Globalization and liberalization of trade in health services has made medical tourism feasible and continues to grow.

This industry provides new additional financial resources to health systems of the participating countries and also provides saving costs of health services since those countries are outsourcing in this area and present effective services to developing countries.
This study aims to define the challenges and opportunities of medical tourism industry in Iran and propose some mechanisms to make Iran prosper with this new Industry.
The potential opportunities and challenges of Iran medical tourism got through interview, this phase leaded to create the 5 point Likert scale questionnaire.
Data gathered from the questionnaires were answered by health services providers in private sector and was analyzed by MADM approach, TOPSIS method. The most important challenges Iran Medical Tourism faced by are:
- To create dual market structure in health services, non-portability of health insurances and lack of support of private sector by the government and main opportunities are increasing access to medical tourism market that resulted to increasing revenues,
- To grow private sector participation in health services and
- To decrease the number of patients who go abroad for treatment. The opportunities and challenges of this industry are different between countries and every country should enter this area with attention to its relative advantages.
Health systems are evolving and continuously faced by new challenges. Trade in health services is one of the most complex and important challenges that health systems have to respond to, and nowadays it seems to be one of the best mechanisms of financing and creating additional resources for health systems in developing countries.
In fact liberalization of trade in health services has the potential to create new challenges as well as creating new opportunities, particularly in low and middle income countries for the provision of efficient and sustainable health services.
Health services, in recent years, have become increasingly traded, because of advances in InformationTechnology, growing mobility of health services provider and customers and increased private sector participation in delivery of health services.
An increasing number of countries are competing to become key exporters of health services.
It was caused by the high cost of health care in developed countries, the steep rise in demand for health services as a result of the ageing of populations in those countries and the increasing availability of advanced health and medical services in developing countries with high quality and lower prices than in developed countries, in addition to long waiting lists for surgery in those countries.
The lack of health insurance is the most common factor for medical travel (health tourism statistics and facts).
A study indicates that key drivers for this new industry are: increased costs of health services, limited medical insurance coverage, affordable and high quality alternative options, increased facilities with international accreditation, increasing access to IT and linkages between key players of the industry and some of the geopolitical events such as incident of 11 September.
In a growing number of fields of treatment, the most cost effective option is traveling to a developing country.
Hence, the provision of world class health care services and facilities at competitive prices has opportunity for those developing countries that can do.
In fact globalization and liberalization of trade in health services has made health tourism possible and continues to flourish.
According to GATS, the most important multilateral agreement about trade in services, health tourism is the second mode of trade in health services.
In this mode customers (patients) leave their home country and go to the providers’ country to obtain health care services with high quality and affordable prices.
Health tourism according to Jabbari (2009) is divided to wellness tourism, curative tourism and medical tourism and medical tourism refers to modern medical treatment and complementary medicine.
Medical tourism is the abroad looking for available quality combined with cost effective and low price health services while offering a similar level of safety to the patient.
Medical tourism has become a US$60 billion a year business with growing rate about 20% by a year which could increase to $100 billion by 2012 (Herrick, 2007).
A projection estimates that only US patients will expend more than $40 billion for health services abroad by year 2017 (Deloitte, 2008a).
Nowadays many governments and insurance firms are to outsourcing medical services to low cost providers abroad.
Apart from the savings aspect from the patient’s perspective, medical tourism is a growing part of the global health market with countries taking on and favoring this activity as a part of their national industry and this attractive industry is open to all countries that can utilize their opportunity of outsourcing health services from developed countries with respect to their capabilities and competences. For a long time medical tourism was commonly the travel of rich patients from a less developed country to the health facilities in more developed countries that had advanced medical facilities to obtain better treatment.
But today the worldwide market place for health and medical care has changed and medical tourists go in both directions, from rich and poor countries in a similar way and developing countries became the main destinations where high quality combined with affordable healthcare is available (Smith, 2008). After Asian economics crisis in 1990, health and medical tourism has grown in some countries (Kazemi, 2007).
Asia has become the hub of medical tourism and successful Asian countries in this mode of supply of medical services are Thailand, Malaysia, Singapore, India and Jordan.
In Iran despite of its high potential for this industry focusing on low cost and high quality of healthcare services and access to Arab market (Jabbari, 2009) at present, medical tourism does not have grown well. Some hospitals and health care centers began to enter to this industry but they faced by so challenges.
Health system in Iran: The Islamic Republic of Iran is a low middle income and oil exporting country.
It is the 4th largest country of Asia and 17th largest country in the world with an area of 1,648,195 km2.
It is an ancient country located in the Middle East, a region between Asia, Europe and Africa (Mehrdad, 2009).
The country has 31 provinces, 293 districts, 885 cities and about 68000 villages and total population was estimated to be 70,000,000 in 2007 (EMRO, 2009).
The country is bordered on the East by Pakistan and Afghanistan, on the North by Turkmenistan, Armenia and Azerbaijan, as well as the Caspian Sea, on the west by Iraq and Turkey and on the south by the Persian Gulf and the sea of Oman. At present, 830 hospital provide health care services in the second and tertiary level of health system and more than 70% evaluated with first degree of health evaluation system of Iran (Jabbari, 2009).
According to last statistics of statistical center of Iran, about 120000 hospital beds and 4551 laboratories, 3042 rehabilitation centers, 2293 radiology and imaging centers and 7601 pharmacies are providing health services in Iran. Medical tourism in Iran: Medical tourism is not a new phenomenon in the world, as well as in Iran.
In the past, some people from neighbor countries especially from Arab countries of Persian Gulf came to Iran especially to Fars province to get health care services.
In this area in the country, there are no exact statistics about medical tourists who have come to the country, but some resources indicate that about 17500 patients have entered Iran in 2005.
The most popular and demanding procedures include advanced treatments in the field of cardiology and surgeries, cosmetic surgeries, fertility treatments and organ transplants (CHN news).
The main reasons of coming patients to Iran are:
- Quality of health services and low cost of treatments and drugs in comparison with other countries of the region (Middle East and Middle Asia),
- Access to advanced and new medical procedures, equipment and qualified professionals and medical staff,
- Similarity of culture and language in some regions of Iran with neighboring counties such as Iraq, Azerbaijan and lack of some medical procedures, equipment, medical professionals and health infrastructures in those countries combined with
- Natural attractions, ancient and historical buildings in famous cities of Iran (Jabbari, 2009).
Despite of these factors and existence of some legal factors such as the 4th and at present 5th program of economic, social, cultural development of Iran, medical tourism in Iran has not developed yet and some hospitals and medical and health centers individually are working in the area of importing patients from foreign countries and provide health services for them and some patients come to Iran in a traditional way. .
(Source: medwelljournals.com)
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