,1)
WRT C 4 A1 A2
A1 (1,1,1) (1,1,1)
A2 (1,1,1)
WRT C 4 A1 A2
A1 (1,1,1) (4,5,6)
A2 (1,1,1)
WRT C 4 A1 A2
A1 (1,1,1) (1,1,1)
A2 (1,1,1)
313
WRT C 4 A1 A2
A1 (1,1,1) 1 1 1
( , , )
6 5 4
A2 (1,1,1)
WRT C 4 A1 A2
A1 (1,1,1) 1 1 1
( , , )
4 3 2
A2 (1,1,1)
Local weights
A1 A2
WRT C 4
0.5 0.5
Table 9.16: Reciprocal Fuzzy PCJMs for Criteria A1 and A2 with Respect to Criterion D1 and their
Local Weights

WRT D 1 A1 A2
A1 (1,1,1) 1 1 1
( , , )
4 3 2
A2 (1,1,1)
WRT D 1 A1 A2
A1 (1,1,1) 1 1 1
( , , )
4 3 2
A2 (1,1,1)
WRT D 1 A1 A2
A1 (1,1,1) (6,7,8)
A2 (1,1,1)
314
WRT D 1 A1 A2
A1 (1,1,1) (2,3,4)
A2 (1,1,1)
WRT D 1 A1 A2
A1 (1,1,1) (4,5,6)
A2 (1,1,1)
WRT D 1 A1 A2
A1 (1,1,1) (4,5,6)
A2 (1,1,1)
WRT D 1 A1 A2
A1 (1,1,1) (2,3,4)
A2 (1,1,1)
WRT D 1 A1 A2
A1 (1,1,1) (2,3,4)
A2 (1,1,1)
WRT D 1 A1 A2
A1 (1,1,1) 1 1 1
( , , )
6 5 4
A2 (1,1,1)
Local weights
A1 A2
WRT D 1
0.167 0.833
Figure 9.8: Local Weights for Criteria A1 and A2 with Respect to Criterion D1 by Using the Fuzzy Group
315
Local Weights

WRT D 2 A1 A2
A1 (1,1,1) (2,3,4)
A2 (1,1,1)
WRT D 2 A1 A2
A1 (1,1,1) (2,3,4)
A2 (1,1,1)
WRT D 2 A1 A2
A1 (1,1,1) (4,5,6)
A2 (1,1,1)
WRT D 2 A1 A2
A1 (1,1,1) (2,3,4)
A2 (1,1,1)
WRT D 2 A1 A2
A1 (1,1,1) (2,3,4)
A2 (1,1,1)
WRT D 2 A1 A2
A1 (1,1,1) (4,5,6)
A2 (1,1,1)
WRT D 2 A1 A2
A1 (1,1,1) (2,3,4)
A2 (1,1,1)
WRT D 2 A1 A2
A1 (1,1,1) (2,3,4)
A2 (1,1,1)
WRT D 2 A1 A2
A1 (1,1,1) (2,3,4)
A2 (1,1,1)
Local weights
A1 A2
WRT D 2
0.184 0.816
316
Figure 9.9: Local Weights for Criteria A1 and A2 with Respect to Criterion D2 by Using the Fuzzy Group
Local Weights

WRT D 3 A1 A2
A1 (1,1,1) (4,5,6)
A2 (1,1,1)
WRT D 3 A1 A2
A1 (1,1,1) (4,5,6)
A2 (1,1,1)
WRT D 3 A1 A2
A1 (1,1,1) 1 1 1
( , , )
8 7 6
A2 (1,1,1)
WRT D 3 A1 A2
A1 (1,1,1) (2,3,4)
A2 (1,1,1)
WRT D 3 A1 A2
A1 (1,1,1) 1 1 1
( , , )
8 7 6
A2 (1,1,1)
WRT D 3 A1 A2
A1 (1,1,1) (4,5,6)
A2 (1,1,1)
WRT D 3 A1 A2
317
A1 (1,1,1) (4,5,6)
A2 (1,1,1)
WRT D 3 A1 A2
A1 (1,1,1) 1 1 1
( , , )
6 5 4
A2 (1,1,1)
WRT D 3 A1 A2
A1 (1,1,1) 1 1 1
( , , )
6 5 4
A2 (1,1,1)
Local weights
A1 A2
WRT D 3
0.125 0.875
Figure 9.10: Local Weights for Criteria A1 and A2 with Respect to Criterion D3 by Using the Fuzzy
Group Prioritisation Solver
Local Weights

WRT D 4 A1 A2
A1 (1,1,1) (4,5,6)
A2 (1,1,1)
WRT D 4 A1 A2
A1 (1,1,1) 1 1 1
( , , )
8 7 6
A2 (1,1,1)
WRT D 4 A1 A2
A1 (1,1,1) 1 1 1
( , , )
6 5 4
318
A2 (1,1,1)
WRT D 4 A1 A2
A1 (1,1,1) (2,3,4)
A2 (1,1,1)
WRT D 4 A1 A2
A1 (1,1,1) -
A2 (1,1,1)
WRT D 4 A1 A2
A1 (1,1,1) 1 1 1
( , , )
8 7 6
A2 (1,1,1)
WRT D 4 A1 A2
A1 (1,1,1) (4,5,6)
A2 (1,1,1)
WRT D 4 A1 A2
A1 (1,1,1) 1 1 1
( , , )
6 5 4
A2 (1,1,1)
WRT D 4 A1 A2
A1 (1,1,1) (2,3,4)
A2 (1,1,1)
Local weights
A1 A2
WRT D 4
0.180 0.820
319
Local Weights

WRT D 5 A1 A2
A1 (1,1,1) -
A2 (1,1,1)
WRT D 5 A1 A2
A1 (1,1,1) 1 1 1
( , , )
4 3 2
A2 (1,1,1)
WRT D 5 A1 A2
A1 (1,1,1) 1 1 1
( , , )
4 3 2
A2 (1,1,1)
WRT D 5 A1 A2
A1 (1,1,1) -
A2 (1,1,1)
WRT D 5 A1 A2
A1 (1,1,1) 1 1 1
( , , )
4 3 2
A2 (1,1,1)
WRT D 5 A1 A2
A1 (1,1,1) -
A2 (1,1,1)
WRT D 5 A1 A2
A1 (1,1,1) 1 1 1
( , , )
6 5 4
A2 (1,1,1)
WRT D 5 A1 A2
A1 (1,1,1) 1 1 1
( , , )
4 3 2
A2 (1,1,1)
WRT D 5 A1 A2
A1 (1,1,1) 1 1 1
( , , )
6 5 4
A2 (1,1,1)
Local weights
A1 A2
WRT D 5
0.215 0.785
320
Local Weights

