Journal of Tourism and Development

Journal of Tourism and Development

Meta-analysis of Barriers to Medical Tourism Development in Iran

Document Type : Original Article

Author
Associate Professor of Geography and Urban Planning, Shahid Chamran University of Ahvaz, Ahvaz, Iran
10.22034/jtd.2024.474178.2955
Abstract
The present study aimed to do a meta-analysis of the barriers to the development of medical tourism in Iran. This applied study employed a descriptive-analytical research method and a meta-analysis technique. For this purpose, 21 articles were extracted from ISC, Scopus, Web of Science and Google Scholar databases and finally 17 selected articles were entered into CMA software for analysis. Among them, 12 factors were identified in several studies and the effect size of each was obtained in relation to the underdevelopment of medical tourism in Iran. These factors include: the weaknesses of the administrative system; international sanctions and challenges; Multiplicity of decision-making centers; weak cooperation between the private and public sectors; Weakness of statistical and information system; Weakness of laws, supervision and monitoring; Weakness of the service delivery process in the medical tourism service chain; informal and underground activity in the chain of providing medical tourism services; Weak competitiveness of Iran's medical tourism services in international markets; Obstacles to investment; barriers to marketing and advertising; and cultural barriers. The selected studies were conducted by survey method and questionnaire tool in different statistical societies. In the first step of the evaluation, homogeneity and heterogeneity and publication bias were investigated, and the findings showed no publication bias and heterogeneity of the studies. The results of the independent and combined effect sizes of the variables in CMA software demonstrated that the significance levels of the variables "weakness of the statistical and information system" as 0.654, "informal and underground activity in the medical tourism service supply chain (MTSSC)" as 0.478, and "weak competitiveness of Iran's medical tourism services in international markets" as 0.103, are higher than the standard significance level of 0.05. That is, the effect sizes of these variables are not acceptable. In other words, the mentioned three variables do not significantly affect the underdevelopment of medical tourism in Iran. Moreover, the significance level of other variables is lower than the standard significance level. Therefore, their effect size is significant, and their effect on the underdevelopment of medical tourism in Iran is confirmed. The effect sizes of the three variables, "weakness of the service delivery in the MTSSC", "investment barriers", and "marketing and advertising barriers", are high and more than the other variables.
Keywords

