Achieving sustainable medical tourism: unpacking privacy concerns through a tripartite game theoretic lens

Introduction

Medical tourism has grown significantly, raising critical concerns about the privacy of medical tourists. This study investigates privacy issues in medical tourism from a game theoretic perspective, focusing on how stakeholders' strategies impact privacy protection.

Methods

We employed an evolutionary game model to explore the interactions between medical institutions, medical tourists, and government departments. The model identifies stable strategies that stakeholders may adopt to protect the privacy of medical tourists.

Results

Two primary stable strategies were identified, with E6(1,0,1) emerging as the optimal strategy. This strategy involves active protection measures by medical institutions, the decision by tourists to forgo accountability, and strict supervision by government departments. The evolution of the system's strategy is significantly influenced by the government's penalty intensity, subsidies, incentives, and the compensatory measures of medical institutions.

Discussion

The findings suggest that medical institutions are quick to make decisions favoring privacy protection, while medical tourists tend to follow learning and conformity. Government strategy remains consistent, with increased subsidies and penalties encouraging medical institutions towards proactive privacy protection strategies. We recommend policies to enhance privacy protection in medical tourism, contributing to the industry's sustainable growth.

Healthcare Facilities and Medical Tourism Across the World: A Bibliometric Analysis

This study aimed to review the literature on healthcare facilities and medical tourism from a range of nations that have established medical tourism sectors and assess the effect of healthcare facilities on medical tourism. A bibliometric study of the Scopus database was carried out by using the search terms '(Facility AND of AND healthcare) AND TITLE-ABS-KEY (health AND tourism) AND medical tourism' for the years 2012-2022. A qualitative evaluation of the literature was then performed to find and locate 92 articles. VOSviewer and NVivo 12 Plus were employed for data analysis. The findings indicated that the following trending subject keywords were used during the period in question: health (rate 1.97), medicine (rate 1.91), tourism (rate 1.70), care (rate 0.83), facilities (rate 0.64) and healthcare (rate 0.61). Furthermore, this research identified four distinct clusters: i) medical tourism, ii) healthcare quality, iii) healthcare system and iv) health services. The study found that healthcare facilities, as actors that have a role in the development of medical tourism, have not been sufficiently explored, even though there is evidence that they play a role in the growth of the sector. This result is in line with Heung's argument, which makes the same point.

Asclepieia in ancient Greece: pilgrimage and healing destinations, the forerunner of medical tourism

Asclepios, the first physician-demigod in Greek mythology, was born in Thessaly of the God Apollo and Coronis, a mortal mother. Asclepieia were healing sanctuaries dedicated to Asclepios. Asclepieia were located throughout the Eastern Mediterranean area, in ancient Greece and the Roman world. Travelers from all over the Mediterranean area seeking healing made pilgrimages to the Asclepieia, the early forerunner of "medical tourism".

Healthcare provision for medical tourism: A comparative review

Providing quality services, using modern technologies, having effective marketing, and providing services at an international level have led to the globalization of hospital services. This study aimed to identify the components of health services in developing countries that provide services to international patients. A comparative review was conducted by searching in PubMed, Scopus, Web of Science, Google Scholar, Google, and the websites of the World Medical Tourism Organization, the World Bank, and the Ministry of Health of the selected countries from 2000 to 2022. Iran, Turkey, Jordan, Costa Rica, the UAE, and Singapore were selected. The data were collected and analyzed using a comparative table. Different strategies were used to develop the medical tourism industry among the studied countries, but the main challenges in this field included the inappropriateness of the quality of the services provided or the provision of services that did not meet the needs of patients, the lack of expert human resource, not using medical facilitation companies, communication problems with patients, insufficient government support for medical tourism, and strict laws regarding business. The development of activities in the medical tourism industry requires planning in various dimensions. It seems that developing the medical marketing and activities of facilitator companies to facilitate patient admission, monitoring the quality of services provided, improving interdepartmental coordination, and considering a single trustee for this industry will improve the medical tourism status in Iran.

A review of the United Arab Emirates healthcare systems on medical tourism and accreditation

This paper aims to review the healthcare system in the United Arab Emirates (UAE) and the utilisation of international accreditation to improve the quality of healthcare services and to grow its medical tourism industry. Medical tourism has contributed to the UAE's economy. Hence, the country mandated international accreditation in public and private facilities to attract patients and boost medical tourism. Accreditation is recognised worldwide as one of the main drivers for implementing quality and patient safety standards, which has sparked considerable interest in studying the effects and outcomes of such assessments. Therefore, the second aim of this paper is to review the UAE's strategic goals to improve the quality of healthcare services using international accreditation. Although striving to achieve global accreditation attracts tourists, it is essential to understand the needs and outcomes of such assessments. This review showed how the UAE healthcare sector has evolved to improve the quality of its healthcare services through accreditation. While enhancing the quality of such services and increasing the medical tourism industry provided many opportunities for expatriates to move to the UAE, the country should aim to strengthen its medical services by expanding to other Middle Eastern countries. This paper could influence policymakers implementing international accreditation in the UAE and the Middle Eastern region.

ST773 Pseudomonas aeruginosa wound infection as a result of medical tourism to Turkey

Medical tourism for cheaper aesthetic surgeries in countries like Turkey may result in infections like carbapenem-resistant Pseudomonas aeruginosa. Bioinformatics analysis of a reported case in Israel revealed a highly virulent and antibiotic-resistant strain, emphasizing the need for infection control and appropriate antibiotic use in medical tourism.