WRT D 6 A1 A2
A1 (1,1,1) (4,5,6)
A2 (1,1,1)
WRT D 6 A1 A2
A1 (1,1,1) (4,5,6)
A2 (1,1,1)
WRT D 6 A1 A2
A1 (1,1,1) -
A2 (1,1,1)
WRT D 6 A1 A2
A1 (1,1,1) (4,5,6)
A2 (1,1,1)
WRT D 6 A1 A2
A1 (1,1,1) (2,3,4)
A2 (1,1,1)
WRT D 6 A1 A2
A1 (1,1,1) -
A2 (1,1,1)
WRT D 6 A1 A2
321
A1 (1,1,1) (2,3,4)
A2 (1,1,1)
WRT D 6 A1 A2
A1 (1,1,1) (2,3,4)
A2 (1,1,1)
WRT D 6 A1 A2
A1 (1,1,1) (2,3,4)
A2 (1,1,1)
Local weights
A1 A2
WRT D 6
0.025 0.975
Table 9.22: Reciprocal Fuzzy PCJMs for Criteria A1 and A2 with Respect to Criterion E1 and their
Local Weights

WRT E 1 A1 A2
A1 (1,1,1) (2,3,4)
A2 (1,1,1)
WRT E 1 A1 A2
A1 (1,1,1) (4,5,6)
A2 (1,1,1)
WRT E 1 A1 A2
A1 (1,1,1) 1 1 1
( , , )
8 7 6
A2 (1,1,1)
322
WRT E 1 A1 A2
A1 (1,1,1) (2,3,4)
A2 (1,1,1)
WRT E 1 A1 A2
A1 (1,1,1) 1 1 1
( , , )
6 5 4
A2 (1,1,1)
WRT E 1 A1 A2
A1 (1,1,1) (4,5,6)
A2 (1,1,1)
WRT E 1 A1 A2
A1 (1,1,1) (4,5,6)
A2 (1,1,1)
WRT E 1 A1 A2
A1 (1,1,1) 1 1 1
( , , )
4 3 2
A2 (1,1,1)
WRT E 1 A1 A2
A1 (1,1,1) 1 1 1
( , , )
4 3 2
A2 (1,1,1)
Local weights
A1 A2
WRT E 1
0.167 0.833
Figure 9.14: Local Weights for Criteria A1 and A2 with Respect to Criterion E1 by Using the Fuzzy
323
Local Weights

WRT E 2 A1 A2
A1 (1,1,1) (2,3,4)
A2 (1,1,1)
WRT E 2 A1 A2
A1 (1,1,1) (2,3,4)
A2 (1,1,1)
WRT E 2 A1 A2
A1 (1,1,1) -
A2 (1,1,1)
WRT E 2 A1 A2
A1 (1,1,1) (2,3,4)
A2 (1,1,1)
WRT E 1 A1 A2
A1 (1,1,1) (4,5,6)
A2 (1,1,1)
WRT E 2 A1 A2
A1 (1,1,1) (4,5,6)
A2 (1,1,1)
WRT E 2 A1 A2
A1 (1,1,1) (4,5,6)
A2 (1,1,1)
WRT E 2 A1 A2
A1 (1,1,1) 1 1 1
( , , )
4 3 2
A2 (1,1,1)
WRT E 2 A1 A2
A1 (1,1,1) (2,3,4)
A2 (1,1,1)
Local weights
A1 A2
WRT E 2
0.794 0.206
324
Local Weights

WRT E 3 A1 A2
A1 (1,1,1) -
A2 (1,1,1)
WRT E 3 A1 A2
A1 (1,1,1) (8,9,10)
A2 (1,1,1)
WRT E 3 A1 A2
A1 (1,1,1) (1,1,1)
A2 (1,1,1)
WRT E 3 A1 A2
A1 (1,1,1) -
A2 (1,1,1)
WRT E 3 A1 A2
A1 (1,1,1) (1,1,1)
A2 (1,1,1)
WRT E 3 A1 A2
A1 (1,1,1) (4,5,6)
A2 (1,1,1)
WRT E 3 A1 A2
325
A1 (1,1,1) (2,3,4)
A2 (1,1,1)
WRT E 3 A1 A2
A1 (1,1,1) (1,1,1)
A2 (1,1,1)
WRT E 3 A1 A2
A1 (1,1,1) (1,1,1)
A2 (1,1,1)
Local weights
A1 A2
WRT E 3
0.5 0.5
Local Weights

WRT E 4 A1 A2
A1 (1,1,1) (4,5,6)
A2 (1,1,1)
WRT E 4 A1 A2
A1 (1,1,1) (8,9,10)
A2 (1,1,1)
WRT E 4 A1 A2
A1 (1,1,1) -
A2 (1,1,1)
326
WRT E 4 A1 A2
A1 (1,1,1) -
A2 (1,1,1)
WRT E 4 A1 A2
A1 (1,1,1) (2,3,4)
A2 (1,1,1)
WRT E 4 A1 A2
A1 (1,1,1) (2,3,4)
A2 (1,1,1)
WRT E 4 A1 A2
A1 (1,1,1) (2,3,4)
A2 (1,1,1)
WRT E 4 A1 A2
A1 (1,1,1) -
A2 (1,1,1)
WRT E 4 A1 A2
A1 (1,1,1) (2,3,4)
A2 (1,1,1)
Local weights
A1 A2
WRT E 4
0.747 0.253
327
Table 9.26: Reciprocal Fuzzy PCJMs for Criteria C1-C4 with Respect to Criterion A1 and their Local
Weights

WRT A 1 C1 C2 C3 C4
C1 (1,1,1) (2,3,4) (4,5,6) (6,7,8)
C2 (1,1,1) (2,3,4) -
C3 (1,1,1) 1 1 1
( , , )
4 3 2
C4 (1,1,1)
WRT A 1 C1 C2 C3 C4
C1 (1,1,1) (2,3,4) (4,5,6) (4,5,6)
C2 (1,1,1) (4,5,6) (6,7,8)
C3 (1,1,1) (1,1,1)
C4 (1,1,1)
WRT A 1 C1 C2 C3 C4
C1 (1,1,1) (4,5,6) (6,7,8) (8,9,10)
C2 (1,1,1) (4,5,6) (4,5,6)
C3 (1,1,1) 1 1 1
( , , )
6 5 4
C4 (1,1,1)
WRT A 1 C1 C2 C3 C4
C1 (1,1,1) (2,3,4) (4,5,6) (4,5,6)
C2 (1,1,1) (6,7,8) (6,7,8)
C3 (1,1,1) (1,1,1)
C4 (1,1,1)
WRT A 1 C1 C2 C3 C4
C1 (1,1,1) (6,7,8) (2,3,4) (6,7,8)
C2 (1,1,1) (2,3,4) (1,1,1)
C3 (1,1,1) (1,1,1)
C4 (1,1,1)
WRT A 1 C1 C2 C3 C4
C1 (1,1,1) (6,7,8) (6,7,8) (6,7,8)
C2 (1,1,1) (4,5,6) (4,5,6)
C3 (1,1,1) (1,1,1)
C4 (1,1,1)
WRT A 1 C1 C2 C3 C4
C1 (1,1,1) (4,5,6) (6,7,8) (4,5,6)
C2 (1,1,1) (2,3,4) (2,3,4)
C3 (1,1,1) (2,3,4)
C4 (1,1,1)
WRT A 1 C1 C2 C3 C4
C1 (1,1,1) (2,3,4) (2,3,4) (4,5,6)
C2 (1,1,1) (1,1,1) (2,3,4)
C3 (1,1,1) (4,5,6)
C4 (1,1,1)
WRT A 1 C1 C2 C3 C4
C1 (1,1,1) (4,5,6) (2,3,4) (2,3,4)
C2 (1,1,1) (1,1,1) (1,1,1)
C3 (1,1,1) (1,1,1)
C4 (1,1,1)
Local weights
C1 C2 C3 C4
WRT A 1
0.034 0.322 0.322 0.322
328
Figure 9.18: Local Weights for Criteria C1-C4 with Respect to Criterion A1 by Using the Fuzzy Group
Table 9.27: Reciprocal Fuzzy PCJMs for Criteria C1-C4 with Respect to Criterion A2 and their Local
Weights

