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ABSTRACT Linguistic landscape (LL), functioning as a form of health communication, offers a lens through which to examine whether the visual representation of languages in medical spaces ensures accessibility for all and communicates spatial justice. Recent studies on LL have primarily concentrated on elucidating LL as a cognitive and affective indicator of public space, with less attention to how sign‐readers affectively perceive and engage with public signage in medical and migrant contexts. Exploring sign‐readers’ affective responses to the LL can help us understand whether the spatial resources indicated by that LL meet their practical and psychological needs. This empirical study contributes to LL research by examining affective responses to the LL among immigrant patients in a Shanghai international hospital, illuminating the interactions between LL and spatial justice in a medical context. Based on 260 signs collected through photography and interviews with eight international patients, we aimed to explore their feelings and thoughts about the LL at the moment of their experience of it. After identifying various affective responses triggered by the LL, we found that the use of English in the LL projects the hospital's espoused values of “care” and “quality”, while the absence of languages such as Korean and Japanese constrains linguistic equality and spatial justice, triggering anxiety among those who speak neither English nor Mandarin. Future planning of the LL in Shanghai's international communities might be informed by a multilingual awareness to promote the subjective well‐being of transnational immigrants and to improve the epistemic diversity and inclusivity of urban spaces. [ABSTRACT FROM AUTHOR]

This research addresses the current situation of international health service providers in Cali, identifying challenges and opportunities. Through a qualitative-inductive approach and using grounded theory, 8 providers selected by eligibility criteria were interviewed. The data were processed with Atlas.ti software. Strengths in quality, portfolio and infrastructure were identified. However, challenges such as lack of government support, limited bilingualism and citizen insecurity were highlighted. It was suggested that tourism should be promoted, health marketing should be strengthened, and greater government collaboration should be sought. As emphasized in the development, the importance of language skills to communicate with medical tourists. In conclusion, Cali shows potential in health services, but faces regulatory and competitive challenges. Promotion, collaboration and focus on the patient experience are essential for sustainable development in the sector and in the different activities that take place in these spaces. [ABSTRACT FROM AUTHOR]

Aim: To identify common challenges nurses face when caring for international patients, irrespective of specialty, medical facility, or nursing experience. Background: Internationalization in medical facilities is progressing worldwide, and the number of international patients is increasing, as is evident in Japan. Introduction: Delivering high‐quality nursing care to international patients can be challenging owing to language and socio‐cultural barriers. Research examining the challenges faced by nurses in these situations is limited. It is necessary to clarify and analyze the current situation when interacting with international patients. Methods: This study employed a qualitative design. Semistructured interviews were conducted with 11 registered nurses experienced in caring for non‐Japanese patients. Qualitative content analysis was performed following Mayring's approach. Results: We identified 56 subcategories, 23 categories, and 8 core categories for challenges faced by nurses interacting with international patients: language, religion or culture, medical culture, financial status, treatment continuity, care support, hospital protocols, and addressing requests or requirements for international patients. Discussion: This study analyzed the religious, lifestyle, and cultural differences (along with the various language and communication barriers) faced by nurses who treat international patients. It also discussed the need for accessible, cross‐cultural information in hospitals that have limited accommodations for international patients. Conclusion: Nurses could be more accommodating of patients' religions, lifestyles, and cultures by familiarizing themselves with relevant background information beforehand. Implications for nursing policy: Differences in health care cultures across countries can lead to malpractice, as dealing with cultural differences is difficult for nurses who interact with international patients and they may not be fully informed about the challenges posed by such differences. It is important for nurses to share their experiences in dealing with international patients and prepare for the increasing number of international patients in the future. [ABSTRACT FROM AUTHOR]

Medical Tourism, a sector still in the infancy stage in India, forms a part of the global Medical Tourism corridor and is acknowledged in the itinerary of any medical tourist. This paper intends to explore the scope of Medical Tourism in the developing cities of India. It aims to investigate the reasons for low medical tourism penetration despite possessing all the competitive advantages vital for a medical tourism destination. A survey conducted at 21 hospitals in Mangalore uncovered the extent of awareness among healthcare workers and initiatives taken by the healthcare industry to outperform this sector. Simple random sampling was employed to arrive at the sample size and the Chi-square test was applied to analyze the data. The findings reveal promotion as a crucial element for awareness creation and show a clear linkage between awareness and the potential of Medical Tourism. The paper presents healthcare practitioners and tour operators with an insight into Medical Tourism in developing cities like Mangalore and the effective strategies imperative to excel in this sector. This study evaluates if developing cities of India have the potential to be promoted as Medical Tourism hubs reaping benefits to the economy of India. [ABSTRACT FROM AUTHOR]