Botulism after intragastric botulinum toxin injections for weight reduction

Although-considering the risk-benefit ratio-botulinum neurotoxin A (BoNT/A) is unequivocally recommended to treat severe neurological diseases such as dystonia, this has not yet been determined for its endoscopic intragastric injection aimed at weight reduction in obesity. However, severe adverse effects of intragastric BoNT/A had not yet been reported, prompting some European countries to endorse its (off-label) use and treat patients transnationally. We here present three cases of botulism after intragastric BoNT/A injections for obesity treatment in a Turkish hospital. Patients presented with cranial nerve affection, bulbar symptoms, and descending paresis, and benefited from treatment with BoNT antitoxin and pyridostigmine. We assume that iatrogenic botulism was induced by overdosing in combination with toxin spread via the highly vascularized gastric tissue. Of note, within a few weeks, more than 80 cases of iatrogenic botulism were reported across Europe after identical intragastric BoNT/A injections. These cases demonstrate the risks of BoNT/A injections if they are not applied within the limits of evidence-based medicine. There is a need for international guidelines to define the indication and a safe dosing scheme, especially in the context of medical tourism.

Update on Outbreak of Fungal Meningitis among U.S. Residents who Received Epidural Anesthesia at Two Clinics in Matamoros, Mexico

BACKGROUND

Public health officials are responding to an outbreak of fungal meningitis among patients who received procedures under epidural anesthesia at two clinics (River Side Surgical Center and Clinica K-3) in Matamoros, Mexico, during January 1-May 13, 2023. This report describes outbreak epidemiology and outlines interim diagnostic and treatment recommendations.

METHODS

Interim recommendations for diagnosis and management were developed by the Mycoses Study Group Research Education and Consortium (MSGERC) based on the clinical experience of clinicians caring for patients during the current outbreak or during previous outbreaks of healthcare-associated fungal meningitis in Durango, Mexico, and the United States.

RESULTS

As of July 7, 2023, the situation has evolved into a multistate and multinational fungal meningitis outbreak. A total of 185 residents in 22 U.S. states and jurisdictions have been identified who might be at risk of fungal meningitis because they received epidural anesthesia at the clinics of interest in 2023. Among these patients, 11 suspected, 10 probable, and 10 confirmed U.S. cases have been diagnosed, with severe vascular complications and eight deaths occurring. Fusarium solani species complex has been identified as the causative agent, with antifungal susceptibility testing of a single isolate demonstrating poor in vitro activity for most available antifungals. Currently, triple therapy with intravenous voriconazole, liposomal amphotericin B, and fosmanogepix is recommended.

CONCLUSIONS

Efforts to understand the source of this outbreak and optimal treatment approaches are ongoing, but infectious diseases physicians should be aware of available treatment recommendations. New information will be available on CDC's website.

Knowledge and attitude of students of medical sciences universities regarding health tourism: A cross-sectional study

Background and Aims

Health tourism is already one of the most important sources of revenue for many countries all over the world, but it appears that it has not progressed as much in Iran. The aim of this study was to determine the knowledge and attitudes of students of Iranian medical sciences universities about this subject, which could have a great impact on the future of this industry in Iran.

Methods

In this cross-sectional study, the students of medical sciences universities in Iran were selected through convenience sampling; they filled out an online 36-item self-administrated questionnaire. The data were analyzed using SPSS software (version 25). Descriptive statistics of knowledge and attitude were provided. Also, independent samples t-test and analysis of variance were used as statistical tests and p value <0.05 was considered as the significant level.

Results

Overall, 390 students with a mean age of 24 ± 1.5 years and a female-to-male ratio of 1.9 participated in this study. The respondents answered 38% of the questions correctly in the knowledge section. Age, ethnicity, education level, job experience, experience of a health tourism-related job, participation in health tourism courses, and geographical region of the province of residence showed a significant association with the participants' knowledge. Also, most participants had an almost positive attitude regarding the potential for development of the industry.

Conclusion

According to the results obtained, the students' knowledge about health tourism was not desirable; however, their attitudes were almost positive. Therefore, educational interventions are highly recommended to be conducted in this regard.

Evaluation of YouTube Bariatric Surgery Videos in the Context of Medical Tourism

Introduction The increasing prevalence of obesity has led to the popularity of bariatric and metabolic surgery, often sought through medical tourism due to constraints within public healthcare systems. This study aimed to examine the quality and impact of YouTube videos related to bariatric surgery within the context of medical tourism. Materials and methods In June 2023, a YouTube search for "Bariatric Surgery Medical Tourism" and "Obesity Surgery Medical Tourism" yielded the top 200 videos, from which 33 were chosen after applying exclusion criteria. These videos underwent further screening based on source, duration, and content. Quality was assessed using established scales, including the Journal of American Medical Association (JAMA) criteria, the Global Quality Scale (GQS), and modified DISCERN score. Results Thirty-three videos were chosen for comprehensive analysis. Among the videos, 48.5% portrayed patient experiences in the context of medical tourism bariatric surgery, providing valuable insights. The videos had varying durations and engagement metrics, with an average GQS score of 2.09, JAMA score of 2.57, and DISCERN score of 3.06. Notably, videos depicting patient experiences had distinct characteristics and higher evaluation scores, emphasizing their significance within the study. Conclusion This study assessed YouTube videos related to bariatric surgery within the realm of medical tourism. The research illuminated diverse facets of medical tourism concerning obesity surgery and the quality of information disseminated on YouTube. Although patient experience videos received higher quality ratings, the overall reliability and content diversity underscored the potential and challenges of utilizing YouTube as an information source for medical tourism.

Mycobacterium abscessus Meningitis Associated with Stem Cell Treatment During Medical Tourism

Mycobacterium abscessus infections have been reported as adverse events related to medical tourism. We report M. abscessus meningitis in a patient who traveled from Colorado, USA, to Mexico to receive intrathecal stem cell injections as treatment for multiple sclerosis. We also review the management of this challenging central nervous system infection.

