Barriers of medical tourism development in Iran

 

Barriers of medical tourism development in Iran – Dr. Samira Raoofi: Hospital administration expert in safiran salamat kavir co

Introduction

It is widely accepted that globalization of health services has led to the formation of a new type of tourism known as health tourism, which has grown extraordinarily in the past few years (Heung et al., 2010). Medical tourism involves patients intentionally leaving their home country to access non-emergency health care services abroad (Johnston et al., 2015). In fact, medical tourism provides access to services at a high level of quality and low price as well as shortest waiting queue for treatment (Yeoh et al., 2013). There has been a growth in the number of patients traveling abroad to receive healthcare services, and the number of these individuals is expected to rise in the future (Crooks et al., 2010). It is estimated that 14 to16 million patients worldwide will seek medical care abroad each year (Kucukusta et al., 2019).

Therefore, the medical tourism industry is a growing part of the global market and its effects have exceeded economic and commercial aspects. With the increase of demand for tourism and the important role of the tourism industry, many countries have attempted to increase this potential to attract health tourists, especially the developing countries in Asia. (Ganguli & Ebrahim, 2017). According to global reports, the global medical tourism market was valued at $61.1 billion in 2016, anticipating to reach US$165.3 billion by 2023 with a combined growth rate of 15% (Campbell et al., 2019). India, Singapore, Thailand, and the Philippines have become top medical tourism destinations for those seeking specialized medical care in Asia (LG, 2011). Investment in this sector can result in increased revenue, improved services, and higher foreign exchange earnings (Johnston et al., 2015).

Literature review

Compared to other countries in the Middle East region, Iran has an interesting potential for developing medical tourism, including four-season nature, abundant natural resources, low prices of medical services, internationally recognized physicians, and successful performance in surgeries at the global level (Jabbari et al., 2013). However, despite this potential for the development of medical tourism in Iran, this country was not among the top 30 destinations for medical tourists in 2016 based on the medical tourism index (MTI) (Fetscherin & Stephano, 2016). While measures have been taken to increase the market share of the medical tourism industry in the past years, Iran has faced various obstacles: international and structural requirements for participating in the global market, weakness of the medical tourism information management system, as well as political, managerial, brokerage, transportation, cultural, and marketing problems (Azadi et al., 2012; Jafari et al., 2016; Momeni et al., 2018; Momeni et al., 2014; Momeni et al., 2017).

Over the past few years, several studies have been conducted in Iran to recognize the challenges and barriers to the development of medical tourism. For instance, barriers reported by some authors included ineffective coordination between organizations responsible for medical tourism (Izadi et al., 2012). In this regard, Amouzegar (2016) considered poor marketing, insurance coverage, and political instability. Momeni (2018) reported international issues, culture, management and transportation. Each of these studies has identified different barriers, but no study has been conducted capable of providing a comprehensive picture of the barriers to the development of medical tourism in Iran. Therefore, the present study aimed to analyze the obstacles to the development of medical tourism in Iran by providing a comprehensive picture in this area and being able to eliminate or reduce the effects of these factors in addition to contributing to medical tourism development and the positive effects of economic development followed by it.

Results

According to the proposed framework, three main themes of results were extracted, including infrastructural factors, legal and government factors (inter-sectoral), and factors related to the health system (intra- sectoral).

Infrastructural Factors

The infrastructural factors included four subthemes of basic infrastructures, marketing, competitiveness, and information system.
Basic infrastructure: Poor air transportation and lack of adequate international airlines are some of the factors associated with basic infrastructure, which is emphasized in about half of the articles. The next factor is the inadequacy of hotels and accommodation facilities due to the lack of hotels, hospitals, and the desired welfare services for health tourists and their companions. However, the poor transfer of patients in terms of patient guidance mechanisms is another factor that must be added to the list. Inadequate hardware facilities due to the underdevelopment of these facilities and the non-standard price of tourism services and the provision of services at different prices are other factors in this subtheme.

Marketing:

In this subtheme, improper advertisements are of the most repetitive factors, which have been mentioned in most articles. The next frequent factors are the inadequate and insufficient marketing processes related to the weakness of Iranian medical tourism in the field of international marketing. In this subtheme, another important factor was poor branding for important clinical diagnostic and treatment services. Overall, Iran has no specific brand in the field of diagnostic, clinical, and surgical services. The informal activity of unauthorized brokers and intermediaries in medical tourism in unofficial markets is another factor in this subtheme. Finally, insufficient knowledge of target markets and positioning of target markets are other factors of the subtheme.

1-3-Competitiveness

Inadequate competitiveness is the most frequent factor in this subtheme considering the increasing competitiveness of competitors. Another challenge is an international investment in the countries neighboring Iran, such as the investment of the USA in some of the neighboring countries of Iran. The next factor is strengthening the tourism infrastructure of rival countries in the region due to the large investment in this sector.

1-4-Medical tourism information system

In this subtheme, the most repetitive factor was the lack of a system to record the information and statistics of foreign patients due to a lack of specific instruction in this context. Another factor related to this subtheme was the lack of a system for assessing foreign patients’ satisfaction, lack of responding to dissatisfied tourists, and poor follow-up system. Inefficient IT infrastructures in service centers for the proper use of cyberspace and the Internet were other important factors mentioned in this subtheme.

2-Legal and government Factors (inter-sectoral)

This theme included five main subthemes of political, management, economic, security, policy making, and planning issues, recognized as factors caused by the poor or inefficient performance of the government in line with the medical tourism development.