an interpretive structural modelling approach. International Journal of Healthcare Management, 14(2), 563-575. https://doi.org/10.1080/20479700.2019.1677036
Asheri, A. (2016). Investigating factors affecting the development of medical tourism in Tehran. Master's thesis, Ecotourism, Faculty of Natural Resources and Earth Sciences, Kashan University. [In Persian]
Azizi, F., & Zahedi, S. (2016). Assessment of the Barriers to the Development of Health Tourism in Yazd Province, Iran. Health Information Management, 12(6), 799-806. https://him.mui.ac.ir/article_11470_en.html?lang=fa [In Persian]
Badiei, F., Ebrahimi, A., & Didekhani, H. (2017). Medical Tourism Development in Golestan Province; An Assessment of Identified Solutions. New Marketing Research Journal, 6(4), 25-36. https://doi.org/10.22108/nmrj.2017.21266 [In Persian]
Baghi, A., Vazifeh Doost, H., & Mirabi, V. R. (2019). Development of Mashhad's health system through the interpretation model (ISM). Geography (Regional Planning), 9(35), 613-623. https://dorl.net/dor/20.1001.1.22286462.1398.9.3.16.4 [In Persian]
Bookman, M., & Bookman, K. (2007). Medical Tourism in Developing Countries. Palgrave Macmillan, Basingstoke, Hants, UK.
Bulatovic, I., & Iankova, K. (2021). Barriers to Medical Tourism Development in the United Arab Emirates (UAE). International Journal of Environmental Research and Public Health, 18(3), 1365. https://doi.org/10.3390/ijerph18031365
Burke, R. J. (2018). Human resource management in the hospitality and tourism sector. In Handbook of human resource management in the tourism and hospitality industries (3-39). Edward Elgar Publishing. https://doi.org/10.4337/9781786431370
Choi, Y., Ashurova, Z., & Lee, H. (2021). Sustainable Governance on the Intention of Medical Tourism in Uzbekistan. Sustainability, 13(12), 6915. https://doi.org/10.3390/su13126915
Cohen, E. (2008). Medical tourism in Thailand. In: Cohen, E. (ed.) Explorations in Thai Tourism: Collected Case Studies (pp.225-255). Emerald, Bingley, West Yorkshire, UK.
Dalen, J. E., & Alpert, J. E. (2019). Medical Tourists: Incoming and Outgoing. The American Journal of Medicine, 132(1), 9-10.
De la Hoz-Correa, A., Muñoz-Leiva, F., & Bakucz, M. (2018). Past themes and future trends in medical tourism research: A coword analysis. Tourism Management, 65, 200–211. https://doi.org/10.1016/j.tourman.2017.10.001
Delavar, A. (2004). Theoretical and practical foundations of research in humanities and social sciences. 4th edition, Tehran: Rushd Publications. [In Persian]
Ehrbeck, T., Guevara, C., & Mango, P. (2008). Mapping the market for medical tourism. The McKinsey Quarterly May, 11, 1–11. https://strategie.archives-spm.fr/cas/system/files/bf12e815d01.pdf.
Erfurt-Cooper, P., & Cooper, M. (2009). Health and Wellness Tourism. Channel View Publications, Bristol.
Ghanbari, A., Karami, F., & Imanzadeh, T. (2022). Assessment of Medical Tourism Barriers In Tabriz City. Urban tourism, 9(2), 27-39. https://doi.org/10.22059/jut.2021.316388.868 [In Persian]
Gholami, Z., & Ziari, Y. (2021). Analysis of Barriers to Medical Tourism Development (Case Study: District 6 of Tehran). Strategic Management Studies of National Defence Studies, 11(42), 324-295. https://smsnds.sndu.ac.ir/article_1453.html?lang=en [In Persian]
Gholipour Soute, R., Amiry, M., Zargham Boroujeny, H., & Kiani Feizabadi, Z. (2019). Exploring the barriers of medical tourism development in Iran with an emphasis on policymaking requirements. Journal of Tourism and Development, 7(4), 38-60. https://doi.org/10.22034/jtd.2018.142305.1473 [In Persian]
Goodarzi, M., Soltani, Z., & Poormoghadam, A. (2023). Investigation and Analysis of Factors Affecting the Demand for Foreign Medical Tourism in Ahvaz Metropolis. Journal of Tourism and Development, 12(1), 201-218. https://doi.org/10.22034/jtd.2022.331809.2577 [In Persian]
Goodarzi, M., Taghvaei, M., & Zangiabadi, A. (2014). Developing of Domestic Medical Tourism in Shiraz. Health Information Management, 11(4), 485-496. https://him.mui.ac.ir/article_11325.html?lang=en [In Persian]
Hakim, A., & Longman estarki, S. (2023). Approaches to The Development Of Medical Tourism In Iran From The Point Of View Of Managers. Journal of Tourism and Development, 12(4), 29-47. https://doi.org/10.22034/jtd.2023.385022.2738 [In Persian]
Hosseini, M., & As’adi M. (2014). The Study of Communicational Barriers of medical Tourism in Iran. Jhosp, 13(1), 79-89. http://jhosp.tums.ac.ir/browse.php?a_id=5296&sid=1&slc_lang=en [In Persian]
Hosseini, S. S., & Taghvaei, M. (2021). Medical tourism development determinants & strategies by taking an Approach towards Services Integration (Case study of three health areas). Journal of Tourism and Development, 10(4), 199-214. https://doi.org/10.22034/jtd.2020.250391.2138 [In Persian]
Hosseini, S. S., Tagvayi, M., Ataev, Z. V., & Bratkov, V. V. (2021). Problems and prospects of creating health tourism villages as a potential for developing medical tourism in the Islamic Republic of Iran (Case study: Yazd province). South of Russia: Ecology, Development, 15(3), 97-116. https://doi.org/10.18470/1992-1098-2020-3-97- 116
Horowitz, M. D., & Rosensweig, J. A. (2008). Medical tourism vs. traditional international medical travel: A tale of two models. MTJ – International Medical Travel Journal, 9(4), 33- 47.
Howit, D. & Cramer, D. (2017). Introduction to Statistics in Psycology. Translated by Pashasharifi, H., Najafi Zand, J., Mirhashemi, M., Sharifi, N., & Manavipour, D, Tehran, Sokhan Press. [In Persian]
Huang, Y., & Coelho, V.R. (2017). Sustainability performance assessment focusing on coral reef protection by the tourism industry in the coral Triangle region. Journal of Tourism management, 59, 510-527. https://doi.org/10.1016/j.tourman.2016.09.008