WRT A 2 C1 C2 C3 C4
C1 (1,1,1) (2,3,4) (6,7,8) (4,5,6)
C2 (1,1,1) (2,3,4) -
C3 (1,1,1) (4,5,6)
C4 (1,1,1)
WRT A 2 C1 C2 C3 C4
C1 (1,1,1) (2,3,4) (4,5,6) -
C2 (1,1,1) (4,5,6) (4,5,6)
C3 (1,1,1) -
C4 (1,1,1)
WRT A 2 C1 C2 C3 C4
C1 (1,1,1) (4,5,6) (2,3,4) (2,3,4)
C2 (1,1,1) (4,5,6) (2,3,4)
C3 (1,1,1) -
C4 (1,1,1)
WRT A 2 C1 C2 C3 C4
C1 (1,1,1) - (6,7,8) (4,5,6)
C2 (1,1,1) - (4,5,6)
C3 (1,1,1) 1 1 1
( , , )
4 3 2
C4 (1,1,1)
WRT A 2 C1 C2 C3 C4
C1 (1,1,1) (4,5,6) (6,7,8) (4,5,6)
C2 (1,1,1) (4,5,6) (4,5,6)
C3 (1,1,1) (2,3,4)
C4 (1,1,1)
WRT A 2 C1 C2 C3 C4
C1 (1,1,1) - (2,3,4) (4,5,6)
C2 (1,1,1) (6,7,8) (4,5,6)
C3 (1,1,1) 1 1 1
( , , )
6 5 4
C4 (1,1,1)
329
WRT A 2 C1 C2 C3 C4
C1 (1,1,1) (6,7,8) (8,9,10) (6,7,8)
C2 (1,1,1) (4,5,6) (4,5,6)
C3 (1,1,1) (2,3,4)
C4 (1,1,1)
WRT A 2 C1 C2 C3 C4
C1 (1,1,1) (2,3,4) (2,3,4) (4,5,6)
C2 (1,1,1) (2,3,4) (2,3,4)
C3 (1,1,1) (2,3,4)
C4 (1,1,1)
WRT A 2 C1 C2 C3 C4
C1 (1,1,1) (4,5,6) (2,3,4) (4,5,6)
C2 (1,1,1) (2,3,4) (2,3,4)
C3 (1,1,1) (4,5,6)
C4 (1,1,1)
Local weights
C1 C2 C3 C4
WRT A 2
0.561 0.252 0.077 0.110
Figure 9.19: Local Weights for Criteria C1-C4 with Respect to Criterion A2 by Using the Fuzzy Group
Table 9.28: Reciprocal Fuzzy PCJMs for Criteria C1-C4 with Respect to Criterion B1 and their Local
Weights

WRT B 1 C1 C2 C3 C4
C1 (1,1,1) (2,3,4) (6,7,8) (2,3,4)
C2 (1,1,1) (2,3,4) (2,3,4)
C3 (1,1,1) 1 1 1
( , , )
4 3 2
C4 (1,1,1)
WRT B 1 C1 C2 C3 C4
C1 (1,1,1) (2,3,4) (6,7,8) (6,7,8)
C2 (1,1,1) (2,3,4) (2,3,4)
C3 (1,1,1) -
C4 (1,1,1)
330
WRT B 1 C1 C2 C3 C4
C1 (1,1,1) (4,5,6) (6,7,8) (4,5,6)
C2 (1,1,1) - -
C3 (1,1,1) -
C4 (1,1,1)
WRT B 1 C1 C2 C3 C4
C1 (1,1,1) (6,7,8) (6,7,8) (4,5,6)
C2 (1,1,1) (4,5,6) (2,3,4)
C3 (1,1,1) 1 1 1
( , , )
6 5 4
C4 (1,1,1)
WRT B 1 C1 C2 C3 C4
C1 (1,1,1) (6,7,8) (4,5,6) (6,7,8)
C2 (1,1,1) (2,3,4) (2,3,4)
C3 (1,1,1) (6,7,8)
C4 (1,1,1)
WRT B 1 C1 C2 C3 C4
C1 (1,1,1) (2,3,4) (2,3,4) (2,3,4)
C2 (1,1,1) (4,5,6) (4,5,6)
C3 (1,1,1) 1 1 1
( , , )
4 3 2
C4 (1,1,1)
WRT B 1 C1 C2 C3 C4
C1 (1,1,1) (4,5,6) (6,7,8) (6,7,8)
C2 (1,1,1) (2,3,4) -
C3 (1,1,1) -
C4 (1,1,1)
WRT B 1 C1 C2 C3 C4
C1 (1,1,1) (4,5,6) (6,7,8) (2,3,4)
C2 (1,1,1) (4,5,6) (6,7,8)
C3 (1,1,1) (4,5,6)
C4 (1,1,1)
WRT B 1 C1 C2 C3 C4
C1 (1,1,1) (4,5,6) (4,5,6) (4,5,6)
C2 (1,1,1) 1 1 1 -
( , , )
4 3 2
C3 (1,1,1) (6,7,8)
C4 (1,1,1)
Local weights
C1 C2 C3 C4
WRT B 1
0.604 0.112 0.078 0.206
331
Figure 9.20: Local Weights for Criteria C1-C4 with Respect to Criterion B1 by Using the Fuzzy Group
Weights