[The problem of risks in medical tourism (literature review)]

Known for unpredictable outcomes and potential patient safety issues, medical tourism is a term that refers to travel outside the country (region) of residence to receive medical care. The article presents a review of the literature reflecting the results of scientific research on medical and non-medical risks of tourists traveling abroad to receive medical care. The review is based on the content analysis of foreign publications in scientific and peer-reviewed journals.

Assessing the associated medical, legal, and social issues in medical tourism and its implications for Nigeria

Medical tourism is thriving in Nigeria among both elites and non-elites with over $1 billion annual expenditure on medical tourism. Inadequate healthcare infrastructure caused by economic problems, corruption and low budgetary allocation to the country's health sector, and lack of trust in the country's healthcare systems to handle complex medical procedures have contributed to this trend. This article discusses the trend of medical tourism in Nigeria and the associated medical, legal, and social issues in medical tourism generally, relying on relevant literature. The paper concludes that medical tourism is not inherently dangerous; however, unequal economic and power status may influence the quality of hospitals where patients receive treatment and the quality of treatment received. This unequal power and economic status may also determine justice in cases of substandard treatment in foreign hospitals. The study recommends that the Nigerian government should improve healthcare systems in the country to reverse the trend of medical tourism and to reduce the financial burden that medical tourism exerts on average Nigerians who need a high level of care but cannot access it in their country. It is also recommended that a regulatory framework that ensures protection from substandard hospitals and justice for Nigerians who fall victim to substandard care abroad must be put in place by the Nigerian government. Relevant health stakeholders should also continue to sensitize the public about the complications that may be associated with some medical procedures sought outside Nigeria especially cosmetic surgery which may result in follow-up challenges.

[The development of medical tourism in conditions of globalization health care]

The article considers impact of process of health care globalization on development of medical tourism. The main trends in health care that drastically changes the situation in conditions of COVID-19 pandemic and implementation of digitization are presented. The normative legal base in force regulating medical services export is analyzed. The study of conditions of development of medical tourism in Russia is carried out. The directions of development of medical services export in modern conditions are considered. The enumeration of issues of global health care is formed. It is accepted to consider health care sector as a part of economics that is most isolated and attached to place of rendering and consumption of services. The outbreak of COVID-19 pandemic and active implementation of digital technologies into processes of organization of health care and medical care provision launched transformation and urged globalization. The conclusion is drew that actual society exists in epoch of globalization and digitization of health care sector. Nowadays, borders of states are not insurmountable obstacle for patients in need of high-tech medical care. The world market of medical tourism demonstrates trend to continuous growth and development permitting largest medical clusters to compete for attention of patients. The purpose of the study is in considering directions of development of medical tourism under the influence of process of health care globalization in modern society.

[The challenge of language learning in nursing education]

For more than a century, French has lost its status as the international language of reference and the health system is no exception to this trend: English has become the official language of medical research, the number of non-English speaking patients is increasing and the desire of health students for international mobility is strong. In light of this, language learning during health studies is essential in that it enables future professionals to better understand the changes in society that have an impact on the health system.

International medical tourism of US cancer patients for alternative cancer treatments: Financial, demographic, and clinical profiles of online crowdfunding campaigns

BACKGROUND

Previous research has found that individuals may travel outside their home countries in pursuit of alternative cancer therapies (ACT). The goal of this study is to compare individuals in the United States who propose plans for travel abroad for ACT, compared with individuals who seek ACT domestically.

METHODS

Clinical and treatment data were extracted from campaign descriptions of 615 GoFundMe® campaigns fundraising for individuals in the United States seeking ACT between 2011 and 2019. We examined treatment modalities, treatment location, fundraising metrics, and online engagement within campaign profiles. Clinical and demographic differences between those who proposed international travel and those who sought ACT domestically were examined using two-sided Fisher's exact tests. Differences in financial and social engagement data were examined using two-sided Mann-Whitney tests.

RESULTS

Of the total 615 campaigns, 237 (38.5%) mentioned plans to travel internationally for ACT, with the majority (81.9%) pursuing travel to Mexico. Campaigns that proposed international treatment requested more money ($35,000 vs. $22,650, p < 0.001), raised more money ($7833 vs. $5035, p < 0.001), had more donors (57 vs. 45, p = 0.02), and were shared more times (377 vs. 290.5, p = 0.008) compared to campaigns that did not. The median financial shortfall was greater for campaigns pursuing treatments internationally (-$22,640 vs. -$13,436, p < 0.003).

CONCLUSIONS

Campaigns proposing international travel for ACT requested and received more money, were shared more online, and had more donors. However, there was significantly more unmet financial need among this group, highlighting potential financial toxicity on patients and families.

Determinants of Bangladeshi patients' decision-making process and satisfaction toward medical tourism in India

Objectives

The aims are to explore the factors influencing Bangladeshi patients' decision-making process and their satisfaction level toward medical tourism in India.

Methods

The study used a quantitative research approach with a cross-sectional survey. Data were collected from the patients or their relatives (N = 388) who would have decided to travel to India for medical and treatment purposes at the Chittagong Indian visa center (IVAC). Data were collected using a structured, pre-tested, and facilitator-administered questionnaire, which mainly included the social demographic characteristics, health status, medical tourism information and medical tourism index. Hierarchical regression analysis was performed to explore the factors influencing their satisfaction level toward medical tourism in India.

Results

More than three-fourths of the participants had visited India for self-treatment. Of the participants, 14% were cardiology patients, and 13% suffered from cancer. The relatives were the key source of information regarding medical tourism for more than one-fourth of the respondents. India's availability of well-experienced doctors, hospital/medical facilities with high standards, well-trained doctors, reputable doctors, and quality treatments and medical materials were top-ranked items. Regression results depict that facility and services appeared as the strongest factor (β = 0.24, t = 4.71, p < 0.001) followed by tourism destination factor (β = 0.16, t = 3.11, p = 0.002), medical tourism costs factor (β = 0.16, t = 3.24, p = 0.001) and country environment factor (β = 0.15, t = 2.69, p = 0.007).