Background and Objectives : Despite the dramatic growth of medical tourism in recent years, there is little information about the role of quality, satisfaction and trust in explaining the international patients’ behavior after the purchase. The present study investigated these variables. Material and Methods : The purpose of this study was practical and it is a survey-analytic one. The statistical population of this study was all the patients outside the country (clients) of selected hospitals operating in the field of medical tourism in Mashhad and sampling was conducted as convenience. Data analysis was performed using bifurcated and multivariate regression and structural equation modeling in the SPSS and AMOS software. Based on the data gathered from 174 international patients, validity and reliability of the research were confirmed. Results: The results of the study showed that the quality of medical services and the quality of services, patient satisfaction, trust in staff and trust in the medical clinic had impact on the motivation for subsequent referrals of patients and the motivation for the next visit to the medical centers of medical care in Mashhad. Also, the logical price has a moderating role for thoese relationship. Conclusion: The role of tested variables, especially the reasonable price of health services, is important for the international referral of patients, and therefore requires the cooperation of all health care administrators, including nurses, doctors and managers to include these for the prosperity of the tourism industry and the development of the country.

Health tourism is a term that has risen from the rapid growth of industry where people from all around the world are travelling to other countries to obtain good medical care. Due to Covid-19 Pandemic, industry showed reduction in the amount of people travelled to India for medical purposes, but the domestic medical industry in India is trying best to have its share from the emerging global market. Narayana Health, Bangalore has given importance to attract international patients through various marketing methods and its low cost strategies. The present research paper aimed to find out opportunities and challenges of health tourism in Bangalore and factors that attract international patients to Narayana Health. Researchers also studied international marketing strategies followed by Narayana Health. The researcher conducted exploratory research with quantitative and qualitative variables. Using convenient sampling researcher collected primary data from 50 international Patients Collected data was analysed descriptively using SPSS. Thematic content analysis with some grounded theory was used to analyse qualitative data. NVivo12 Pro software was used for the qualitative data analysis. Results indicate Narayana Health hospital in Bangalore is attracting many international patients using unique marketing strategy and cost effective practices. [ABSTRACT FROM AUTHOR]

India is an uphill industry as a destination for medical tourism. In this present global healthcare, service patients are seeking the best medical facility at a low cost. Certain patients who go for low - cost treatment will move to the country where facilities are at a high standard, technologically advanced at low cost. So, patients travelling from one home country to another country for seeking treatment are named as Medical tourism. In this global scenario, most Asian countries are becoming competitors for the growth of medical tourism namely India, Singapore, Malaysia, Thailand. Indian medical tourism is rapidly growing with a CAGR of 22.87%. In this stage, the researcher felt the choice of international patients is very important and identified the variables like quality of service and Diagnostic facilities after doing extensive literature which influences the choice of a healthcare facility. A structured questionnaire is conducted by taking International patients as samples and SPSS is used for analyzing the data. [ABSTRACT FROM AUTHOR]

Objectives: Published estimates of willingness to pay (WTP) for quality adjusted life years (QALYs) based on elicited preferences vary widely, especially across health procedures. The study evaluated the revealed WTP for QALYs by older adult patients who paid fully out-of-pocket for common inpatient procedures in the United States. Methods: Patient-level discharge data were from academic medical center members of the University Health System Consortium Clinical Data Base from 2005 to 2015 (now Vizient) for patients who paid 'cash-in-full.' The median, 25th percentile, and 75th percentile of charges, payments, and payment to charge ratio were examined and combined with available measures on QALYs by procedure. Results: Among patients over age 50 from 22 academic medical centers there were 846 self-pay patients, and the majority were international. The mean out-of-pocket payment was $57731 and the payment to charge ratio was 0.53. For the five procedures with available QALYs, the lower bound median payment based estimates of WTP ranged from $2949 for PTCA to $15441 for replacement or repair of aortic valve. Conclusions: The study was designed to provide lower bound estimates of revealed preferences for QALYs. WTP and how it should intersect with payment policy remains an important area for future research. [ABSTRACT FROM AUTHOR]

