Journal of Education and Health Promotion

REVIEW ARTICLE
Year
: 2022  |  Volume : 11  |  Issue : 1  |  Page : 146-

Identifying the themes of medical tourism business in Iran: A systematic review


Nafiseh Karimi Badrabadi1, Sogand Tourani2, Asef Karimi3,  
1 Department of Health Services Management, School of Health Management and Information Sciences, International Campus, Iran University of Medical Sciences, Tehran, Iran
2 Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
3 Department of Business Management, Faculty of Management and Accounting, College of Farabi, University of Tehran, Tehran, Iran

Correspondence Address:
Dr. Sogand Tourani
Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran
Iran

Abstract

BACKGROUND: Nowadays, medical tourism reports impressive growth in terms of number of persons, income, and number of countries involved in cross-border flows. It refers to people traveling abroad (from home to a target country) to obtain medical treatment. The present study aimed to identify the themes and codes of the medical tourism business in Iran. MATERIALS AND METHODS: We searched international databases (such as PubMed, Scopus, Embase, and Web of Science) and Iranian bibliography thesaurus and repositories (namely, Scientific Information Database and Magiran) using keywords such as medical tourism, international medical travel, and medical tourism business in the English and Persian literature, published between January 2000 and December 2019, identified with no restriction on the type of the studies. The data were analyzed based on the content analysis method. RESULTS: Out of 1054 articles, 14 were finally selected. In the end, eight themes of the medical tourism business including competitive pricing, safety and security, information and communication technology, labor market and human resources, structure management, leading the way in medical tourism, infrastructure, and exchange with the international world were identified which on the whole contain 45 codes. Most of the articles were quantitative. Four of the themes (competitive price, labor market and human resources, structure management, and infrastructure) were most frequent and of the highest importance. CONCLUSION: The themes and codes identified in this study helps companies and individuals who want to work in the field of medical tourism. According to this study, all 8 themes and 45 codes are of high value, but still, some themes are of higher value than others and special attention should be paid to them.



How to cite this article:
Badrabadi NK, Tourani S, Karimi A. Identifying the themes of medical tourism business in Iran: A systematic review.J Edu Health Promot 2022;11:146-146


How to cite this URL:
Badrabadi NK, Tourani S, Karimi A. Identifying the themes of medical tourism business in Iran: A systematic review. J Edu Health Promot [serial online] 2022 [cited 2022 Jul 6 ];11:146-146
Available from: http://www.https://jehp.net//text.asp?2022/11/1/146/344087


Full Text



 Introduction



Tourism is one of the most important economic activities around the world, which has significant direct impacts on the countries' gross domestic product (GDP) and accounts for more than 9.5% of the countries' GDP.[1]

The tourism industry is undergoing a substantial change. The advance in new technologies and a skilled and demanding consumer target means that the organizations and destinations need new marketing and management tools to meet the modern tourists' expectations and the industry's requirements for innovation.[2]

According to the latest report on Travel and Tourism Competitiveness in 2017, Iran is located 93rd out of 136 countries in terms of competitiveness of the tourism industry. Among Iran's competitive pillars, the best performance belongs to the price competitiveness pillar, ranking as the top one. Moreover, the weakest performances belong to environmental sustainability pillar, ranking as 119, and prioritizing travel and tourism pillar, ranking as 117.[3]

In recent years, medical tourism has become one of the fastest-growing industries in the world.[4] It is estimated that the income of every case of medical tourism is three times that of a typical tourist.[5]

The following items can be listed as the main reasons for people's travel to other countries: healthcare, consumer values changing, population aging and increasing need for healthcare, high costs of treatment in the home country, and the possibility of taking a vacation while receiving treatment.[6],[7]

The number of patients in India, Malaysia, Taiwan, and South Korea in 2017 was 495,056, 150,000, 1,414,000, and 321,574, respectively.[8],[9],[10],[11],[12] Given the growing number of international medical tourists in Asia and the Pacific, the region's market revenue was worth $4.8 billion a year.[13]