Conclusions

We found that the factor related to facility and services is one of the strongest predictors in our models. Therefore, home countries must strengthen the health care providers' advanced professional training, including service attitudes. Moreover, it is important to lessen the language barrier, reduce the airfare for medical tourists, and make the treatment cost more affordable for patients.

Interplay between Networking Capability and Hospital Performance in Indonesia's Medical Tourism Sector

Medical tourism is an industry that is currently developing, but research that focuses on the analysis of supply and institutions as a unit in Indonesia is sparse. This research aims to investigate the variables of digital transformation and resource integration that influence hospital performance, considering the expansion of hospitals' capacities for networking in medical tourism. A structural equation model is used to evaluate the hypothesis. According to our findings, digital transformation and resource integration both have a beneficial effect on networking capabilities. On the other hand, the implementation of digital transformation does not improve hospital performance. Digital transformation has a good link with hospital performance but has no statistically significant effect on hospital performance. In the meantime, the capabilities of resource integration and networking have a positive effect on the overall operation of hospitals. In a similar vein, the ecosystem of medical tourism helps to improve the connection between a hospital's networking capabilities and its overall performance. It is anticipated that the findings of this study will serve as a reference for those in the policymaking and healthcare industries to develop medical tourism.

[The motivation and consumer preferences in medical tourism]

The article considers issues reflecting characteristics of motivation of medical tourists to travel to country other than their residence placement to receive medical care. The most popular directions of medical tourism are identified as well as medical services for which travels are made.

[CORPORATE CULTURE IN A MEDICAL ORGANIZATION: THE ETHNO-CONFESSIONAL AFFILIATION OF PATIENTS]

The purpose of the article is to study approaches to the development of corporate culture of healthcare workers in terms of forming a tolerant attitude towards patients belonging to various ethno-cultural and confessional groups. Among the measures of managerial influence is the further development of the foundations of the corporate culture of employees of medical organizations, which can contribute to solving the problem of attracting patients belonging to a variety of national and religious groups. The results of the analysis (systematization of scientific literature and sociological survey in the form of interviews conducted by the authors of the article) of the main problems, the solution of which is associated with the development of corporate culture, showed that the attitude of patients and medical personnel to euthanasia, termination of pregnancy, death (including suicide); methods of reproduction of life (artificial conception, surrogacy); obstacles to religious rituals during the treatment of patients.This article presents conclusions on the analysis of these problems and possible approaches to their solution: the authors propose measures for the formation of new competencies in corporate culture (as a set of formal and informal requirements in a medical organization imposed on its employees) aimed at preventing and overcoming conflict situations arising from misunderstandings in relationships between patients and medical staff.

[SOME ASPECTS OF LEGISLATIVE SUPPORT FOR THE DEVELOPMENT OF MEDICAL TOURISM IN THE RUSSIAN FEDERATION]

The article discusses the prospects for the development of the export of medical services and issues of regulatory regulation of medical tourism in the Russian Federation. Today, Russian legislation does not unite a number of concepts related to medical tourism and are drivers of the development of the tourism industry. The development of medical tourism has a close relationship with plans to expand the volume of incoming tourist flow and attract funds from foreign investors to Russia. At the same time, medical organizations and structures providing treatment and rehabilitation of foreign citizens note the absence of the concept of «medical tourism» in the regulatory legal framework, which acts as a significant barrier to the transformation of this process. In this regard, it is necessary to improve the current legislative framework and develop an appropriate model law.

[THE RUSSIAN HEALTHCARE IMAGE DURING THIRD WAVE OF COVID-19 IN THE INFO FIELD]

The article contains the results of primary research of the information field of medical tourism in Russia, conducted in the period before the COVID-19 pandemic in the Yandex search engine and the Medialogia media database from January 01, 2019 to December 31, 2019. The analysis of the results of the study with measurements of the beginning of the year and the end is carried out. The results of the study are one of the parts of the panel study of the image of medical tourism in Russia and can be used in the future by interested structures in order to adjust it.

Commercial Surrogacy: An Overview

OBJECTIVE

 Surrogacy is the process in which a woman carries and delivers a baby to other person or couple, known as intended parents. When carriers are paid for surrogacy, this is known as commercial surrogacy. The objective of the present work is to review the legal, ethical, social, and cultural aspects of commercial surrogacy, as well as the current panorama worldwide.

METHODS

 This is a review of the literature published in the 21st century on commercial surrogacy.

RESULTS

 A total of 248 articles were included as the core of the present review. The demand for surrogate treatments by women without uterus or with important uterine disorders, single men and same-sex male couples is constantly increasing worldwide. This reproductive treatment has important ethical dilemmas. In addition, legislation defers widely worldwide and is in constant change. Therefore, patients look more and more for treatments abroad, which can lead to important legal problems between countries with different laws. Commercial surrogacy is practiced in several countries, in most of which there is no specific legislation. Some countries have taken restrictive measures against this technique because of reports of exploitation of carriers.

CONCLUSION

 Commercial surrogacy is a common practice, despite important ethical and legal dilemmas. As a consequence of diverse national legislations, patients frequently resort to international commercial surrogacy programs. As of today, there is no standard international legal context, and this practice remains largely unregulated.

