International Journal of Travel Medicine & Global Health

Infection Diseases Section Review Article

Health in ; Identifying Obstacles for Development of This Industry

Morteza Izadi1, Seyed Hasan Saadat2, Ali Ayoubian3, Zahra HashemiDehaghi*4, Mohammad Reza Karbasi5, Ali Reza Jalali6

Abstract

Medical tourism plays an important role in national revenue of many 1. Health Research Center, Baqiyatallah countries; This industry earns about 100 billion dollars for the gov- University of Medical Sciences, , Iran. ernments each year. However, Tourism is not developed in Iran and 2. Behavioral Sciences Research Center, it is in its initial paces. As a matter of fact, the Ministry of Health Baqiyatallah University of Medical Sciences, recognized tourism-therapy in 2003. In addition, by doing this, rather Tehran, Iran than supporting tourism-therapy, the ministry mainly tried to create 3. Hospital Management Research Center, new jobs for the graduates of medical sciences. However, tourism- Iran University of Medical Sciences, Tehran, Iran therapy was introduced as an independent industry in 2004 by the 4. Eye Research Center, Tehran University of merger The Cultural Heritage Organization to The Iran and World Medical Sciences, Tehran, Iran Tourism. According to the planning, the Iranian has de- 5. Director General Islamic Chamber ICCIMA vised plans to cover 30% of medical and health needs of the country, 6. Trauma Research Center, Baqiyatallah th by the end of 4 national development program, through exporting University of Medical Sciences, Tehran, Iran. medical products and services. Therefore, determining the obstacles in the way of optimum development of tourism-therapy industry is *Corresponding Author of great help to the country. Zahra HashemiDehaghi, Eye Research Center, Tehran University of Medical Sciences, Tehran, Iran Email: mitra_hashemi @yahoo.com

Submission: 6 Aug 2013 Keywords: Health Tourism, Medical Tourism, Iran Accepted: 3 Sep 2013

Introduction and complicated type of industry for the third Tourism is one of the most dynamic and fast world and the best candidate for replacing other growing industries in the world. It is recognized profitable industries [4]. by the UN as one of the main tools of economic According to the estimates by World Tourism development, employment and higher income [1- Org. (WTO), about 25 million world tourist pop- 3]. In the developed countries, tourism adds to di- ulation in 1950 reached to 700 million in 2000, versity of incomes and reduction of incoherence and the figure is expected to hit 1.6 billion in in the economy, while in the developing coun- 2020. These figures convey a growth rate of 7% tries, the industry is a chance to increase exports in a 50 year period (1950-2000). In addition, in- at a faster pace comparing to the traditional ways. come of the industry in 1980 was about 105 bil- Moreover, fewer negative consequences, more lion dollars and 476 billion dollars in 2000; This profit margin, direct/indirect job opportunities, figure for 2020 is estimated 1trillion and 590 mil- public benefits, and proper economic models are lion dollar [5]. some other advantages of the industry. Lowiss Medical tourism, as a fast growing industry, is a Terner argued that tourism is the most promising branch of health-tourism that gives the patients