WRT B 2 C1 C2 C3 C4
C1 (1,1,1) (2,3,4) (6,7,8) (2,3,4)
C2 (1,1,1) (2,3,4) -
C3 (1,1,1) -
C4 (1,1,1)
WRT B 2 C1 C2 C3 C4
C1 (1,1,1) (2,3,4) (4,5,6) (2,3,4)
C2 (1,1,1) (2,3,4) (4,5,6)
C3 (1,1,1) 1 1 1
( , , )
6 5 4
C4 (1,1,1)
WRT B 2 C1 C2 C3 C4
C1 (1,1,1) (2,3,4) (2,3,4) (4,5,6)
C2 (1,1,1) (2,3,4) -
C3 (1,1,1) (2,3,4)
C4 (1,1,1)
WRT B 2 C1 C2 C3 C4
C1 (1,1,1) (6,7,8) (6,7,8) (4,5,6)
C2 (1,1,1) (6,7,8) (6,7,8)
C3 (1,1,1) 1 1 1
( , , )
4 3 2
C4 (1,1,1)
WRT B 2 C1 C2 C3 C4
C1 (1,1,1) (8,9,10) (4,5,6) (6,7,8)
C2 (1,1,1) (4,5,6) -
C3 (1,1,1) (2,3,4)
C4 (1,1,1)
WRT B 2 C1 C2 C3 C4
C1 (1,1,1) (4,5,6) - (2,3,4)
C2 (1,1,1) (2,3,4) -
332
C3 (1,1,1) 1 1 1
( , , )
6 5 4
C4 (1,1,1)
WRT B 2 C1 C2 C3 C4
C1 (1,1,1) (6,7,8) (8,9,10) (6,7,8)
C2 (1,1,1) (4,5,6) (4,5,6)
C3 (1,1,1) 1 1 1
( , , )
4 3 2
C4 (1,1,1)
WRT B 2 C1 C2 C3 C4
C1 (1,1,1) (6,7,8) (4,5,6) (6,7,8)
C2 (1,1,1) (2,3,4) (4,5,6)
C3 (1,1,1) (6,7,8)
C4 (1,1,1)
WRT B 2 C1 C2 C3 C4
C1 (1,1,1) (4,5,6) (2,3,4) (6,7,8)
C2 (1,1,1) 1 1 1 (2,3,4)
( , , )
6 5 4
C3 (1,1,1) (4,5,6)
C4 (1,1,1)
Local weights
WRT B 2 C1 C2 C3 C4
0.519 0.071 0.160 0.250
Weights

WRT B 3 C1 C2 C3 C4
C1 (1,1,1) - (8,9,10) (2,3,4)
C2 (1,1,1) (2,3,4) -
333
C3 (1,1,1) 1 1 1
( , , )
6 5 4
C4 (1,1,1)
WRT B 3 C1 C2 C3 C4
C1 (1,1,1) (2,3,4) (2,3,4) (4,5,6)
C2 (1,1,1) - -
C3 (1,1,1) -
C4 (1,1,1)
WRT B 3 C1 C2 C3 C4
C1 (1,1,1) (2,3,4) (2,3,4) (4,5,6)
C2 (1,1,1) (2,3,4) (2,3,4)
C3 (1,1,1) -
C4 (1,1,1)
WRT B 3 C1 C2 C3 C4
C1 (1,1,1) (4,5,6) (4,5,6) (4,5,6)
C2 (1,1,1) (4,5,6) (2,3,4)
C3 (1,1,1) (2,3,4)
C4 (1,1,1)
WRT B 3 C1 C2 C3 C4
C1 (1,1,1) 1 1 1 (2,3,4) (2,3,4)
( , , )
6 5 4
C2 (1,1,1) (4,5,6) (2,3,4)
C3 (1,1,1) (2,3,4)
C4 (1,1,1)
WRT B 3 C1 C2 C3 C4
C1 (1,1,1) (2,3,4) (2,3,4) (2,3,4)
C2 (1,1,1) (4,5,6) -
C3 (1,1,1) -
C4 (1,1,1)
WRT B 3 C1 C2 C3 C4
C1 (1,1,1) (4,5,6) (6,7,8) (8,9,10)
C2 (1,1,1) (6,7,8) (2,3,4)
C3 (1,1,1) 1 1 1
( , , )
6 5 4
C4 (1,1,1)
WRT B 3 C1 C2 C3 C4
C1 (1,1,1) (4,5,6) (4,5,6) (6,7,8)
C2 (1,1,1) - (2,3,4)
C3 (1,1,1) (4,5,6)
C4 (1,1,1)
WRT B 3 C1 C2 C3 C4
C1 (1,1,1) (4,5,6) (2,3,4) (2,3,4)
C2 (1,1,1) (2,3,4) (4,5,6)
C3 (1,1,1) (4,5,6)
C4 (1,1,1)
Local weights
WRT B 3 C1 C2 C3 C4
0.162 0.514 0.119 0.205
334
Table 9.31: Reciprocal Fuzzy PCJMs for Criteria D1-D6 with Respect to Criterion A1 and their Local
Weights