The State of Cancer Care in the United Arab Emirates in 2022

Cancer is the third-leading cause of death in the United Arab Emirates (UAE); cancer care in the UAE has evolved dramatically over the last 40 years, from a single center in Al Ain in 1981 to more than 30 cancer centers and clinics across the UAE, with at least four comprehensive cancer centers in the UAE nowadays. Despite the significant progress in medical care, cancer quality control across the UAE is still lacking, with significant variations in cancer care across the cancer centers. Access to clinical trials is still hampered by a lack of expertise and research infrastructure and a small population, which renders patient accrual for trials a major challenge. Education and training are other areas for improvement that require immediate attention, and, in this review, we try to address these critical aspects for stakeholders to consider better cancer care in the UAE. Early cancer detection and screening are still evolving in the UAE, and a national screening program is lacking. There is also a need to address barriers to screening and to consider less invasive screening methods such as approved blood-based screening, which is likely to be more acceptable to the UAE population. In this review, we also address new topics that have not been addressed previously, including oncology medical tourism, psycho-oncology, onco-fertility, precision oncology, survivorship, oncology nursing, cancer support programs, and the oncology sector's response to the COVID-19 pandemic, all in the context of the UAE cancer landscape. Finally, we provide recommendations for policymakers, regulators, payers, patient advocacy groups, and the UAE oncology community regarding the delivery and future planning of high-quality cancer care. These recommendations are aligned with the UAE government's vision to reduce cancer mortality and provide high-quality healthcare for its citizens and residents.

[THE NATIONAL PROJECT "HEALTHCARE" AND ITS IMPACT ON THE EXPORT OF THERUSSIAN MEDICAL SERVICES]

The article reports on the main directions of the national project "Healthcare", providing for the formation of a medical sector with hospitals and polyclinics fitted with modern equipment, online services for the convenience of patients and medical personnel and staffed with highly qualified medical personnel. The author analyses the factors influencing the development of medical tourism in the Russian Federation. Preserving the best traditions of medical practice and developing together with global trends in the field of health preservation, Russian medicine is becoming innovative. In order to solve the tasks set to expand the scope of medical care to foreign citizens, the federal project "Development of the export of medical services" is being implemented within the framework of the national project "Healthcare", which has already united 71 regions of the country. The purpose of this work is to identify the factors influencing the development of the export of the Russian medical services within the framework of the implementation of the national project "Healthcare". In conclusion, it is reported that the implementation of the project contributes to the inflow of investment funds into the national healthcare system, the promotion of the Russian medical centers and the creation of a positive image of the country abroad.

Travel for survive! Identifying the antecedents of vaccine tourists' travel intention: Using a stimulus-organism-response model

The COVID-19 global pandemic and the uneven distribution of vaccines have resulted in alternative medical tourism, vaccine tourism. The purpose of this study is to identify the antecedents of vaccine tourists' travel intention. The Stimulus-organism-response model was used as a framework to understand the relationship between risk perception (stimulus), pandemic prevention attitude (organism), decision making (organism), and travel intention (response) in vaccine tourism. An online questionnaire survey method was adopted to address the purpose of the research. Purposive and snowball sampling were used to select eligible respondents who were over 18 years old and had experience in vaccine tourism. A total of 520 online questionnaires were collected, and description analysis, confirmatory factor analysis, and structural equation modeling were utilized to analyze the collected data. The findings indicated that pandemic prevention attitude is a full mediator between risk perception and travel intention. There is a significant causal relationship between risk perception and pandemic prevention attitude and between pandemic prevention attitude and travel intention. Furthermore, tourists' travel decision-making also significantly influences their travel intention. However, the relationship between tourists' risk perception and travel decision-making has no significant effect. Vaccine tourism was created based on the COVID-19 context. Therefore, in order to avoid vaccine travel becoming an infection control breach, pandemic prevention planning and the medical quality of the destination, and the prevention policies between the countries should be completely assessed and conducted.

Designing the competency-based training model of Iranian medical tourism

BACKGROUND

Despite the great comparative advantage of Iran in terms of infrastructure, technology, and human resources as well as the significance of medical tourism in the tourist industry, in practice, the quality of human resources has received less attention. Consequently, this study was conducted to design a model of competency-based training for Iranian medical tourism.

MATERIALS AND METHODS

This study was an exploratory mix, and the Delphi method and semi-structured interviews were used for the qualitative part of this study. In the second part, the analytical method was utilized for the quantitative part of this study.

RESULTS

The results indicated the main components of medical tourism to be public interactions and private interactions and seven subcomponents. Medical Tourism's Competency includes three main components and seven subcomponents.

CONCLUSION

Although some training separated and scattered is present in Iran's medical tourism. However, Iran requires a comprehensive training model of which its design was explained in this paper.

The Perils of Cosmetic Surgery Tourism: Evolving Knowledge, Awareness, and Challenges

Concern has been expressed for some years about the risks of complications and the need for revision procedures after cosmetic surgery tourism. Such tourism is large and growing. Recent literature and coroners' inquests have provided a new evidence base for evaluating the extent of the dangers posed by a variety of overseas cosmetic surgery procedures. This article reviews such literature and identifies reason for considerable concern about cosmetic surgery tourism as well as about the deficits in regulatory and legal liability that might otherwise inhibit substandard practice. Provision of carefully drafted information about risk issues which patients can factor into their decision-making before embarking on overseas trips for the purpose of cosmetic surgery is a constructive initiative deserving of further attention by relevant Colleges, professional association and health advocacy groups.

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

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.

A case series of infectious complications in medical tourists requiring hospital admission or outpatient home parenteral therapy

BACKGROUND

Travelling for medical care is increasing, and this medical tourism (MT) may have complications, notably infectious diseases (ID). We sought to identify MT-related infections (MTRIs) in a large Canadian health region and estimate resulting costs.

METHODS

Retrospective and prospective capture of post-MT cases requiring hospital admission or outpatient parenteral antimicrobial therapy was completed by canvassing ID physicians practising in Calgary, Alberta, from January 2017 to July 2019. Cost estimates for management were made with the Canadian Institute for Health Information's (CIHI's) patient cost estimator database tool applied to estimated rates of Canadians engaging in MT from a 2017 Fraser Institute report.