Hwang, S., Lee, D., & Kang, C. Y. (2018). Medical tourism: focusing on patients’ prior, current and post experience. International Journal of quality Innovation, 4(4), 1-22. https://doi.org/10.1186/s40887-018-0024-2
Karoubi, M., & Ahmadi, S. (2020). Strategic planning of medical tourism using the SWOT Matrix - Fuzzy Topsis Technique. Tourism Management Studies, 15(51), 1-30. https://doi.org/10.22054/tms.2020.17137.1480 [In Persian]
Khodayi Sarkhanlou, J., Gharehbiglo, H., Iranzadeh, S., & Shahinpour, A. (2024). Analysis of the relationship between the development of health tourism in Iran and content marketing Case example: Tehran city. Urban tourism, 10(4), 97-113. https://doi.org/10.22059/jut.2023.363230.1148 [In Persian]
Kim, Soojung. & Arcodia, Charles. & Kim, Insin. (2019) Critical Success Factors of Medical Tourism: The Case of South Korea. Int. J. Environ. Res. Public Health, 6(24), 4964. https://doi.org/10.3390/ijerph16244964
Lee, C. A. (2012). Health Create Crossroads: Medical Tourism and the Dismantling of Costa Rican Exceptionalism (Doctoral dissertation, University of Colorado Denver).
Li, H., Du, Y., Xue, T., & Jenkins, C. L. (2022). Chinese medical tourism: review and research agenda. Journal of Quality Assurance in Hospitality & Tourism, 24(5), 663–687. . https://doi.org/10.1080/1528008X.2022.2073939
Loghman Estarki, S., & Hakim, A. (1402). Providing a strategic model for the development of medical tourism in the country in the post-corona era. Medicine and Cultivation, 32(1), 58-72. [In Persian]
Lunt, N., & Carrera, P. (2010). Medical tourism: assessing the evidence on treatment abroad. Maturitas 66, 27–32. https://doi.org/10.1016/j.maturitas.2010.01.017
Miller, A., Smith, R., Woods, N., & Warholak, T. (2021). Analysis of medical tourism at the Andrade port of entry. J Am Pharm Assoc, 61(2), e114-9. https://doi.org/10.1016/j.japh.2020.10.018.
Mueller, H., & Kaufmann, E. (2001). Wellness tourism: market analysis of a special health tourism segment and implications for the hotel industry. Journal of Vacation Marketing, 7, 5–17. https://doi.org/10.1177/135676670100700101
Nemati, V., Ebrahimpour, H., Babaee, Y., & Abbasgholizadeh, N. (2016). Assessing Barriers to the Development of Medical Tourism Case Study: Ardabil. j.health, 7(2), 118-133. URL: http://healthjournal.arums.ac.ir/article-1-910-fa.html [In Persian]
Nhai, F. (2009). It’s procedure, not tourism. Medica Tourism 1, 106.
Nilashia, M., Samadc, S., Manafd, A. A., Ahmadie, H., Rashidf, T. A., Munshid, A., Almukadih, W., Ibrahimg, O., & Hassan Ahmede, O. (2019). Factors influencing medical tourism adoption in Malaysia: A Dematel-Fuzzy Topsis approach. Computers and Industrial Engineering, 137(43), 106005. https://doi.org/10.1016/j.cie.2019.106005
Norouzzadeh, A., Hosseini, M., & Motamedi, M. (2020). Analysis and investigation of communication and cultural barriers to the development of medical and health tourism using structural interpretive modeling (case study: Meshkinshahr city). Geographical Journal of Tourism Space, 10(39), 21-34. [In Persian]
Reisman, D. (2010). Health Tourism, Social Welfare through International Trade. Edward Elgar, Cheltenham, Glos, UK.
Ridderstaat, J., Singh, D., & DeMicco, F. (2019). The impact of major tourist markets on health tourism spending in the United States. Journal of Destination Marketing & Management, 11, 270-280. https://doi.org/10.1016/j.jdmm.2018.05.003
Rokni, L., Avci, T., & Park, S. H. (2017). Barriers of developing medical tourism in a destination: a case of South Korea. Iran J Public Health, 46(7), 930-937. https://pmc.ncbi.nlm.nih.gov/articles/PMC5563875/
Sandberg, D. S. (2017). Medical tourism: An emerging global healthcare industry. International Journal of Healthcare Management, 10(4), 281-288. https://doi.org/10.1080/20479700.2017.1296213
Sharon, L. & Normand, T. (1999). Tutorial in biostatistics: Meta-analysis formulating evaluating combining and reporting. Statistic in medicine, 18(3), 321- 359. https://doi.org/10.1002/(SICI)1097-0258(19990215)18:3<321::AID-SIM28>3.0.CO;2-P
Smith, M., & Puczko, L. (2009). Health and wellness tourism. Elsevier, Oxford.
Sobo, E. (2009). Medical travel: what it means, why it matters. Medical Anthropology, 28, 326–335. https://doi.org/10.1080/01459740903303894
Suess, C., Baloglu, S., & Busser, J. A. (2018). Perceived impacts of medical tourism development on community wellbeing. Tourism Management, 69, 232-245. https://doi.org/10.1016/j.tourman.2018.06.006
Suess, C., Kang, S., Dogru, T., & Mody, M. (2020). Understanding the influence of “feeling at home” on healthcare travelers’ well-being: a comparison of Airbnb and hotel homescapes. Journal of Travel & Tourism Marketing, 37(4), 479-494. http://dx.doi.org/10.1080/10548408.2020.1759481
Taghvaei, M., & Goodarzi, M. (2016). Developing and Prioritizing the Formation of Strategies in Medical Tourism (Case Study: Shiraz Metropolis). Journal of Urban Research and Planning, 7(24), 1-22. https://dorl.net/dor/20.1001.1.22285229.1395.7.24.3.0 [In Persian]
Tonga, F., Caglar, Y. S., & Aktan, E. S. (2021). Possible early examples of medical tourism. Am J Med Sci, 362(3), 227-232. https://doi.org/10.1016/j.amjms.2021.05.026
Turner, L. (2011). Canadian medical tourism companies that have exited the marketplace: Content analysis of websites used to market transnational medical travel. Globalization and Health, 7(1), 1-16. https://doi.org/10.1186/1744-8603-7-40
Zhang, W., Zhaoxiang, Qin., & Jun, T. (2022). Economic Benefit Analysis of Medical Tourism Industry Based on Markov Model. Journal of Mathematics, 2022(1), 6401796. http://dx.doi.org/10.1155/2022/6401796