Journal of Education and Health Promotion

: 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


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 May 26 ];11:146-146
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Full Text


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.


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).


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.


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.


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.


1Horowitz MD, Rosensweig JA. Medical tourism vs. traditional international medical travel: A tale of two models. Int Med Travel J 2008;3:3-30.
2Alagoz SB, Ekici N. Experiential marketing and vacation experience: The sample of Turkish airlines. Procedia Soc Behav Sci 2014;150:500-1.
3The Travel & Tourism Competitiveness Report; 2017. Available from: [Last updated on 2017 Apr 05; Last accessed on 2020 Feb 09].
4Loncaric D, Loncaric D, Markovic S. Health tourism customer satisfaction and quality of Life: The role of specialty hospital. Tourism in Southern and Eastem 2015;3:159-73.
5Delgoshaei B, Ravaghi H, Abolhassani N. Importance - Performance analysis of medical tourism in Tehran province from medical tourists and medical services providers' perspective. Hospital 2012;11:63-72.
6Sultana S, Haque A, Momen A, Yasmin F. Factors affecting the attractiveness of medical tourism destination: An empirical study on India- review article. Iran J Public Health 2014;43:867-76.
7Honarvar k, Ghafori F, Farzam F, Sharifian A. Important codes in the marketing of sports tourism in Iran. Olympic J 2008;4:31-45.
8Patients Beyond Borders Medical Tourism Statistics and Facts; 2013. Available from: [Last updated on 2019 Nov16; Last accessed on 2020 Feb 09].
9IMTJ Analysis of 2017 India Medical Tourist Data. IMTJ Analysis of 2017 India Medical Tourist Data. Available from: [Last updated on 2018 Sep 20; Last accessed on 2020 Feb 09].
10Thomas J. Malaysia's Medical Tourism on a High. Available from: [Last updated on 2019 May 03; Last accessed on 2020 Feb 09].
11TMA Healthcare. Available from: [Lastupdated on 2018 Sep 20; Last accessed on 2020 Feb 09].
12Journal I.M.T. Medical Tourism Profile for South Korea. Available from: [Last updated on 2020 Sep 20; Last accessed on 2020 Feb 09].
13Global Market Insights Medical Tourism Market Size by Application (Cardiovascular Surgery, Cosmetic Surgery {Hair Transplant, Breast Augmentation}, Dental Surgery, Orthopedic Surgery, Bariatric Surgery, Fertility Treatment, Oncology Treatment) Industry Analysis Report, Regional Outlook, Application Potential, Price Trends, Competitive Market Share & Forecast, 2019–2025. Available from: [Last updated on 2019 Aug 20; Last accessed on 2020 Feb 09].
14Jabbari A, Ferdosi M, Keyvanara M, Agharahimi Z. Analysis of medical tourism industry stakeholders: Providing effective strategies in Isfahan. Health Informat Manage J 2013;9:878-86.
15Firozjaeian A, Firozjaeian M, Patrodi H, Rezazadeh FG. Application techniques interpretive structural modeling (ISM) in tourism studies (pathological analytical approach). Plann Dev Tourism 2013;2:129-59.
16Sarahi H, Safdari R, Mahmudi M, Mohammadzadeh N. Mechanisms of health care information technology development. Payavard Salamat 2007;1:32-8.
17Safdari R, Dargahi H, Mahmoodi M, Torabi M, Mohammadzadeh N. Assessing the viewpoint of faculty members of medical record departments in Iran about the impact of information technology on health system 2004. ISMJ 2006;9:93-101.
18Lurie N, Fremont A. Building bridges between medical care and public health. JAMA 2009;302:84-6.
19Goldstein MM, Blumenthal D. Building an information technology infrastructure. J Law Med Ethics 2008;36:709-15, 609.
20Blumenthal D. Stimulating the adoption of health information technology. N Engl J Med 2009;360:1477-9.
21Byrne CM, Mercincavage LM, Pan EC, Vincent AG, Johnston DS, Middleton B. The value from investments in health information technology at the U.S. Department of Veterans Affairs. Health Aff (Millwood) 2010;29:629-38.