RESULTS

We identified 12 cases of MT-related infectious syndromes. Eight had microbial etiologies identified. MTs were young (mean 40.3 [SD 12.2] y) and female (n = 11) and pursued surgical treatment (n = 11). Destination countries and surgical procedures varied but were largely cosmetic (n = 5) and orthopaedic (n = 3). Duration to organism identification (mean 5.3 wk) and treatment courses (mean 19 wk) appeared lengthy. CIHI cost estimates for management of relevant infectious complications of our cases ranged from $6,288 to $20,741, with total cost for cases with matching codes (n = 8) totalling $94,290.

CONCLUSIONS

In our series of MTRIs, etiologic organisms often found in Canadian-performed post-procedural infections were identified, and prolonged treatment durations were noted. Young women pursuing cosmetic surgery may be a population to target with public health measures to reduce the incidence of MTRIs and burden of disease.

Motives of patients crossing borders to pursue assisted reproduction - why the Czech Republic is a frequent choice for egg donation treatment

Cross-border reproductive care is undoubtedly a current phenomenon. The number of people interested in receiving reproductive care abroad is increasing every year. This new context needs a political solution that would respond to the definition of standard care within the circumstances of providing healthcare to the citizens of another country. Patients that undergo reproductive treatment abroad very often face complications such as language problems, insufficient information, separation from family members, cultural differences and customs, potential unrealistic expectations, and also restrictions by law. This work is descriptive in nature and aims to illustrate the variables that come into play when choosing the Czech Republic over other destinations as a country to receive infertility treatment. We analyze the phenomenon by selecting documents used as sources of data. In our research, we focused on infertility treatment and justified the reasons why foreign citizens choose the Czech Republic over other destinations for infertility treatment. The variables that lead to the selection of cross-border infertility treatment in the Czech Republic include no waiting time, anonymous donations, international departments in various languages, and affordable prices compared to other destinations.

Extensively Drug-Resistant Carbapenemase-Producing Pseudomonas aeruginosa and Medical Tourism from the United States to Mexico, 2018-2019

Carbapenem-resistant Pseudomonas aeruginosa (CRPA) producing the Verona integron‒encoded metallo-β-lactamase (VIM) are highly antimicrobial drug-resistant pathogens that are uncommon in the United States. We investigated the source of VIM-CRPA among US medical tourists who underwent bariatric surgery in Tijuana, Mexico. Cases were defined as isolation of VIM-CRPA or CRPA from a patient who had an elective invasive medical procedure in Mexico during January 2018‒December 2019 and within 45 days before specimen collection. Whole-genome sequencing of isolates was performed. Thirty-eight case-patients were identified in 18 states; 31 were operated on by surgeon 1, most frequently at facility A (27/31 patients). Whole-genome sequencing identified isolates linked to surgeon 1 were closely related and distinct from isolates linked to other surgeons in Tijuana. Facility A closed in March 2019. US patients and providers should acknowledge the risk for colonization or infection after medical tourism with highly drug-resistant pathogens uncommon in the United States.

Islamic Republic of Iran - a surprisingly progressive centre of medical tourism

The Islamic Republic of Iran is a very progressive state in the field of medical research and its application. Although the country is fully subject to Islamic law (shari&#39;a) and the influence of Shi&#39;ite clerics, the development of medical science is not limited at all; Shi&#39;ite medical ethics (unlike Sunnite) allows most of the modern medical techniques. Due to this attitude, Iran specializes today in many techniques that are prohibited in other countries for religious or ethical reasons. For example, Iranian research on cloning, cell and gene therapy reaches the world level, patients can use a third-party donor program and surrogacy for infertility treatment, the sale of kidney for transplantation was legalized, gender reassignment surgery is performed, and the country is a centre of cosmetic surgery. All of these services (excluding transplantation) are also offered to foreign patients. Thanks to these unlimited possibilities, high quality and low price, Iran has been currently gaining a strong position in the medical tourism market, not only in the Middle East region, but also worldwide.

A Look at Collaborative Service Provision: Case for Cosmetic Surgery Medical Tourism at Korea for Chinese Patients

Consumers admiring the beauty standards of other countries are approaching cosmetic surgery medical tourism. This study examines the roles of hospitals and facilitating agents as the main entities of cosmetic surgery medical tourism. 334 Chinese patients who underwent cosmetic surgery in Korea were collected and structural equation modeling is used to analyze the data. The results show that a hospital’s service quality in terms of tangibles, assurance, and empathy affect customers’ attitudes toward medical tourism for cosmetic surgery, which in turn, influences satisfaction with medical tourism. More importantly, facilitating agents’ service quality moderates the effects of hospitals’ service quality dimensions on service satisfaction. Findings extend the existing literature on medical tourism by identifying the roles of hospitals and facilitating agents to enhance customers’ attitudes and satisfaction with respect to collaborative service provision. Moreover, this research provides the first empirical evidence for the facilitating agents’ role in determining satisfaction with medical tourism.

Identification of Factors for the Development of Medical Tourism in the World

The overall objective of the given paper was to study the relationship of inbound medical tourism destinations with international tourism, economic development of recipient countries, the development of national healthcare systems and the institutional features of their environment, in terms of protection of the rights and freedoms of both business and citizens. In order to achieve this objective, the authors used methods of grouping, as well as correlation and regression analysis. The conducted study revealed that the formation of medical tourism destinations in countries with high social and economic development occurs in a balanced and unidirectional manner; simultaneously, one can see that the countries with “new economic development” form a sufficiently powerful and competitive market for medical tourism. All these countries have one thing in common: namely, there is a link between medical tourism and healthcare funding, international tourism and development of political and civil freedoms. Nevertheless, the noted aspects are not dominant enough, and this indicates that there are other internal factors and their configurations which shape a positive image of countries for medical tourism development. This finding leads to the necessity of further analysis in this field with a breakdown into separate countries or destinations.