D1 (1,1,1) (2,3,4) (4,5,6) (2,3,4) (8,9,10) 1 1 1
( , , )
4 3 2
D2 (1,1,1) (4,5,6) (4,5,6) (8,9,10) 1 1 1
( , , )
6 5 4
D3 (1,1,1) (2,3,4) - 1 1 1
( , , )
6 5 4
D4 (1,1,1) - 1 1 1
( , , )
10 9 8
D5 (1,1,1) 1 1 1
( , , )
10 9 8
D6 (1,1,1)
D1 (1,1,1) 1 1 1 (4,5,6) (6,7,8) (8,9,10) 1 1 1
( , , ) ( , , )
4 3 2 6 5 4
D2 (1,1,1) (2,3,4) (4,5,6) (6,7,8) 1 1 1
( , , )
8 7 6
D3 (1,1,1) (2,3,4) (6,7,8) 1 1 1
( , , )
8 7 6
D4 (1,1,1) (6,7,8) 1 1 1
( , , )
6 5 4
D5 (1,1,1) 1 1 1
( , , )
10 9 8
D6 (1,1,1)
D1 (1,1,1) (2,3,4) (4,5,6) (2,3,4) (6,7,8) 1 1 1
( , , )
6 5 4
D2 (1,1,1) 1 1 1 (2,3,4) (6,7,8) 1 1 1
( , , ) ( , , )
4 3 2 6 5 4
D3 (1,1,1) (2,3,4) (6,7,8) 1 1 1
( , , )
8 7 6
D4 (1,1,1) (6,7,8) 1 1 1
( , , )
8 7 6
D5 (1,1,1) 1 1 1
( , , )
8 7 6
335
D6 (1,1,1)
D1 (1,1,1) (4,5,6) (2,3,4) (2,3,4) (8,9,10) (4,5,6)
D2 (1,1,1) (4,5,6) (4,5,6) - -
D3 (1,1,1) 1 1 1 (6,7,8) 1 1 1
( , , ) ( , , )
4 3 2 8 7 6
D4 (1,1,1) (4,5,6) 1 1 1
( , , )
8 7 6
D5 (1,1,1) 1 1 1
( , , )
10 9 8
D6 (1,1,1)
D1 (1,1,1) (4,5,6) (4,5,6) (4,5,6) (6,7,8) 1 1 1
( , , )
10 9 8
D2 (1,1,1) 1 1 1 1 1 1 (6,7,8) 1 1 1
( , , ) ( , , ) ( , , )
6 5 4 4 3 2 10 9 8
D3 (1,1,1) 1 1 1 (6,7,8) 1 1 1
( , , ) ( , , )
4 3 2 10 9 8
D4 (1,1,1) (4,5,6) 1 1 1
( , , )
6 5 4
D5 (1,1,1) 1 1 1
( , , )
10 9 8
D6 (1,1,1)
D1 (1,1,1) (4,5,6) (2,3,4) (6,7,8) - 1 1 1
( , , )
6 5 4
D2 (1,1,1) 1 1 1 (6,7,8) - 1 1 1
( , , ) ( , , )
8 7 6 8 7 6
D3 (1,1,1) (2,3,4) (6,7,8) 1 1 1
( , , )
8 7 6
D4 (1,1,1) - 1 1 1
( , , )
6 5 4
D5 (1,1,1) 1 1 1
( , , )
10 9 8
D6 (1,1,1)
D1 (1,1,1) (4,5,6) (2,3,4) - (6,7,8) 1 1 1
( , , )
4 3 2
D2 (1,1,1) 1 1 1 1 1 1 (6,7,8) 1 1 1
( , , ) ( , , ) ( , , )
6 5 4 4 3 2 6 5 4
D3 (1,1,1) 1 1 1 (6,7,8) 1 1 1
( , , ) ( , , )
4 3 2 6 5 4
D4 (1,1,1) (8,9,10) 1 1 1
( , , )
8 7 6
D5 (1,1,1) 1 1 1
( , , )
10 9 8
D6 (1,1,1)
D1 (1,1,1) (6,7,8) (2,3,4) (2,3,4) (8,9,10) 1 1 1
( , , )
6 5 4
D2 (1,1,1) 1 1 1 1 1 1 (4,5,6) 1 1 1
( , , ) ( , , ) ( , , )
4 3 2 6 5 4 8 7 6
D3 (1,1,1) 1 1 1 (4,5,6) 1 1 1
( , , ) ( , , )
4 3 2 8 7 6
D4 (1,1,1) (4,5,6) 1 1 1
( , , )
8 7 6
D5 (1,1,1) 1 1 1
( , , )
10 9 8
D6 (1,1,1)
D1 (1,1,1) (4,5,6) (2,3,4) (2,3,4) (6,7,8) 1 1 1
( , , )
4 3 2
D2 (1,1,1) 1 1 1 1 1 1 (2,3,4) 1 1 1
( , , ) ( , , ) ( , , )
6 5 4 6 5 4 6 5 4
D3 (1,1,1) (2,3,4) (6,7,8) 1 1 1
( , , )
6 5 4
336
D4 (1,1,1) (6,7,8) 1 1 1
( , , )
6 5 4
D5 (1,1,1) 1 1 1
( , , )
10 9 8
D6 (1,1,1)
Local weights
0.12 0.14 0.09 0.07 0.05 0.53
Table 9.32: Reciprocal Fuzzy PCJMs for Criteria D1-D6 with Respect to Criterion A2 and their Local
Weights

D1 (1,1,1) (2,3,4) (2,3,4) (2,3,4) (6,7,8) (2,3,4)
D2 (1,1,1) 1 1 1 (4,5,6) - 1 1 1
( , , ) ( , , )
4 3 2 10 9 8
D3 (1,1,1) (2,3,4) (4,5,6) 1 1 1
( , , )
4 3 2
D4 (1,1,1) (6,7,8) 1 1 1
( , , )
4 3 2
D5 (1,1,1) 1 1 1
( , , )
8 7 6
D6 (1,1,1)
D1 (1,1,1) 1 1 1 (2,3,4) - (6,7,8) 1 1 1
( , , ) ( , , )
6 5 4 8 7 6
D2 (1,1,1) (4,5,6) (2,3,4) (6,7,8) 1 1 1
( , , )
8 7 6
D3 (1,1,1) (2,3,4) (8,9,10) 1 1 1
( , , )
4 3 2
D4 (1,1,1) (1,1,1) 1 1 1
( , , )
10 9 8
337
D5 (1,1,1) 1 1 1
( , , )
10 9 8
D6 (1,1,1)
D1 (1,1,1) (2,3,4) (2,3,4) - - 1 1 1
( , , )
6 5 4
D2 (1,1,1) (2,3,4) (2,3,4) (6,7,8) 1 1 1
( , , )
6 5 4
D3 (1,1,1) 1 1 1 - 1 1 1
( , , ) ( , , )
4 3 2 4 3 2
D4 (1,1,1) - 1 1 1
( , , )
8 7 6
D5 (1,1,1) 1/5
D6 (1,1,1)
D1 (1,1,1) (4,5,6) (4,5,6) 1 1 1 (6,7,8) (6,7,8)
( , , )
4 3 2
D2 (1,1,1) 1 1 1 1 1 1 (6,7,8) 1 1 1
( , , ) ( , , ) ( , , )
6 5 4 6 5 4 6 5 4
D3 (1,1,1) (4,5,6) (6,7,8) 1 1 1
( , , )
6 5 4
D4 (1,1,1) (6,7,8) 1 1 1
( , , )
8 7 6
D5 (1,1,1) 1 1 1
( , , )
8 7 6
D6 (1,1,1)
D1 (1,1,1) (4,5,6) (4,5,6) (4,5,6) (8,9,10) 1 1 1
( , , )
8 7 6
D2 (1,1,1) 1 1 1 1 1 1 (4,5,6) 1 1 1
( , , ) ( , , ) ( , , )
4 3 2 8 7 6 10 9 8
D3 (1,1,1) 1 1 1 (6,7,8) 1 1 1
( , , ) ( , , )
8 7 6 10 9 8
D4 (1,1,1) (6,7,8) 1 1 1
( , , )
10 9 8
D5 (1,1,1) 1 1 1
( , , )
10 9 8
D6 (1,1,1)
D1 (1,1,1) (6,7,8) (8,9,10) (8,9,10) (8,9,10) (8,9,10)
D2 (1,1,1) (6,7,8) (4,5,6) (8,9,10) 1 1 1
( , , )
4 3 2
D3 (1,1,1) (2,3,4) - 1 1 1
( , , )
8 7 6
D4 (1,1,1) (6,7,8) 1 1 1
( , , )
6 5 4
D5 (1,1,1) 1 1 1
( , , )
8 7 6
D6 (1,1,1)
D1 (1,1,1) (2,3,4) (2,3,4) (2,3,4) (6,7,8) 1 1 1
( , , )
8 7 6
D2 (1,1,1) 1 1 1 1 1 1 - 1 1 1
( , , ) ( , , ) ( , , )
4 3 2 8 7 6 6 5 4
D3 (1,1,1) 1 1 1 - 1 1 1
( , , ) ( , , )
4 3 2 8 7 6
D4 (1,1,1) - -
D5 (1,1,1) 1 1 1
( , , )
6 5 4
D6 (1,1,1)
D1 (1,1,1) (6,7,8) (2,3,4) (2,3,4) - 1 1 1
( , , )
6 5 4
D2 (1,1,1) 1 1 1 1 1 1 - 1 1 1
( , , ) ( , , ) ( , , )
4 3 2 4 3 2 8 7 6
D3 (1,1,1) 1 1 1 (6,7,8) 1 1 1
( , , ) ( , , )
4 3 2 6 5 4
338
D4 (1,1,1) (4,5,6) 1 1 1
( , , )
8 7 6
D5 (1,1,1) 1/5
D6 (1,1,1)
D1 (1,1,1) (4,5,6) (4,5,6) (2,3,4) (6,7,8) 1 1 1
( , , )
4 3 2
D2 (1,1,1) 1 1 1 1 1 1 (4,5,6) 1 1 1
( , , ) ( , , ) ( , , )
4 3 2 6 5 4 10 9 8
D3 (1,1,1) 1 1 1 (4,5,6) 1 1 1
( , , ) ( , , )
4 3 2 4 3 2
D4 (1,1,1) (4,5,6) 1 1 1
( , , )
4 3 2
D5 (1,1,1) 1 1 1
( , , )
8 7 6
D6 (1,1,1)
Local weights
0.17 0.11 0.04 0.15 0.10 0.43
Table 9.33: Reciprocal Fuzzy PCJMs for Criteria E1-E4 with Respect to Criterion A1 and their Local
Weights