The aim of this study was to detect the frequency of methicillin-resistant Staphylococcus aureus (MRSA) colonization at admission in a group of presumably high-risk international or Turkish patients referred to our center for elective operations, some of whom were from countries with an unknown prevalence of MRSA infection or colonization. The results of nasal swab screening for MRSA colonization performed using a specific algorithm between 2011 and 2018 in a private medical center were retrospectively reviewed. Presence of MRSA was ascertained using culture and/or real-time polymerase chain reaction (real-time PCR). A total of 3,795 patients were included in the study. More than half of the patients were ≤19 years of age (2,094, 55.2%), and MRSA positivity was more common among these patients. Turkish patients constituted 24.5% of the study population. International patients were most frequently referred from Iraq (55.92%), Libya (11.44%), Romania (2.69%), and Bulgaria (1.98%). MRSA positivity was significantly more common among patients referred from other countries when compared to Turkish nationals (11.5% vs. 4.4%, P = 0.00001). Countries with the highest prevalence rates of MRSA colonization were as follows with decreasing order: United Arab Emirates, 25.0%; Georgia, 23.1%; Russia, 22.7%; Iraq, 13.0%, Romania, 12.7%. Other countries with high number of admitted patients (>70 patients) had the following MRSA rates: Turkey, 4.4%; Libya, 6.0%; Bulgaria, 5.3%. Although MRSA has a low prevalence in our center, a variation in the rate of MRSA positivity was observed across patients from different countries. Absence hospital acquired contamination or outbreaks in our institution may be attributed to the screening algorithm used and underscores the importance of risk analysis for patients referred from geographical locations with unknown MRSA frequency, to reduce the risk of transmission. [ABSTRACT FROM AUTHOR]

Background and Objectives: Despite the dramatic growth of medical tourism in recent years, there is little information about the role of quality, satisfaction and trust in explaining the international patients' behavior after the purchase. The present study investigated these variables. Material and Methods: The purpose of this study was practical and it is a survey-analytic one. The statistical population of this study was all the patients outside the country (clients) of selected hospitals operating in the field of medical tourism in Mashhad and sampling was conducted as convenience. Data analysis was performed using bifurcated and multivariate regression and structural equation modeling in the SPSS and AMOS software. Based on the data gathered from 174 international patients, validity and reliability of the research were confirmed. Results: The results of the study showed that the quality of medical services and the quality of services, patient satisfaction, trust in staff and trust in the medical clinic had impact on the motivation for subsequent referrals of patients and the motivation for the next visit to the medical centers of medical care in Mashhad. Also, the logical price has a moderating role for thoese relationship. Conclusion: The role of tested variables, especially the reasonable price of health services, is important for the international referral of patients, and therefore requires the cooperation of all health care administrators, including nurses, doctors and managers to include these for the prosperity of the tourism industry and the development of the country. [ABSTRACT FROM AUTHOR]

Purpose: Every year, an increasing number of international patients seek medical care in the United States (U.S.), yet little is known about their impact. Based on single institution experiences, we wanted to explore the perceived impact of international pediatric patients on large academic U.S. pediatric intensive care units (PICUs), as they are already taxed systems.Methods: To explore current perceptions, seven geographically diverse institutions who advertise care for international patients on their websites and have ≥24 PICU beds were identified after IRB approval was obtained. We consented and interviewed PICU division chiefs or medical directors from each institution regarding their demographics and international patients. Common themes were identified.Results: Participating institutions were diverse in geographic location, census, and resource allocation strategies. Five of the seven institutions reported the presence of a formal international patient program. Four of those five reported an increase in international patients receiving PICU care over the past 5 years. International patients sought complex surgeries, advanced cancer treatments and metabolic/genetic evaluations. We identified three primary domains that require further exploration and research: (1) cultural and language differences leading to barriers in providing optimal care to international patients (2) institutional financial considerations, and (3) perceived positive and negative impact on the care of local/domestic patient populations.Conclusions: The presence of international programs raises a number of important ethical questions, including whether clinicians have a greater duty to serve residents of the local community as opposed to international patients when resources are limited. Further exploration is warranted.