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All rights reserved for official publication of Baqiyatallah university of medical sciences© Izadi M. et al , Health tourism in Iran; Identify obstacles for development of this industry chance to travel abroad seeking medical care. , Malaysia, and Thailand have attracted more Such services include optional treatments, essen- than 4.1 medical tourists in 2003, which brought tial and special treatment, major/minor surgeries, them 1 billion Dollars. In 2005, the number of the and even routine checkups [6,7]. tourists reached 5.2 million. Currently, the popu- The definition by WTO implies that one of the lation covered by this industry reaches 40-60 bil- purposes that motivates tourists to visit other lion, and it is experiencing an annual growth rate places is to seek health. What health is defined by of 20%. the tourists is a type of tourism that is aimed to It is estimated that about 750000 Americans have improve health condition (mental/physical) and travelled overseas in 2007 for receiving medical only takes 24hrs or less in a year [8]. care. This figure is estimated to hit 6 million indi- Among the different definitions by the WTO, we viduals in 2013 [16]. In general, about 40% of an- encounter other cases that are defined under the nual income of health services sectors is from the health tourism. source of medical tourism [17]. Wellness tourism: The term is used for the tour- Jordan is one of the most successful instances in istic trips to health villages that in many cases wellness tourism in the region. The country has have hot spring and mineral water. The tourist managed to offer medical services to 120 wellness tries to stay away from the daily life stresses and tourist and gain an income of 620 million dollars pays a visit to these places without direct medical [18]. attention and to rest. In most of the case, the tour- Porter et al. emphasized the necessity of a special ist does not suffer from any specific disease and health insurance system for medical tourists in the they mainly aim to enjoy the healing nature of the tourism development program in Philippine [19]. region [9-11]. A research conducted in Thailand recommended Curative tourism: the term refers to trips which some measures to improve tourism industry: 1- to are aimed to enjoy natural treatment resources employ skillful and well-trained physicians; 2- to (mineral waters, salt, mud, etc.). Such trips are invest in medical equipment and improve quality usually for medical purposes or spending recuper- of medical services facilities; 3- to separate the ation under medical supervision or intervention. general and medical wards; 4- to establish a con- Regarding mud-therapy, Iran is one of the most sultation relation between the physician and the favorite destinations in the region [3-5]. patient through fast response services to the pa- Medical tourism: The term refers to touristic trips tients. Other facilities such as translator, recrea- to seek medical attention which is featured with tional facilities, and hotel reservation services specific surgeries in specific facilities designed were also recommended [20]. for the tourists. In such cases, the patient may still need to spend a while in medical touristic spots The main challenges of health tourism in Iran (e.g. hot springs) [3-5]. As mentioned earlier, in spite of cultural richness South East Asian countries like Thailand, Malay- and variety and several national and sia, and Singapore are amongst leading countries attractions, Iran has failed to gain a comparable in wellness tourism. Thailand has gained a good share in the world tourism industry. Although, reputation in sex alteration surgeries and aesthetic several advantages of tourism have made devel- surgeries [12,13]. India is one of the world’s med- opment of tourism inevitable, the problems and ical tourism destinations and along the variety of obstacles in the way of tourism development still services provided, the country has made great ef- hinder the development. Some of these problems forts to improve its infrastructures, medical tech- are listed below. nologies, cost-benefit rates, and endorse interna- a. Economic tional medical protocols. As a result of these Oil-dependent economy and no need for tourism measures, rate of successful complicated cardiac income, reluctance of private sector to invest in surgeries, bone marrow and kidney transplanta- tourism industry and low income margin are some tion in this country is comparable with the world’s of the factors that negatively influence Iran’s tour- top rated hospitals [14,15]. ism development [21]. Private section of medical

90 International Journal of Travel Medicine and Global Health, Volume 1, Issue 2, Summer 2013 Izadi M. et al , Health tourism in Iran; Identify obstacles for development of this industry industry has simply low activity in this section of foreign currency needs of the health and treat- [22]. ment sectors at the end of the 4th development pro- A study in India emphasized that annual growth gram from the source of the incomes of medical of medical tourism market in India (about 2.2 bil- exports [29]. lion US dollars in 2012) and the state’s commit- Lack of well-trained workforce in tourism indus- ments motivate the private sector to make more try, lack of knowledge among the staff of tourism investment in tourism so that American Private institutes (hotel servants, tourism agency staff) Finance Fund and Indian investors have made are along with some of administrative and organ- more than 40 million dollars in health services in izational problems of Iran’s wellness tourism India [23]. [30]. b. Social As suggested by the world trade organization Lack of public knowledge as for tourism and na- (WTO), value of service business in 2001 reached tional tourism attractions, enough welfare, health, 1.4 trillion dollars (25% of world trade), and this and medical facilities, legal problems (customs share is expected to reach 50% of int’l trade by regulations, visa issuance) are among the social 2020. Service sector comprises 46% of Iran’ challenges ahead of tourism industry [24]. GNP, still the sector suffers lack of supportive Development of transportation infrastructures and programs and health tourism constitutes a small ease of traveling foster travels to seek medical portion of the market [31]. care at international standard and prices of the A study in Thailand (2006) revealed that Thailand third world. In this regard, an ineffective airline government is planning strategies based on infra- service in Iran is a great challenge ahead of Iran’s structural development in health, hospitals, medi- tourism industry [25,26]. cal technologies and equipment, and expert hu- c. Administrative and organizational man force toward development of medical tour- Realization of tourism development depends on ism industry [32]. Mehrabi studied the challenges the factors such as proper organizational struc- ahead of development of Iran’s tourism industry ture, programming, trained workforce, and tour- and found a significant relation between adminis- ism and foreign investment regulations. Perma- trative problems and development of the industry nent development of tourism industry demands a [33]. capable and integrated management and correla- To improve health experts’ knowledge regarding tion between public and private sectors. There are new procedures, access to higher education, fi- several roles played by the government including nancial resources in the developing countries are coordinating the policies, programming, reporting the chances given to them to use the opportunity statistics, commissioning research works, deter- of the new market and improve their health sys- mining tourism standards an regulations, support- tem [34]. ing investments, offering marketing services, Lack of infrastructural institutes for provision and training skillful workforce, and developing infra- improvement of quality and standard of the ser- structures [27]. Tourism programming was first vices was highlighted by Heng Leng as one of the started in Iran in 1962 (initiation of the 3rd na- challenges of medical tourism development [35] tional development program), however, after Gonzales named improvement of legal frame- more than 40 years, Iran’s tourism is not in ac- works to protect the consumer’s right and to enjoy ceptable position [28]. high quality health care as the key factors of med- Ministry of Health, Treatment, and Medical ical tourism industry [36]. Training is in charge of preparing for playing ef- d. Research and education fective role in international markets and introduc- In view of the fact that the industry is a newly ing Iran as the center of health and wellness ser- emerged market in many developing countries, vices in the region, and to this end to provide the most of them suffer lack of expert work force and required facilities for introducing the capacities even training facilities are not fully developed yet and marketing the medical services, products, [37]. Lack of permanent education for training drugs, and equipment based on the strategic and technical, executive, and training staff, and lack commercial policies. The target is to cover 30%