In contrast to other countries, while the cost of Iran's medical services is very low, its quality and its equivalence with the latest methods of medical science in the world are the most important reasons that can promote medical tourism in Iran. However, statistics show that our country has not yet made much progress in this area[14] and is severely weak in attracting domestic and foreign tourists.[15]

Considering the themes of new businesses in the health-care sector in various countries, many benefits include improving the quality of medical services, increasing efficiency, reducing costs, and increasing revenue.[16],[17],[18],[19],[20],[21]

Medical tourism, like many other businesses, should be profitable. One of the essential codes of a medical tourism business model is the cost and, on the whole, revenue stream.[22],[23] By examining the benefits of new technology on the tourism business, Law and Huang have stated that as an essential combination to tourism, a hospital needs to pay more attention to its business model and revise its main and strategic processes.[24]

Zott and Amit have said that business executives have also sought to change the elements of their business model to gain a competitive position. New business models should focus on value chains, support activities, and how to generate revenue.[25]

Kimble has argued that the business model can be used by researchers and regulatory agencies to assess the opportunities and risks of medical travels and help medical tourism service providers to develop international programs.[26]

Despite the conducted studies, statistics show that there has been no business tourism research in the country so far. Taking into account the numerous capacities for attracting medical tourists,[14] the severe weaknesses in attracting foreign tourists,[15] and the lack of a proper framework for medical tourism business,[25],[26] this study aims to identify the main codes of medical tourism business through a systematic review in Iran.

 Materials and Methods



This systematic review adhered to the “Preferred Reporting Items for Systematic Reviews and Meta-Data Analysis” guidelines.[27]

Literature search

Several scholarly international databases, namely the PubMed, Scopus, Web of Science, as well as Iranian bibliographic thesaurus and repositories (namely, Scientific Information Database and Magiran), and databases using simple search terms “medical tourism” or “business model in medical tourism” or “medical travel” OR “wellness tourism” (to ensure that all pertinent citations were searched), along with searching the reference lists of identified articles for additional pertinent articles. The entire review process took place between September 2018 and January 2019.

Study selection

The selection process electronic search results collected were in an Endnote library (for de-duplication of records). Finally, 14 studies were extracted for study.

First, one of the authors (NK) screened all article references based on title and abstract to identify potentially eligible articles, and another author (ST) independently cross-checked the initial results on the basis of the following inclusion criteria:

Only studies that concern medical tourism/business medical tourism were included in the selection. The aim is to identify codes that are important in medical tourism. The reasons why patients seek medical care abroad were not of interest. Original researches were a case study, and we excluded conference proceedings, commentaries, editorials, and letters. Moreover, we gather English or Persian language articles and excluded articles published in other languages.

Methodological quality assessment

Then, two of the authors (ST and NK) independently screened remaining articles' complete full text to confirm eligibility and then independently rated the included studies using Critical Appraisal Skills Programmer checklists as a quality appraisal tool. Inter-rater reliability (for both study selection and quality appraisal processes) was assessed applying the Kappa statistic.[28] Substantial agreement was observed between raters for the full-text review and quality appraisal of the included articles. Whenever one of them was doubtful about eligibility or quality, an agreement was reached through discussion.

Data extraction

A data extraction form was designed before data collection. One author (NK) independently extracted study characteristics (name of the first author, publication year, country, study design, and research objective) as well as key findings related to the business model of tourism medical to a destination country from included articles, and another reviewer (ST) verified the data extracted. In any event of disagreement between them, the consensus was reached through discussion and using a third reviewer (KA) as required. For mixed-methods studies, we extracted only the qualitative components.

Data synthesis

The collected data were analyzed using the content analysis method, which is a way of identifying, analyzing, and reporting themes within a particular. Data were reviewed several times for familiarization. There was no specific grouping before the analysis, and codes and themes were developed according to their repetition within the text. The analysis and coding steps consisted of getting familiar with the data by reading it several times, identifying and extracting primary codes, merging the codes to build themes, reviewing and completing the themes, naming and defining the themes, and assuring reliability of the codes and themes by reaching an agreement between the two coders.