WRT A 1 E1 E2 E3 E4
E1 (1,1,1) (2,3,4) (4,5,6) (6,7,8)
E2 (1,1,1) (4,5,6) (2,3,4)
E3 (1,1,1) 1 1 1
( , , )
4 3 2
E4 (1,1,1)
WRT A 1 E1 E2 E3 E4
E1 (1,1,1) (2,3,4) (6,7,8) (4,5,6)
E2 (1,1,1) (4,5,6) (4,5,6)
E3 (1,1,1) 1 1 1
( , , )
6 5 4
E4 (1,1,1)
WRT A 1 E1 E2 E3 E4
E1 (1,1,1) (2,3,4) (6,7,8) (8,9,10)
339
E2 (1,1,1) (2,3,4) -
E3 (1,1,1) (2,3,4)
E4 (1,1,1)
WRT A 1 E1 E2 E3 E4
E1 (1,1,1) (2,3,4) (2,3,4) (6,7,8)
E2 (1,1,1) (6,7,8) (6,7,8)
E3 (1,1,1) 1 1 1
( , , )
4 3 2
E4 (1,1,1)
WRT A 1 E1 E2 E3 E4
E1 (1,1,1) (6,7,8) (8,9,10) (8,9,10)
E2 (1,1,1) (6,7,8) (4,5,6)
E3 (1,1,1) 1 1 1
( , , )
6 5 4
E4 (1,1,1)
WRT A 1 E1 E2 E3 E4
E1 (1,1,1) (4,5,6) (6,7,8) (6,7,8)
E2 (1,1,1) (6,7,8) (4,5,6)
E3 (1,1,1) 1 1 1
( , , )
6 5 4
E4 (1,1,1)
WRT A 1 E1 E2 E3 E4
E1 (1,1,1) (4,5,6) (4,5,6) (6,7,8)
E2 (1,1,1) (4,5,6) (6,7,8)
E3 (1,1,1) 1 1 1
( , , )
4 3 2
E4 (1,1,1)
WRT A 1 E1 E2 E3 E4
E1 (1,1,1) (2,3,4) (8,9,10) (6,7,8)
E2 (1,1,1) (6,7,8) (4,5,6)
E3 (1,1,1) 1 1 1
( , , )
4 3 2
E4 (1,1,1)
WRT A 1 E1 E2 E3 E4
E1 (1,1,1) (4,5,6) (4,5,6) (2,3,4)
E2 (1,1,1) (6,7,8) (4,5,6)
E3 (1,1,1) 1 1 1
( , , )
4 3 2
E4 (1,1,1)
Local weights
E1 E2 E3 E4
WRT A 1
0.416 0.305 0.079 0.200
340
Figure 9.25: Local Weights for Criteria E1-E4 with Respect to Criterion A1 by Using the Fuzzy Group
Table 9.34: Reciprocal Fuzzy PCJMs for Criteria E1-E4 with Respect to Criterion A2 and their Local
Weights