International Journal of Travel Medicine and Global Health, Volume 1, Issue 2, Summer 2013 91 Izadi M. et al , Health tourism in Iran; Identify obstacles for development of this industry of effective and efficient research system to rec- and poor electronic public information services of ognize the strategic needs of the industry are of hospitals in particular [44]. the main research and educational obstacles [38]. Tourists need to be attracted through different An international study also emphasized poor Eng- marketing method. Moreover, countries must lish language skills among the work force of spend 3 to 5 percent of their budget for tourism Iran’s hospitals [39]. marketing [45,46]. e. Welfare facilities and services Erfan Nia concluded in a study titled “a compara- 1. Lack of welfare and accommodation ser- tive study on medical tourism information sys- vices in the tourism industry. tems in different countries and solutions for Iran” 2. Lack of supervision and controls on im- that employing integral information system has provement, repair and maintenance. the capacity to manage medical tourism process Poor transportation system, lack of standard ho- and other aspects of service provision. Such sys- tels and other services were mentioned in another tem can be used to introduce outstanding physi- study as infrastructural problems of Iran’s tourism cian in the hospitals as an attraction for medical industry [40]. Furthermore, lack of treatment tourism [47]. VISA makes it impossible for these tourists to use Martin et al. showed in a study that advertisement medical insurances [22]. and public information services play a key role in f. Cultural and advertisement development of tourism and the key to success in 1. Attitudes, negative mental image and tourism is to develop the well-designed system for wrong perception regarding tourists; marketing and advertising [48]. 2. Irrational and different methods in dealing Jabari and Jahani (2008) showed that marketing with tourists; for attracting foreign patients in Iran is not effi- 3. Structural drawbacks in advertisement cient [49,50]. and public information; and 4. Failure to used proper methods in dealing Conclusion with tourists; [41,42] Medical tourism must be dealt with is a systematic Cultural differences and lack of knowledge of the way. Specialized committees must undertake hosts regarding the tourists’ needs on one hand tourism attraction and advertisement measures. and lack of knowledge among the tourists regard- Moreover, the trend of patients leaving the coun- ing culture of the host society, which causing sev- try for medical care must be stopped through in- eral problems is one of the major challenges that vestment in research and education fields and de- the tourism industry is dealing with. In many velopment of modern and traditional health ser- cases, people develop negative attitudes regarding vices centers. tourism when they face with irregular behaviors Programming to overcome each one of the men- of the tourism or encounter with cultural differ- tioned problems is recommended for further de- ences. There are also cases that local community velopment of tourism industry. Although the fac- considers being in tourism business as a low level tors introduced in this work are mutually related work so that many of them refuse working in such and working on none of them in isolation may businesses [43]. solve the problems of the tourism industry in Iran, Results of a study showed that one of the main they can be dealt with through a step-by-step pro- problems of medical tourism industry that results gram toward realization of the objectives of 1400 in lack of interest among domestic and foreign outlook plan. medical tourists to use the int’l medical capacities is lack of professional and effective information 2. Garrod B. Local participation in the planning and man- References agement of ecotourism: a revised modelapproach. Journal of Ecotourism. 2003; 2(1): 33-53. Goeldner C.R.Ritchie J.R.B. Tourism: Principles, Prac- 1. 3. Izadi M, Joneidi N, Ranjbar R, Ayoobian A. Health tour- tices, Philosophies. 9th ed.NY: John Wiley & Sons, Inc. ism in Iran: Competitive advantage factor. Tehran; Asia Pa- 2003. cific Travel Health Conference, 2012. 4. Alvani S. Pirouzbakht M. Tourism Management Process., Tehran; Cultural Research Office, 2006.

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