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• Emergency nurses hesitated to engage with international patients due to ambiguity. • Emergency nurses lacked confidence in caring for international patients. • Educational interventions are needed to enhance nurses' competence. An increasing number of international patients continue to visit emergency departments (EDs) in Japanese hospitals. However, nurses in Japan perceive challenges when caring for patients from other countries. This study explored ED nurses' perceptions of barriers when caring for walk-in international patients. Five semi-structured online focus group interviews involving 15 registered nurses with experience in caring for patients in an ED at a university referral hospital located in the center of Tokyo were conducted. Thematic analysis was used to identify patterns from the interviews. The themes that emerged were as follows: (1) hesitation to engage with patients due to ambiguity, (2) loss of harmony in the ED, (3) difficulty with mutual goal settings, and (4) decreased professional self-efficacy. The findings provide an understanding of the challenges faced when caring for walk-in international patients. Educational interventions for ED nurses and other strategies, such as the use of interpreters, can enhance nurses' abilities to improve patient safety and maintain equality. [ABSTRACT FROM AUTHOR]

An understanding of patient mobility, international patients and medical tourism includes supply and demand side considerations. As well as micro-level reports of motivation and satisfaction we must acknowledge broader system-level dynamics. Exploring these may unearth more complex geographies of patient travel.

Background: Role of information source, perceived benefits and risks, and destination image has significantly been examined in travel and tourism literature; however, in medical tourism it is yet to be examined thoroughly. The concept discussed in this article is drawn form well established models in tourism literature. Methods: The purpose of this research was to identify the source of information, travel benefits and perceived risks related to movement of international patients and develop a conceptual model based on well-established theory. Thorough database search (Science Direct, utmj.org, nih.gov, nchu.edu.tw, palgrave-journals, medretreat, Biomedcentral) was performed to fulfill the objectives of the study. Results: International patients always concern about benefits and risks related to travel. These benefits and risks form images of destination in the minds of international patients. Different sources of information make international patients acquaint about the associated benefits and risks, which later leads to development of intention to visit. This conceptual paper helps in establishing model for decision-making process of international patients in developing visit intention. Conclusion: Ample amount of literature is available detailing different factors involved in travel decision making of international patients; however literature explaining relationship between these factors is scarce.

There is a growing global market in healthcare and patients. And while there is a small body of evidence emerging around this phenomenon commonly known as medical tourism there remain significant unanswered policy and research questions which need to be addressed. We outline some of the key issues set against the six key disciplinary preoccupations of the journal: epidemiology, health economics, health policy ethics, politics of health, health management, and health policy.

We extracted major topic by applying natural language processing and keyword extracting using TF, TF-IDF, TextRank, Yake, KeyBERT. 1452 consultation data were collected from the website and official hospital e-mail. We found six topics categorized into “Medical opinion” related to hospital characteristics and “Non-medical service guidance”. Based on this result, it is necessary to establish marketing plan and develop a digital solution for effective consultation. [ABSTRACT FROM AUTHOR]

Background: Medical tourism has attracted considerable interest within the Latin American and Caribbean (LAC) region. Governments in the region tout the economic potential of treating foreign patients while several new private hospitals primarily target international patients. This analysis explores the perspectives of a range of medical tourism sector stakeholders in two LAC countries, Guatemala and Barbados, which are beginning to develop their medical tourism sectors. These perspectives provide insights into how beliefs about international patients are shaping the expanding regional interest in medical tourism. Methods: Structured around the comparative case study methodology, semi-structured interviews were conducted with 50 medical tourism stakeholders in each of Guatemala and Barbados (n = 100). To capture a comprehensive range of perspectives, stakeholders were recruited to represent civil society (n = 5/country), health human resources (n = 15/country), public health care and tourism sectors (n = 15/country), and private health care and tourism sectors (n = 15/country). Interviews were transcribed verbatim, coded using a collaborative process of scheme development, and analyzed thematically following an iterative process of data review. Results: Many Guatemalan stakeholders identified the Guatemalan-American diaspora as a significant source of existing international patients. Similarly, Barbadian participants identified their large recreational tourism sector as creating a ready source of foreign patients with existing ties to the country. While both Barbadian and Guatemalan medical tourism proponents share a common understanding that intra-regional patients are an existing supply of international patients that should be further developed, the dominant perception driving interest in medical tourism is the proximity of the American health care market. In the short term, this supplies a vision of a large number of Americans lacking adequate health insurance willing to travel for care, while in the long term, the Affordable Care Act is seen to be an enormous potential driver of future medical tourism as it is believed that private insurers will seek to control costs by outsourcing care to providers abroad. Conclusions: Each country has some comparative advantage in medical tourism. Assumptions about a large North American patient base, however, are not supported by reliable evidence. Pursuing this market could incur costs borne by patients in their public health systems. [ABSTRACT FROM AUTHOR]