2-1-Political issues and international relations

The political instability of the country is the main factor related to political issues and international relations. Other barriers to the development of medical tourism in Iran include presenting a negative and false image of Iran in the Western media, political and security attitudes towards tourism and, consequently, medical tourism, issues arising from the interference of the duties of the political sphere of tourism and health due to the ambiguity and lack of understanding of the duties and powers of the responsible institutions, restricted foreign relations of Iran with other countries, and inefficient cooperation and coordination of Iran with organizations such as World Trade Organization (WTO).

2-2-Managerial issues

Managerial instability at all levels was the most repetitive factor in this subtheme. Administrative system problems such as structural weakness, the inefficiency of decision-making bodies, instability of existing regulations, poor operational management due to lack of sufficient operational capability, and lack of strategic and operational planning in the field of medical tourism were other challenges mentioned in this subtheme.

2-3-Economic issues

In this subtheme, the most repetitive barriers to the development of medical tourism were economic problems caused by international political sanctions against Iran. However, an internal factor reported for this subtheme was economic constraints and insufficient financial support from the government, which is due to the unclear share of this sector in the economy.

2-4-Security issues

This subtheme included the factors of security and terrorism issues arising from insecurity in the Middle East and drug trafficking into the country in the form of medical tourism coverage.

2-5-Policy-making and planning

Intersect oral poor cooperation and coordination to improve the medical tourism industry was the most repetitive factor in this subtheme, which was formerly mentioned in most studies. Other factors introduced in this subtheme included a lack of a comprehensive program for medical tourism development in terms of a lack of a specific strategy at the national, regional, and international levels, inadequate laws and regulations, and inefficient government support of medical tourism (e.g., lack of support of official units by the government). Moreover, insufficient capacity due to the lack of a clear stewardship of health tourism and the lack of necessary support of the private sector by the government, such as bureaucratic processes to obtain a license to enter the field of medical tourism, were other factors in this regard.

3. Health System-related Factors (intra-sectoral)

The third and last identified theme included three subthemes of medical insurance and tariffs, international accreditation, and the quality and issues related to human resources.

3-1-Medical services tariffs and health insurance

Factors related to health insurance were lack of insurance and non-acceptance of tourist insurance coverage and weakness of medical liability insurance in case of medical error. In this subtheme, one of the most repetitive factors was inconsistency and non-standard service prices provided to medical tourists due to unbalanced prices in the country›s hospitals. Other challenges of the subtheme included a lack of presenting service prices on the hospital›s website to inform medical tourists and a lack of monitoring medical tariffs by regulatory bodies.

3-2-International accreditation and service quality

As pointed out in more than half of the articles, the issue of lack of international hospital accreditation licenses, which raises concerns about the quality of services for tourists, was the most repetitive factor of this subtheme. In this subtheme, another reported factor was the poor medical care quality and standards in terms of lack of global standards in medical centers. Moreover, the lack of up-to-date diagnostic and therapeutic technologies, poor monitoring of healthcare centers in terms of lack of design of a monitoring service system were other factors in this subtheme. In addition, a saturation of the capacity of government centers and inefficient service delivery processes were reported as other factors related to the subtheme of international accreditation and service quality.

3-3-Human resources

In this subtheme, the most repetitive factor was improper interaction with the personnel because of cultural differences and lack of accurate identification of foreign patients’ needs, which was pointed out in almost 50% of the articles. Another repeated challenge was poor language proficiency of the personnel, especially English and Arabic. Inadequate professional skills of clinical staff and lack of attention to the topic of medical tourism in the educational content of university curriculums were other factors of this subtheme.

Given the identification of three main factors that act as barriers to the development of medical tourism in Iran, policymakers can improve medical tourism industry in Iran by taking action on key identified problems. Although medical tourism has negative effects such as medical tourists› use of subsidized medical services and medicines or the use of medical capacity reserved for the citizens of the country, its positive role in economic development can reduce the negative effects and pave the way for its development.
It is suggested that health services and medical capabilities of the country be introduced to health tourists with the improvement and development of information technology infrastructure in line with the infrastructural factors. In addition, it is recommended that the context be provided for extensive marketing through social networks since the activities of brokers in the field can be reduced by the identification and expansion of the scope of activities of tourism agencies and facilitation companies.

In terms of legal and governmental factors, some of the improvements to consider might include determining specific budgets to health tourism, assigning all related affairs to a single organization to issue licenses for facilitation companies and hospitals and monitor the quality of their services, enhancing domestic and international relations, developing instructions related to health tourism as a guide for healthcare centers and patients, changing the current standards related to medical tourism and their development according to the different conditions of hospitals, supporting and expanding the activities of private centers to provide health tourism services, and reducing the waiting time in public hospitals.

Regarding issues related to hospitals and treatment, some of the effective steps included reviewing the standards of the international patients’ unit and obligating hospitals to conduct health tourism training courses, defining instructions such as healthcare service tariffs, using up-to-date medical equipment, using insurance for health tourists and professional liability insurance for service providers, improving the ability of personnel in the field of communication and the dominant language of patients, developing marketing activities in hospitals to introduce services, paying attention to the follow-up procedures after discharging the patients, and providing health tourism services in a limited number of hospitals for the better monitoring of the quality of services.

Study Limitations and future directions

Considering a limited number of search databases for search studies, publishing after-time studies intended for searching study articles and lack of access to the full text of some articles are some of the limitations of the present study, it is suggested that researchers in future studies to help identify and solve the problems of medical tourism by considering the above limitations and conducting a study on a wider (global) level.