22Snyder J, Crooks VA, Adams K, Kingsbury P, Johnston R. The 'patient's physician one-step removed: The evolving roles of medical tourism facilitators. J Med Ethics 2011;37:530-4.
23Simpson K, Bretherton P. The impact of community attachment on host society attitudes and behaviours towards visitors. Tourism Hosp Plan Dev 2009;6:235-46.
24Law R, Huang T. How do travelers find their travel and hotel websites. Asia Pac J Tourism Res 2006;11:239-46.
25Zott C, Amit R. Business model design: An activity system perspective. Long Range Plann 2010;4:216-26.
26Kimble C. Business models for e-health: Evidence from ten case studies. Global Bus Organizat Exc 2015;34:18-23.
27Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 2015;4:1.
28Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977;33:159-74.
29Singh N. Exploring the codes influencing the travel motivations of US medical tourists. Curr Issues Tourism 2013;16:436-54.
30Martínez Álvarez M, Chanda R, Smith RD. The potential for bi-lateral agreements in medical tourism: A qualitative study of stakeholder perspectives from the UK and India. Global Health 2011;7:11.
31Mona AA, Suzanne CM, Rohit P. Hospital ability to attract international patients: A conceptual framework. Int J Pharma Healthc Mark 2011;5:205-21.
32Maboodi MT, Hakimi H. Determinant codes on medical tourism (Case study: Iran). J Tourism Plann Dev 2016;4:80-106.
33Morovati-Sharifabadi A, Asadian-Ardakani F. A model for health tourism development using fuzzy TOPSIS and interpretive structural modeling in Yazd province. J Health Adm 2014;17:73-88.
34Anabestani AA, Anabestani Z. Codes affecting in choosing of mashhad as a medical tourist destination. J Urban Tourism 2015;2:275-89.
35Bayat S, Hashemzadeh- Hosseini D, Bod M. Attracting codes identification of medical tourists in hospitals of tehran city. J Hosp 2017;16:35-53.
36Abd Manaf NH, Hussin H, Jahn Kassim PN, Alavi R, Dahari Z. Country perspective on medical tourism: The Malaysian experience. Leadersh Health Serv (Bradf Engl) 2015;28:43-56. Available from: [Last accessed on 2020 Feb 09].
37Nemati V, Ebrahimpour H, Babaee Y, Abbasgholizadeh N. Assessing barriers to the development of medical tourism case study: Ardabil. J Health 2016;7:118-33.
38Goodarzi M, Taghvaei M, Zangiabadi A. Investigation and evaluation of the impacting codes on the development of medical tourism in Shiraz megalopolis. Tourism Manage Stud 2014;8:1-25.
39Jabbari A, Delgoshaei B, Farzin M, Shaarbafchizadeh N, Tabibi SJ. Current medical tourism in Iran: A case study. Payesh J 2012;11:171-9.
40Maleki S, Tavangar M. Analyzing health tourism challenges in Mashhad from the perspective of foreign patients. J Geography Urban Space Dev 2016;2:153-65.
41Hamidizadeh MR, Javidi H, Mojarrad F. Iran's competitive advantage in medical tourism marketing: A case study on open heart and cataract removal surgeries. J Health Informat Manage 2016;13:373-9.
42Saraei M, Afsharipour M. Evaluation of medical tourism structure based on the Porter diamond model in the metropolis of Mashhad. Urban Tourism J 2019;5:117-30.
43Dargahi H, Mohammadzadeh N, Rezaianzadeh HR. Electronic business in the field of health. J Outcom 2012;5:39-48.
44Sultana S, Haque A, Momen A, Yasmin F. Codes affecting the attractiveness of medical tourism destination: An empirical study on India- review article. Iran J Public Health 2014;43:867-76.
45Runnels V, Carrera PM. Why do patients engage in medical tourism? Maturitas 2012;73:300-4.
46Lee WI, Shih BY. Application of neural networks to recognize profitable customers for dental services marketing: A case of dental clinics in Taiwan. Exp Syst Applications 2009;36:199-20.
47Rezaee R, Mohammadzadeh M. Effective codes in expansion of medical tourism in Iran. Med J Islam Repub Iran 2016;30:409-14.
48Jabbari A, Rahimi Zarchi MK, Kavosi Z, Shafaghat T, Keshtkaran A. The marketing mix and development of medical tourism in shiraz. Mater Sociomed 2013;25:32-6.
49Badiei F, Ebrahimi A, Didekhani H. Medical tourism development in Golestan province: An assessment of identified solutions. New Market Res J 2016;6:25-36.