WRT A 2 E1 E2 E3 E4
E1 (1,1,1) (2,3,4) (4,5,6) (2,3,4)
E2 (1,1,1) (2,3,4) -
E3 (1,1,1) 1 1 1
( , , )
6 5 4
E4 (1,1,1)
WRT A 2 E1 E2 E3 E4
E1 (1,1,1) (2,3,4) - -
E2 (1,1,1) (2,3,4) (2,3,4)
E3 (1,1,1) 1 1 1
( , , )
6 5 4
E4 (1,1,1)
WRT A 2 E1 E2 E3 E4
E1 (1,1,1) (4,5,6) (4,5,6) (2,3,4)
E2 (1,1,1) (6,7,8) (4,5,6)
E3 (1,1,1) 1 1 1
( , , )
4 3 2
E4 (1,1,1)
WRT A 2 E1 E2 E3 E4
E1 (1,1,1) (2,3,4) (2,3,4) (2,3,4)
E2 (1,1,1) (4,5,6) -
E3 (1,1,1) -
E4 (1,1,1)
WRT A 2 E1 E2 E3 E4
E1 (1,1,1) (4,5,6) (2,3,4) (4,5,6)
E2 (1,1,1) (6,7,8) (2,3,4)
E3 (1,1,1) 1 1 1
( , , )
6 5 4
E4 (1,1,1)
WRT A 2 E1 E2 E3 E4
341
E1 (1,1,1) (2,3,4) (6,7,8) (6,7,8)
E2 (1,1,1) (6,7,8) (4,5,6)
E3 (1,1,1) 1 1 1
( , , )
8 7 6
E4 (1,1,1)
WRT A 2 E1 E2 E3 E4
E1 (1,1,1) (2,3,4) (4,5,6) (2,3,4)
E2 (1,1,1) (6,7,8) (6,7,8)
E3 (1,1,1) 1 1 1
( , , )
4 3 2
E4 (1,1,1)
WRT A 2 E1 E2 E3 E4
E1 (1,1,1) (6,7,8) (4,5,6) (4,5,6)
E2 (1,1,1) (2,3,4) (4,5,6)
E3 (1,1,1) 1 1 1
( , , )
4 3 2
E4 (1,1,1)
WRT A 2 E1 E2 E3 E4
E1 (1,1,1) (4,5,6) (4,5,6) (4,5,6)
E2 (1,1,1) (4,5,6) (4,5,6)
E3 (1,1,1) 1 1 1
( , , )
6 5 4
E4 (1,1,1)
Local weights
WRT A 2 E1 E2 E3 E4
0.585 0.206 0.062 0.147
Figure 9.26: Local Weights for Criteria E1-E4 with Respect to Criterion A2 by Using the Fuzzy Group
342
Appendix F: Decision Matrices for the Four Alternatives under All Criteria
P1 (4,5,6) (2,3,4) (0,1,2) (4,5,6) (4,5,6) (2,3,4) (2,3,4) (2,3,4) (0,1,2) (4,5,6) (4,5,6) (2,3,4) (2,3,4) (0,1,2) (4,5,6) (2,3,4) (2,3,4) (4,5,6) (2,3,4)
P2 (2,3,4) (0,1,2) (0,1,2) (2,3,4) (2,3,4) (2,3,4) (0,1,2) (0,1,2) (0,1,2) (2,3,4) (2,3,4) (2,3,4) (2,3,4) (0,1,2) (4,5,6) (0,1,2) (2,3,4) (0,1,2) (2,3,4)
P3 (6,7,8) (4,5,6) (6,7,8) (6,7,8) (6,7,8) (6,7,8) (8,9,10) (4,5,6) (6,7,8) (6,7,8) (6,7,8) (6,7,8) (6,7,8) (6,7,8) (6,7,8) (4,5,6) (6,7,8) (6,7,8) (4,5,6)
P4 (8,9,10) (8,9,10) (6,7,8) (8,9,10) (6,7,8) (8,9,10) (8,9,10) (6,7,8) (6,7,8) (8,9,10) (6,7,8) (8,9,10) (6,7,8) (4,5,6) (6,7,8) (6,7,8) (6,7,8) (6,7,8) (4,5,6)
P1 (4,5,6) (2,3,4) (2,3,4) (2,3,4) (0,1,2) (4,5,6) (2,3,4) (0,1,2) (0,1,2) (2,3,4) (2,3,4) (2,3,4) (2,3,4) (0,1,2) (2,3,4) (2,3,4) (2,3,4) (2,3,4) (2,3,4)
P2 (2,3,4) (0,1,2) (0,1,2) (2,3,4) (0,1,2) (2,3,4) (2,3,4) (0,1,2) (0,1,2) (2,3,4) (2,3,4) (2,3,4) (2,3,4) (0,1,2) (2,3,4) (0,1,2) (0,1,2) (2,3,4) (2,3,4)
P3 (6,7,8) (4,5,6) (6,7,8) (6,7,8) (6,7,8) (6,7,8) (6,7,8) (6,7,8) (6,7,8) (6,7,8) (8,9,10) (6,7,8) (6,7,8) (4,5,6) (4,5,6) (6,7,8) (6,7,8) (6,7,8) (6,7,8)
P4 (6,7,8) (6,7,8) (8,9,10) (6,7,8) (6,7,8) (8,9,10) (8,9,10) (6,7,8) (8,9,10) (6,7,8) (8,9,10) (6,7,8) (8,9,10) (6,7,8) (8,9,10) (8,9,10) (6,7,8) (6,7,8) (8,9,10)
P1 (2,3,4) (2,3,4) (2,3,4) (2,3,4) (2,3,4) (4,5,6) (4,5,6) (2,3,4) (2,3,4) (2,3,4) (4,5,6) (2,3,4) (2,3,4) (0,1,2) (4,5,6) (2,3,4) (2,3,4) (2,3,4) (0,1,2)
P2 (2,3,4) (0,1,2) (2,3,4) (0,1,2) (2,3,4) (0,1,2) (2,3,4) (0,1,2) (0,1,2) (2,3,4) (2,3,4) (2,3,4) (2,3,4) (0,1,2) (4,5,6) (0,1,2) (2,3,4) (2,3,4) (0,1,2)
P3 (6,7,8) (6,7,8) (6,7,8) (6,7,8) (6,7,8) (8,9,10) (6,7,8) (6,7,8) (6,7,8) (8,9,10) (6,7,8) (6,7,8) (6,7,8) (6,7,8) (8,9,10) (6,7,8) (6,7,8) (6,7,8) (6,7,8)
P4 (8,9,10) (8,9,10) (8,9,10) (6,7,8) (6,7,8) (8,9,10) (6,7,8) (8,9,10) (6,7,8) (8,9,10) (8,9,10) (8,9,10) (6,7,8) (6,7,8) (8,9,10) (6,7,8) (8,9,10) (6,7,8) (6,7,8)
343
P1 (2,3,4) (2,3,4) (2,3,4) (2,3,4) (4,5,6) (4,5,6) (4,5,6) (2,3,4) (0,1,2) (2,3,4) (4,5,6) (2,3,4) (4,5,6) (0,1,2) (4,5,6) (2,3,4) (2,3,4) (0,1,2) (2,3,4)
P2 (2,3,4) (0,1,2) (0,1,2) (2,3,4) (0,1,2) (2,3,4) (2,3,4) (0,1,2) (0,1,2) (2,3,4) (2,3,4) (2,3,4) (2,3,4) (0,1,2) (2,3,4) (0,1,2) (0,1,2) (0,1,2) (2,3,4)
P3 (6,7,8) (6,7,8) (8,9,10) (6,7,8) (6,7,8) (8,9,10) (8,9,10) (8,9,10) (6,7,8) (6,7,8) (8,9,10) (6,7,8) (6,7,8) (4,5,6) (6,7,8) (6,7,8) (6,7,8) (6,7,8) (8,9,10)
P4 (8,9,10) (8,9,10) (8,9,10) (8,9,10) (8,9,10) (8,9,10) (8,9,10) (8,9,10) (8,9,10) (6,7,8) (8,9,10) (8,9,10) (6,7,8) (4,5,6) (8,9,10) (8,9,10) (8,9,10) (8,9,10) (8,9,10)
P1 (2,3,4) (4,5,6) (2,3,4) (4,5,6) (4,5,6) (4,5,6) (2,3,4) (0,1,2) (2,3,4) (2,3,4) (6,7,8) (0,1,2) (2,3,4) (0,1,2) (6,7,8) (2,3,4) (4,5,6) (2,3,4) (2,3,4)
P2 (2,3,4) (0,1,2) (0,1,2) (2,3,4) (2,3,4) (2,3,4) (0,1,2) (0,1,2) (0,1,2) (2,3,4) (4,5,6) (0,1,2) (2,3,4) (0,1,2) (4,5,6) (0,1,2) (4,5,6) (2,3,4) (2,3,4)
P3 (4,5,6) (6,7,8) (4,5,6) (6,7,8) (4,5,6) (4,5,6) (6,7,8) (6,7,8) (6,7,8) (6,7,8) (6,7,8) (4,5,6) (4,5,6) (2,3,4) (2,3,4) (4,5,6) (6,7,8) (6,7,8) (4,5,6)
P4 (4,5,6) (6,7,8) (4,5,6) (6,7,8) (4,5,6) (4,5,6) (6,7,8) (4,5,6) (4,5,6) (6,7,8) (6,7,8) (4,5,6) (4,5,6) (2,3,4) (6,7,8) (6,7,8) (6,7,8) (6,7,8) (4,5,6)
P1 (4,5,6) (4,5,6) (0,1,2) (2,3,4) (2,3,4) (0,1,2) (2,3,4) (2,3,4) (2,3,4) (2,3,4) (6,7,8) (2,3,4) (0,1,2) (0,1,2) (6,7,8) (2,3,4) (0,1,2) (0,1,2) (4,5,6)
P2 (4,5,6) (2,3,4) (0,1,2) (0,1,2) (2,3,4) (0,1,2) (2,3,4) (0,1,2) (0,1,2) (2,3,4) (4,5,6) (2,3,4) (0,1,2) (0,1,2) (4,5,6) (0,1,2) (0,1,2) (0,1,2) (0,1,2)
P3 (6,7,8) (4,5,6) (4,5,6) (4,5,6) (4,5,6) (2,3,4) (6,7,8) (2,3,4) (6,7,8) (4,5,6) (6,7,8) (4,5,6) (2,3,4) (2,3,4) (4,5,6) (4,5,6) (6,7,8) (4,5,6) (4,5,6)
P4 (6,7,8) (4,5,6) (4,5,6) (4,5,6) (4,5,6) (4,5,6) (4,5,6) (4,5,6) (6,7,8) (6,7,8) (6,7,8) (4,5,6) (4,5,6) (2,3,4) (6,7,8) (4,5,6) (6,7,8) (6,7,8) (4,5,6)
P1 (2,3,4) (4,5,6) (4,5,6) (6,7,8) (0,1,2) (4,5,6) (2,3,4) (2,3,4) (4,5,6) (4,5,6) (4,5,6) (0,1,2) (4,5,6) (2,3,4) (6,7,8) (2,3,4) (4,5,6) (2,3,4) (2,3,4)
P2 (2,3,4) (2,3,4) (0,1,2) (2,3,4) (0,1,2) (2,3,4) (2,3,4) (0,1,2) (2,3,4) (0,1,2) (4,5,6) (0,1,2) (2,3,4) (0,1,2) (4,5,6) (2,3,4) (2,3,4) (2,3,4) (0,1,2)
P3 (6,7,8) (6,7,8) (6,7,8) (8,9,10) (6,7,8) (6,7,8) (6,7,8) (6,7,8) (8,9,10) (6,7,8) (6,7,8) (8,9,10) (4,5,6) (4,5,6) (4,5,6) (4,5,6) (6,7,8) (6,7,8) (4,5,6)
P4 (6,7,8) (6,7,8) (6,7,8) (8,9,10) (6,7,8) (6,7,8) (6,7,8) (6,7,8) (6,7,8) (8,9,10) (6,7,8) (8,9,10) (4,5,6) (4,5,6) (6,7,8) (6,7,8) (6,7,8) (6,7,8) (4,5,6)
344
P1 (2,3,4) (2,3,4) (4,5,6) (4,5,6) (2,3,4) (4,5,6) (4,5,6) (2,3,4) (2,3,4) (2,3,4) (4,5,6) (2,3,4) (4,5,6) (0,1,2) (2,3,4) (2,3,4) (2,3,4) (2,3,4) (2,3,4)
P2 (2,3,4) (0,1,2) (2,3,4) (2,3,4) (2,3,4) (2,3,4) (4,5,6) (0,1,2) (0,1,2) (2,3,4) (2,3,4) (2,3,4) (2,3,4) (0,1,2) (2,3,4) (0,1,2) (2,3,4) (0,1,2) (2,3,4)
P3 (6,7,8) (6,7,8) (6,7,8) (6,7,8) (6,7,8) (8,9,10) (8,9,10) (4,5,6) (4,5,6) (6,7,8) (6,7,8) (6,7,8) (4,5,6) (4,5,6) (6,7,8) (6,7,8) (8,9,10) (6,7,8) (4,5,6)
P4 (6,7,8) (6,7,8) (6,7,8) (6,7,8) (6,7,8) (8,9,10) (8,9,10) (4,5,6) (4,5,6) (6,7,8) (6,7,8) (6,7,8) (6,7,8) (4,5,6) (6,7,8) (6,7,8) (8,9,10) (6,7,8) (4,5,6)
345