 Results



Our search strategy resulted in 1054 records; the number of records after screening titles and abstracts was 595, 93 full-text articles were reviewed, and finally, 14 studies were chosen to be included in this systematic review. All eligible articles were considered to be of good quality. The search and selection studies are pictorially shown in [Figure 1].{Figure 1}

The themes and codes related to medical tourism business were extracted as it follows and the numbering are based on [Table 1] and [Table 2] and [Figure 2].{Table 1}{Table 2}{Figure 2}

Theme 1: Competitive price

One of the most important factors in attracting medical tourism is price. Given the fact that Iran is in a boycott situation, so its price is very competitive (1, 3–10, and 14–12). In addition to the cost of healthcare, the price of amenities is also important to the patient (3, 5, 7, and 13).

Medical tourists are dissatisfied with the lack of price transparency. The manner and amount of payment should be clear, and there should be no weakness in the financial transaction system (3 and 12). On the other hand, it is important for the senior authorities to standardize the costs of healthcare and tourism (14).

Theme 2: Safety and security

A foreign patient wants a peaceful country for healthcare (8). To protect his/her privacy, the patient chooses a country free from crime, corruption, and terrorist incidents, a country that its laws will protect him/her (1, 2, 8, and 5). He/she also wishes confidentiality between himself/herself and his/her physician (8).

Theme 3: Information and communication technology

In recent decades, with the advances made in all businesses, medical tourism and hospitals are expected to equip themselves with high technology and high bandwidth internet (1, 13, and 14). Using ICT is important in the process of recruitment, marketing, and transactions (4, 10, and 12). On the other hand, since the moment of deciding to choose the destination country until his/her return to his/her home country, the patient expects to be supported via the internet and it is necessary to take effective steps (3 and 7).

Theme 4: Labor market and human resources

A successful business needs committed and competent people, and medical tourism is no exception (1–9 and 13). Medical tourism staff should get the necessary training and be able to communicate well with the patient (1, 4, 5, 6, and 8) and be familiar with the language and culture of the destination country (1, 3, 5, 7, 9, and 12). The number of staff in this sector is significant, and the ratio of clinical staff to patients should be sufficient (1 and 9). The existence of some renowned specialist physicians is a competitive advantage for the host country of medical tourism (7 and 8).

Theme 5: Structure management

Foreign patients, especially European ones, choose the countries that have the permits for medical tourism hospital admissions (5, 7, 8, 10, 12, and 14). Having a complete package of services that cover the cost of medical and tourism is satisfactory to the patient, and hospitals and companies operating in the field are expected to define a complete package of services (1, 3, 7, 10, 12, and 14).

The government should better supervise and delegate the provision of tourist and health services to the private sector and to the facilitating companies (1, 2, and 12). Although short waiting queues and providing specific services are a competitive advantage in Iran (6, 7, 8, and 13), good insurance coverage and an attractive site for medical tourism have not been defined (7 and 14).

Theme 6: Leading the way in medical tourism

A country can be a leader in medical tourism that enjoys government support; policies and laws of government should be in line with this sector (1, 2, 7–9, and 14). Political stability is important for the health tourism recipient country (1, 2, 7, and 8). The government should facilitate the legislation in this sector, and it is expected to reduce the cost of setting up this business and invest at a large level (7–10 and 14).

Theme 7: Infrastructure

Proper infrastructure in all businesses is essential. In the field of health tourism, the infrastructure of the treatment sector must be fully accessible. That is to say, and there should be modern and authentic medical centers and hospitals with proper facilities and equipment which meets the latest standards and also a well-equipped inpatient department ward in each hospital (1–3, 5–14). Proximity between the hotel and the hospital is important to a foreign patient, and hospitals that are near the international hotels or give services as a hospital hotel have a competitive advantage over others (1, 2, and 5–11). Existence of other amenities (translator, driver fluent in English, and food and drink with good quality) is also valuable to foreign patients (1,5–8, 10, and 11).