International dental tourism in a post-COVID era: pre-travel advice

The most significant risk of dental tourism is the timing of air travel after dental interventions in order to avoid the pain or injury caused by barotrauma. Usually the minimum waiting time should be 24 h, but in some cases, it can be up to 2 weeks.

A County Hospital Experience with Reproductive Travelers to the United States for Obstetric Care: Maternal and Neonatal Outcomes

Objective: To describe the maternal and neonatal outcomes, health care utilization, and cost to reproductive travelers for obstetric care (RTOC) at a single institution. Methods: A retrospective chart review was conducted of women identified as reproductive travelers who delivered at Stroger Hospital in Chicago, IL when a self-pay package of obstetrical services was offered. Data included maternal characteristics and obstetric and neonatal outcomes. Results: A total of 413 reproductive travelers delivered during the study period. The majority (88%) was of Nigerian citizenship. The median gestational age at first prenatal visit was 35 weeks with a median of three prenatal visits. The patients were in good health with a high prevalence of infectious disease and a low prevalence of chronic disease. Women had complex obstetric histories, and 28.6% had cesarean delivery, with the most common indication being prior uterine surgery. Severe maternal morbidity occurred in 4.1% of the women and admission to the neonatal intensive care unit (NICU) in 16.3% of the babies. Extra charges beyond those covered by the financial package were incurred by 230 (55.7%) of the women. Conclusion: Reproductive travelers have better obstetric outcomes and fewer NICU admissions than non-travelers who delivered at the same institution. However, the care of RTOC in this manner is fraught with challenges, including late presentation for care, lack of medical records, providers at times managing unfamiliar conditions, and unforeseen financial obligations assumed by patients.

Different Roles of Telehealth and Telemedicine on Medical Tourism: An Empirical Study from Azerbaijan

With the rapid progress in mobile healthcare and Internet medicine, the impact of telehealth and telemedicine on the satisfaction of patients and their willingness to travel has become a focus of the academic research community. This study analyses the differences between telehealth and telemedicine and their role in medical tourism. We examine how the information quality and communication quality of telehealth and telemedicine influence patient satisfaction, and their effects on patients' willingness to undertake medical travel and on their medical travel behaviours. We conducted an empirical study on the use of telehealth and telemedicine and on medical travel behaviour in Azerbaijan using a survey for data collection. A total of 500 results were collected and analysed using SmartPLS 3.0. Results show that (1) the communication quality and information quality of telehealth and telemedicine and their effects on satisfaction have significantly positive influences on willingness to undertake medical travel; (2) the psychological expectations of value and cost (perceived value and perceived cost) have a positive influence on medical travel; and (3) willingness to participate in medical travel positively influences medical travel behaviour. Moreover, results of this study have implications for research on, and the practice of, using telehealth and telemedicine as they relate to medical tourism. This research may help improve knowledge about telehealth and telemedicine and understand the differences between them in detail. This empirical research model may also be useful for researchers from other countries who wish to measure medical travel behaviour.

International stem cell tourism: a critical literature review and evidence-based recommendations

Stem cell tourism is an emerging area of medical tourism activity. Frustrated by the slow translation of stem cell research into clinical practice, patients with debilitating conditions often seek therapeutic options that are not appropriately regulated. This review summarises recent developments in the field of stem cell tourism and provides clinicians with the information necessary to provide basic pretravel health advice to stem cell tourists. PubMed and Scopus databases were consulted for relevant publications, using combinations of the terms 'stem cell', 'tourism', 'regenerative medicine', 'international', 'travel medicine' and 'environmental health'. The leading countries in the international stem cell tourism market are the USA, China, India, Thailand and Mexico. As the majority of clinics offering stem cell therapies are based in low- and-middle-income countries, stem cell tourists place themselves at risk of receiving an unproven treatment, coupled with the risk of travel-related illnesses. These clinics do not generally provide even basic travel health information on their websites. In addition to often being ineffective, stem cell therapies are associated with complications such as infection, rejection and tumorigenesis. Physicians, researchers, regulatory bodies, advocacy groups and medical educators are encouraged to work together to improve patient and physician education and address current legislative deficiencies.

Recurrent ossifying fibroma of the orbit - A case report

Rationale

Ossifying fibromas are mainly found in the jaws and are rare in other parts of the cranium. Orbital involvement is relatively rare.

Patient Details

A case of an otherwise healthy 38-year-old overseas patient with gradual onset of a large growth in the right ocular area involving adjacent bone and operated twice over the last eight years is being presented. The lesion is involving the entire medial wall.

Treatment

Considering the complex loco-regional anatomy as well as the restriction of overseas residence, preservation of a thin margin of bone was performed.

Take-Away Lessons

The need for repeat radiological surveillance was stressed.

Looking around the corner: COVID-19 shocks and market dynamics in US medical tourism

Patients have historically travelled from across the world to the United States for medical care that is not accessible locally or not available at the same perceived quality. The COVID‐19 pandemic has nearly frozen the cross‐border buying and selling of healthcare services, referred to as medical tourism. Future medical travel to the United States may also be deterred by the combination of an initially uncoordinated public health response to the pandemic, an overall troubled atmosphere arising from widely publicized racial tensions and pandemic‐related disruptions among medical services providers. American hospitals have shifted attention to domestic healthcare needs and risk mitigation to reduce and recover from financial losses. While both reforms to the US healthcare system under the Biden Presidency and expansion to the Affordable Care Act will influence inbound and outbound medical tourism for the country, new international competitors are also likely to have impacts on the medical tourism markets. In response to the COVID‐19 pandemic, US‐based providers are forging new and innovative collaborations for delivering care to patients abroad that promise more efficient and higher quality of care which do not necessitate travel.