Hybrid Fuzzy Multi-Criteria Decision Making Model - Health Insurance

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Hybrid Fuzzy Multi-Criteria Decision Making Model - Health Insurance

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Development of a Hybrid Fuzzy Multi-Criteria

Decision Making Model for Selection of Group

A Thesis submitted to the University of Manchester for the degree of

The total word count is 77237 words.

TABLE 2.1: CRITERIA FOR CHOOSING AN INSURANCE PLAN .................................................................................. 45

FIGURE 1.1 THESIS STRUCTURE ............................................................................................................................ 36

AHP - Analytical Hierarchy Process

University of Manchester certain rights to use such Copyright, including for

This page must form part of any such copies made.

intellectual property (the Intellectual Property) and any reproductions of copyright

Intellectual Property and/or Reproductions.

Reproductions described in it may take place is available in the University IP Policy

(see http://documents.manchester.ac.uk/DocuInfo.aspx?DocID=487), in any relevant

Thesis restriction declarations deposited in the University Library, The University

Librarys regulations (see http://www. manchester.ac.uk/library/aboutus/regulations)

and in The Universitys policy on Presentation of Theses.

This is for you, Mom & Dad

In the name of God, the Most Gracious, the Most Merciful,

every time that I needed it.

School for their help and cooperation during my PhD.

country of Saudi Arabia, for offering me this opportunity to achieve my ambition.

2009- 2010: MSc. Operational Research and Applied Statistics

2001-2005: BSc. Mathematics

2005-2007: Alrajhi Bank

2007- Present: Lecturer

Sep. 2013- PT Graduate Teaching Assistant

Publications and conferences:

Almulhim, T., and Mikhailov, L., Development of a Hybrid Fuzzy Multi-Criteria

outline of the research methodology, followed by research contributions in section 1.6.

Finally, the structure of this thesis is described in section 1.7.

1.2 Background to the Problem

insurance, health (medical) insurance, travel insurance etc.

insurance company (the insurer) (Dickerson, 1964).

party to the contract (Dickerson, 1964).

health insurance markets.

evaluating the available alternatives offered in the insurance market.

1.3 The Research Problem

criteria and/or alternatives in decision making environments (Zimmermann, 1987; Stewart,

the potential relationships/dependencies among the criteria, since the assumption of

the evaluation process for the selection problem.

decision making problem, the judgements/assessments of the executive manager of a

defined as the importance weight of the DMs.

(such as money, manpower, method management, materials, skills and knowledge). In

employees in order to enhance their morale and productivity.

meeting the employers needs in uncertain environments.

direction of this study.

3. To explore a proper method to analyse the relationships/dependence among the

criteria in the selection process for group health insurance plans.

model in this study.

empirical validity of the model.

group health insurance plan. The questions are listed below:

can selection be improved?

health insurance plan selection problem?

group health insurance plan?

1.5 Outline of the Research Methodology

in full in the following chapters.

A detailed description of the above mentioned activities is presented in chapter two.

methods in MCDM for modelling uncertainty, studying relationships/dependence, deriving

relationships/dependence among the different criteria, deriving the criteria importance

described in more detail in chapter seven.

Some major assumptions made in this research are listed below:

group in this study.

combining the group decision making judgements can be accepted.

1.6 Research Contributions