Theme 8: Exchange with the international world

One of the most important problems for medical tourists in the country of destination is the issuance of visas. Visa issuance for patients should take place in the least possible time and with the least cost and obstacles (8, 12, and 13). Lack of coherent marketing and lack of participation in international fairs to introduce the country and hospitals are international problems in this field (14).

 Discussion



This study was conducted by reviewing (14 selected) articles related to the medical tourism business. Through analyzing the selected articles, 8 important themes and 45 codes involved in medical tourism business were identified; important themes such as competitive price, safety and security, information and communication technology, labor market and human resources, structure management, leading the way in the field of medical tourism, infrastructure, and exchange with the international world.

The themes identified in this study are in line with the research aspects of e-business in the field of treatment conducted in Iran. Paying attention to socioeconomic codes and providing important technological, communicational, telecommunication, legal, and administrative infrastructure have been considered as important issues. Moreover, the differences were in its emphasis on e-business in the field of treatment.[43] In another study,[44] codes influencing the choice of destination for medical tourists were identified, all of which were considered either as themes or codes in our study.

One of the most important themes of the medical tourism business is the competitive price. Thanks to the boycott, Iran currently has a competitive advantage in price. According to a study conducted in South Korea, the factor of reasonable price played a moderating role and had no direct impact on the return of medical tourists.[45] Although this study emphasizes the importance of price, it does not consider it to be critical. The findings of the study were compatible with the findings of a study by Lee and Shih,[46] who emphasized pricing strategy in today's increasingly competitive therapeutic settings.

In a research conducted by Rezaee and Mohammadzadeh, it was noted that from the perspective of the researcher, the following items were effective codes involved in Iran's medical tourism: macro-operational cooperation and collaboration, appropriate equipment, development of basic and therapeutic infrastructures, and comprehensive and coherent medical tourism.[47]

Jabbari et al. have stated that infrastructure quality is a crucial factor in health tourism, and in the present study, the medical tourists' views are in line with the findings of this study.[39]

The results of the study conducted by Jabbari et al. have shown that effective advertising, infrastructure development and the use of quality management systems significantly promote the development of medical tourism in Iran.[48] Jabbari et al.'s results are in line with the results of the present study.

Badie et al. have shown that the enhancement of private participation in the development of medical tourism in Golestan province, the establishment of hospitals and clinics specialized in medical tourism and participation, and support of the public sector plays an important role in the development of this industry.[49]

The results of the present study highlight the importance of safety and security, infrastructure, leading the way in medical tourism, and structure management. These themes have contributed to the improvement and success of the medical tourism business and are in line with the study of Jabbari et al., Rezaee and Mohammadzadeh, and Badie et al.[39],[47],[48],[49]

Since medical tourism is one of the fastest-growing industries globally, and Iran has great potential, one should think of the medical tourism business more scientifically. As defined in this study, Iran has the potential in some aspects of the business and should place greater emphasis on its strengths and do its marketing on that basis. On the other hand, by focusing on its weaknesses, it should also do proper planning.

Researchers of this study tried to extracted related articles, but some of them were not available. To overcome this limitation, some similar articles were used. In this study, using a systematic review, the dimensions and themes of the medical tourism business have been identified. For future research, it is suggested to use other methods such as meta-synthesis to identify the dimensions of the medical tourism business.

 Conclusion



Medical tourism is one of the most important industries in the world, and all countries are seeking to have a greater share of this market. By acquainting the businesspeople with the important aspects of this business and basing their business on it, this study tries to be a gateway to medical tourism business activists. At present, the public sector (hospitals) and the private sector (companies and agencies) involved in medical tourism have not to find a proper position due to the lack of paying attention to important aspects of business and especially to its themes and components that are vital to the business in terms of country and business conditions.

Acknowledgments

This study was a part of a Ph.D. thesis supported by international campus of Iran University of Medical Sciences (IR.IUMS.REC.1398.1211).

Financial support and sponsorship

This article is a part of the first author thesis that is financially supported by grant number IR.IUMS.REC.1398.1211.

Conflicts of interest

There are no conflicts of interest.

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