title: The healthcare off-shoring industry in developing economies--institutional and economic foundations: an Indian case.
abstract: OBJECTIVE
  Industrialized world-based healthcare providers are increasingly off-shoring low-end healthcare services such as medical transcription, billing and insurance claims. High-skill medical jobs such as tele-imaging and tele-pathology are also being sub-contracted to developing countries. Despite its importance, little theory or research exists to explain what factors affect industry growth. The article's goals, therefore, are to examine economic processes associated with developing economies' shift from low- to high-value information technology enabled healthcare services, and to investigate how these differ in terms of legitimacy from regulative, normative and cognitive institutions in the sending country and how healthcare services differ from other services.
  
  
  METHODS
  This research is conceptual and theory-building. Broadly, its approach can be described as a positivistic epistemology.
  
  
  RESULTS
  Anti off-shoring regulative, normative and cognitive pressures in the sending country are likely to be stronger in healthcare than in most business process outsourcing. Moreover, such pressures are likely to be stronger in high-value rather than in low-value healthcare off-shoring. The findings also indicate that off-shoring low-value healthcare services and emergent healthcare industries in a developing economy help accumulate implicit and tacit knowledge required for off-shoring high-value healthcare services.
  
  
  CONCLUSIONS
  The approach lacks primary data and empirical documentation.
  
  
  CONCLUSIONS
  The article helps in understanding industry drivers and its possible future direction. The findings help in understanding the lens through which various institutional actors in a sending country view healthcare service off-shoring.
  
  
  CONCLUSIONS
  The article's value stems from its analytical context, mechanisms and processes associated with developing economies' shift to high-value healthcare off-shoring services.
authors.affiliation: Bryan School of Business and Economics, The University of North Carolina at Greensboro, Greensboro, North Carolina, USA. nbkshetr@uncg.edu
authors.forename: Nir
authors.initials: N
authors.lastname: Kshetri
mesh_terms: D003906:Developing Countries; D057217:Economic Development; D033161:Government Regulation; D006298:Health Services Administration; D006801:Humans; D007194:India; D008499:Medical Records; D020416:Outsourced Services / Q000191:economics / Q000458:organization & administration*; D017216:Telemedicine / Q000458:organization & administration