The USA has developed a global reputation for providing highquality, cutting-edge medical care, and individuals from across the world travel to the country to receive care for complex medical conditions. Beyond this goal of higher quality of care, however, very little is known about the motivational patterns influencing medical travellers' decision making, including the extent to which existing tourism theory and forecasting models apply to this specialized group. The present study seeks to contribute to the knowledge base by developing and testing a macro-level model of international medical travel to the USA. Using country-level data from the US Department of Commerce, World Health Organization, World Bank and Central Intelligence Agency, a two-part regression analysis was used to assess factors associated with the presence and volume of inbound medical travel by country of origin. The results indicate that travel time and out-of-pocket healthcare expenditure are significant predictors of inbound medical tourism from a given country, and travel time, travel cost, services trade and the number of outbound travellers are significant predictors of the total volume of inbound medical travellers by country. The results are discussed in the light of existing tourism research, and guidance for hospitals, policy makers and the tourism industry is provided on where to target resources for developing relationships with providers and payers abroad. [ABSTRACT FROM AUTHOR]

This paper has a descriptive aim and it presents Romanian medical services employed by international patients. The essay starts with an overview of the Romanian health system, looking at legislation and government and EU-funded development projects. Next, the main institutions providing health services in Romania are mentioned and the National Health Strategy 2014-2020 is briefly outlined. The text ends with a discussion about health services provided to international patients. [ABSTRACT FROM AUTHOR]

Conclusion: Switch-on within 24 h after cochlear implantation can be safely and practically performed. The minimally invasive approach presented here also brought about benefits such as nonstop rehabilitation programs and shorter duration of uncertainty/worry for patients and their families about surgical outcomes. Those were important factors for international patients. Our research invites further studies to show whether instant commencement of electrical stimulation helps to expedite long-term hearing/speech performance in cochlear implantees. Objectives: Initial switch-on generally could not launch until weeks after cochlear implantation due to factors associated with wound conditions. Commencement of electrical stimulation within 24 h after the surgery has long been performed in our department on a routine basis. The idea issued from the need to sew-and-go for international patients. This study presents the safety and feasibility of the procedure. Methods: Charts of 79 subjects with profound hearing impairment were studied. A minimally invasive approach was used for cochlear implantation, with an intention to control wound condition and tissue swelling. Hearing threshold was measured preoperatively and postoperatively. Results: Initial switch-on within 24 h was done in all patients. Good hearing gain was obtained. No major complication occurred. There was no significant difference in hearing postoperatively that was attributable to the early switch-on. [ABSTRACT FROM AUTHOR]

Many public health systems in high- and middle-income countries are under increasing financial pressures as a result of ageing populations, a rise in chronic and non-communicable diseases and shrinking public resources. At the same time the rise in patient mobility and concomitant market in medical tourism provides opportunities for additional income. This is especially the case where public sector hospitals have a reputation as global centres of excellence. Yet, this requires public sector entrepreneurship which, given the unique features of the public sector, means a change to professional culture. This paper examines how and under what conditions public sector entrepreneurship develops, drawing on the example of international patients in the UK NHS. It reports on a subset of data from a wider study of UK medical tourism, and explores inward flows and NHS responses through the lens of public entrepreneurship. Interviews in the English NHS were conducted with managers of Foundation Trusts with interest in international patient work. Data is from seven Foundation Trusts, based on indepth, semi-structured interviews with a range of NHS managers, and three other key stakeholders ( n = 16). Interviews were analysed using a framework on entrepreneurship developed from academic literature. Empirical findings showed that Trust managers were actively pursuing a strategy of expanding international patient activity. Respondents emphasised that this was in the context of the current financial climate for the NHS. International patients were seen as a possible route to ameliorating pressure on stretched NHS resources. The analysis of interviews revealed that public entrepreneurial behaviour requires an organisational managerial or political context in order to develop, such as currently in the UK. Public sector workers engaged in this process develop entrepreneurship – melding political, commercial and stakeholder insights – as a coping mechanism to health system constraints. [ABSTRACT FROM AUTHOR]