The last frontier of globalization: Trade and foreign direct investment in healthcare

Internationalizing far later than other sectors, healthcare has seen trade and foreign direct investment (FDI) grow in recent years. While part of the service economy, healthcare has unique features that distinguish it from other service sectors and imprint on its globalization and spillover patterns. In this paper, we review the trends in healthcare internationalization, its drivers, and the obstacles standing in the way. We outline the special characteristics of the healthcare sector and how they affect the positive and negative spillovers from trade and FDI for home and host-countries. Implications for international business theory, research, and policy are delineated.

Bibliometrix analysis of medical tourism

Medical tourism is an expanding phenomenon. Scientific studies address the changes and challenges of the present and future trend. However, no research considers the study of bibliometric variables and area of business, management and accounting. This bibliometric analysis discovered the following elements: (1) The main articles are based on guest services, management, leadership principles applied, hotel services associated with healthcare, marketing variables and elements that guide the choice in medical tourism; (2) The main authors do not deal with tourism but are involved in various ways in the national health system of the countries of origin or in WHO; (3)cost-efficiency and analytical accounting linked to medical tourism structures and destination choices are not yet developed topics.

Difficulties in Accessing Cancer Care in a Small Island State: A Community-Based Pilot Study of Cancer Survivors in Saint Lucia

Developing robust systems for cancer care delivery is essential to reduce the high cancer mortality in small island developing states (SIDS). Indigenous data are scarce, but community-based cancer research can inform care in SIDS where formal research capacity is lacking, and we describe the experiences of cancer survivors in Saint Lucia in accessing health services. Purposive and snowball sampling was used to constitute a sample of survivors for interviews. Subjects were interviewed with a questionnaire regarding socio-demographics, clinical characteristics, health services accessed (physicians, tests, treatment), and personal appraisal of experience. We recruited 50 survivors (13 men, 37 women). Only 52% of first presentations were with general practitioners. The mean turnaround for biopsy results in Saint Lucia was three times longer than overseas (p = 0.0013). Approximately half of survivors commenced treatment more than one month following diagnosis (median of 32 days, IQR 19-86 days), and 56% of survivors traveled out-of-country for treatment. Most survivors (60%) paid for care with family/friends support, followed by savings and medical insurance (38% each). In conclusion, cancer survivors in Saint Lucia are faced with complex circumstances, including access-to-care and health consequences. This study can guide future research, and possibly guide practice improvements in the near term.

[The trends and perspectives of development of medical tourism]

The article demonstrates that over the past few years medical tourism market goes through significant changes . This especially relates to regional economy and its aspects in the field of tourism. The article presents an important conclusion that nowadays the top-priority factor in the development of medical tourism is a number of crisis points in provision of health tourism services both in the regions of Russia and in the capital region that are related to pandemic and its consequences. The article considers complex of factors related just to epidemiological crisis and its consequences? including economic and social factors related to health-preserving technologies of medical tourism industry. The actual condition of tourism industry, as a branch of the Russian economy,demonstrates that it was among the first ones hit by the pandemic. The article emphasizes that due to emerging problematic trends during epidemics and their aftermaths the possibilities of providing medical tourism services and their concentration in the country, costs and conditions are changing that undoubtedly impact the economic component and health ecology aspects. The conclusion is made that among main conditions of adjustment of medical tourism industry to the new economic conditions are to be truly multidimensional and structured directions and tools that can be applied to look for way out of difficult situations when sales of medical services have fallen to zero, and companies are forced to work out on solutions emerging problems and to make plans of operational way out of existing crisis.

[The impact of COVID-19 pandemic on medical tourism development]

The COVID-19 pandemic impacted tourist business on global scale dramatically. The medical tourism always was considered as the most stable and the least subjected to external circumstances. However, spreading of coronavirus infection shortened both number of arrivals and volume of medical services provided within the framework of their export. The article presents data reflecting COVID-19 pandemic impact on development of medical tourism market.

Vancomycin-Resistant Staphylococcus Aureus Infection Post-Liposuction in South Korea

As antibiotic resistance becomes a serious health issue, medical tourism is an accelerating factor. Several studies report antibiotic-resistant cases in Southeast Asia are increasing every year. We report the first case of a vancomycin-resistant Staphylococcus aureus (VRSA) infection in an Indonesian post-liposuction in South Korea. The patient is a 34-year-old Indonesian woman reporting concerns of fever and abdominal abscess post-liposuction. Culture results before antibiotic therapy were positive for VRSA. After the patient received one-time abscess drainage and initiated oral broad-spectrum antibiotics, the abscess clinically improved. To this date, the most common complication of infection post-liposuction in Indonesia is related to Mycobacterium as etiology. The pathogen transfer correlates to medical tourism, and this becomes a reminder for health care providers to be prepared to encounter problems tied to medical tourism.

Barriers to Medical Tourism Development in the United Arab Emirates (UAE)

Medical tourism is a thriving industry. Many destinations now seek to attract more medical tourists. The United Arab Emirates (UAE) is no exception. As one of the most important pillars of the UAE’s economy, tourism is considered a high priority. However, medical tourism in the UAE is still developing. This paper addresses the main challenges for medical tourism in the UAE and proposes methods to enhance its development. This research utilized qualitative analysis. Twelve professionals in medical tourism were interviewed to provide data. The data were then analyzed using NVivo 12 software. Our results indicate that the key barriers to medical tourism development in the UAE are high costs of medical tourism services, lack of marketing activities, lack of collaboration between medical and tourism service providers, and so forth. Although initiatives from the UAE government are very encouraging, more efficient medical care supply networks, tourism suppliers and intermediaries should be established to ensure its growth. This research could influence national tourism policies in the UAE as well as regional alliances in all Gulf Cooperation Council (GCC) and the Middle East and North Africa (MENA) countries.