While increasing attention has been given to patients traveling internationally for medical care, hospitals face unique challenges in caring for international patients that may increase hospital length of stay (LOS) and cost of care. The objective of this study was to evaluate whether there are variations in LOS by home region of origin for international patients traveling to the USA. This was a retrospective, cross-sectional study using patient-level discharge data from academic medical center members of University HealthSystems Consortium (UHC). The sample included 4517 international patients discharged between October 2008 and March 2012 from academic medical center members of UHC. Generalized linear regression models were fit to test the association between the LOS and country of home origin, controlling for patient demographic and clinical characteristics. Significant variation in LOS existed across countries of home origin. In the adjusted model, Saudi Arabian and Egyptian home origin were associated with the longest LOS (+3.6 and +3.4 days, respectively), followed by Kuwait (+2.6 days). Country of home origin was also associated with a varying impact on LOS in models that stratified by severity of illness (SOI) and clinical condition. Country of home origin was associated with LOS, even after accounting for patient demographic characteristics, SOI, and clinical condition. This suggests that non-clinical factors, such as differences in care coordination, may impact LOS. More work is needed to understand the underlying drivers of these differences, so that hospitals catering to international patients can develop interventions to improve the efficiency and quality of care provided. [ABSTRACT FROM AUTHOR]

It is estimated that over 50,000 individuals from the UK each year elect to fund their own treatment abroad. Such treatments commonly include cosmetic and dental surgery; cardio, orthopaedic and bariatric surgery; IVF treatment; and organ and tissue transplantation. The UK has also experienced inward flows of patients who travel to receive treatment and pay out of pocket, being treated in both private and NHS facilities. The rise of 'medical tourism' presents new opportunities and challenges in terms of treatment options for consumers/patients and health policymakers. Such developments denote a commercialization, commodification and internationalization of health care in a way that UK policy has not experienced to date. This article addresses four key issues. We explain the rise of medical-related travel (applied to the UK), identify key policy considerations for the future, highlight important research gaps and explore conceptual frameworks which might help us understand better the observed patterns of medical tourism. Whilst the context for policy and practice is undoubtedly dynamic, we argue the need for greater clarity in understanding the emergent implications for health policy and health care delivery. [ABSTRACT FROM AUTHOR]

This exploratory study assesses the experiences of medical travelers seeking out of country health care in four destination countries: India, China, Jordan and the United Arab Emirates. It aims to identify the source countries of medical travelers, to understand their reasons for seeking out-of-country care, the type of services they obtained, and their level of satisfaction with the experience. Cost, physician and facility reputation and hospital accreditation were ranked as the most important factors in choosing out-of-country care. Wait times at home or lack of access to care were important motivations for international medical travel. Patient assessment of treatment outcomes is as high as might be found in similar assessments in high-income country facilities. Certain forms of treatment sought by respondents (i.e. organ transplantation) raise specific ethical concerns. Also of concern is that the present health systems in all four countries fail to adequately meet the health needs of their population (notably poorer groups). Evidence and inference strongly suggest that access to health care for poorer groups will worsen in these countries as medical tourism increases, at least in the short term, raising generic ethical and policy challenges over the extent to which access to essential health care by poorer persons is compromised by the public subsidization or promotion of medical tourism. [ABSTRACT FROM PUBLISHER]

Ravaged by diminishing revenues and intense price competition, U.S. hospitals desperately need to find profitable areas of healthcare. International patients that travel to the United States for treatment offer such an opportunity. Marketing directors, administrators and medical staff of leading hospitals are recognizing the value of this market segment. They are making special efforts to attract foreign patients. They have developed tailored services for international patient and are forming alliances with civic and business organizations to support the needs of patients traveling from overseas. [ABSTRACT FROM AUTHOR]

We extracted major topic by applying natural language processing and keyword extracting using TF, TF-IDF, TextRank, Yake, KeyBERT. 1452 consultation data were collected from the website and official hospital e-mail. We found six topics categorized into "Medical opinion" related to hospital characteristics and "Non-medical service guidance". Based on this result, it is necessary to establish marketing plan and develop a digital solution for effective consultation.

An understanding of patient mobility, international patients and medical tourism includes supply and demand side considerations. As well as micro-level reports of motivation and satisfaction we must acknowledge broader system-level dynamics. Exploring these may unearth more complex geographies of patient travel. [ABSTRACT FROM AUTHOR]

Introduction: The Texas Children's Hospital Lung Transplant Program undertook consideration of its first non-resident, non-citizen for lung transplantation in 2011., Methods: Four referrals from the Royal Embassy of Saudi Arabia were received, and two patients were evaluated from 2011 to 2013., Results: After a suitable candidate and family was identified, the program adopted a systematic approach to ensure that all the necessary elements of pre-transplant care, informed consent, and post-transplant care could be effectively delivered., Conclusion: The use of hospital translation services and the development of a strong professional relationship with a well-trained pediatric respirologist in Saudi Arabia combined with an excellent early post-transplant clinical course provide lessons that may be of help to other transplant programs considering international patients as candidates for solid organ transplantation., (© 2021 Publishing services provided by Elsevier B.V. on behalf of King Faisal Specialist Hospital & Research Centre (General Organization), Saudi Arabia.)

There is a growing global market in healthcare and patients. And while there is a small body of evidence emerging around this phenomenon commonly known as medical tourism there remain significant unanswered policy and research questions which need to be addressed. We outline some of the key issues set against the six key disciplinary preoccupations of the journal: epidemiology, health economics, health policy ethics, politics of health, health management, and health policy. [ABSTRACT FROM AUTHOR]

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., (© 2021 John Wiley & Sons Ltd.)

Purpose: Every year, an increasing number of international patients seek medical care in the United States (U.S.), yet little is known about their impact. Based on single institution experiences, we wanted to explore the perceived impact of international pediatric patients on large academic U.S. pediatric intensive care units (PICUs), as they are already taxed systems. Methods: To explore current perceptions, seven geographically diverse institutions who advertise care for international patients on their websites and have ≥24 PICU beds were identified after IRB approval was obtained. We consented and interviewed PICU division chiefs or medical directors from each institution regarding their demographics and international patients. Common themes were identified. Results: Participating institutions were diverse in geographic location, census, and resource allocation strategies. Five of the seven institutions reported the presence of a formal international patient program. Four of those five reported an increase in international patients receiving PICU care over the past 5 years. International patients sought complex surgeries, advanced cancer treatments and metabolic/genetic evaluations. We identified three primary domains that require further exploration and research: (1) cultural and language differences leading to barriers in providing optimal care to international patients (2) institutional financial considerations, and (3) perceived positive and negative impact on the care of local/domestic patient populations. Conclusions: The presence of international programs raises a number of important ethical questions, including whether clinicians have a greater duty to serve residents of the local community as opposed to international patients when resources are limited. Further exploration is warranted., (Copyright © 2019 Berkman, Clark, Diekema and Lewis-Newby.)

Background: Role of information source, perceived benefits and risks, and destination image has significantly been examined in travel and tourism literature; however, in medical tourism it is yet to be examined thoroughly. The concept discussed in this article is drawn form well established models in tourism literature., Methods: The purpose of this research was to identify the source of information, travel benefits and perceived risks related to movement of international patients and develop a conceptual model based on well-established theory. Thorough database search (Science Direct, utmj.org, nih.gov, nchu.edu.tw, palgrave-journals, medretreat, Biomedcentral) was performed to fulfill the objectives of the study., Results: International patients always concern about benefits and risks related to travel. These benefits and risks form images of destination in the minds of international patients. Different sources of information make international patients acquaint about the associated benefits and risks, which later leads to development of intention to visit. This conceptual paper helps in establishing model for decision-making process of international patients in developing visit intention., Conclusion: Ample amount of literature is available detailing different factors involved in travel decision making of international patients; however literature explaining relationship between these factors is scarce.