title: Providers' perspectives on inbound medical tourism in Central America and the Caribbean: factors driving and inhibiting sector development and their health equity implications.
abstract: BACKGROUND
  Many governments and health care providers worldwide are enthusiastic to develop medical tourism as a service export. Despite the popularity of this policy uptake, there is relatively little known about the specific local factors prospectively motivating and informing development of this sector.
  
  
  OBJECTIVE
  To identify common social, economic, and health system factors shaping the development of medical tourism in three Central American and Caribbean countries and their health equity implications.
  
  
  METHODS
  In-depth, semi-structured interviews were conducted in Mexico, Guatemala, and Barbados with 150 health system stakeholders. Participants were recruited from private and public sectors working in various fields: trade and economic development, health services delivery, training and administration, and civil society. Transcribed interviews were coded using qualitative data management software, and thematic analysis was used to identify cross-cutting issues regarding the drivers and inhibitors of medical tourism development.
  
  
  RESULTS
  Four common drivers of medical tourism development were identified: 1) unused capacity in existing private hospitals, 2) international portability of health insurance, vis-a-vis international hospital accreditation, 3) internationally trained physicians as both marketable assets and industry entrepreneurs, and 4) promotion of medical tourism by public export development corporations. Three common inhibitors for the development of the sector were also identified: 1) the high expense of market entry, 2) poor sector-wide planning, and 3) structural socio-economic issues such as insecurity or relatively high business costs and financial risks.
  
  
  CONCLUSIONS
  There are shared factors shaping the development of medical tourism in Central America and the Caribbean that help explain why it is being pursued by many hospitals and governments in the region. Development of the sector is primarily being driven by public investment promotion agencies and the private health sector seeking economic benefits with limited consideration and planning for the health equity concerns medical tourism raises.
authors.affiliation: Department of Geography, Simon Fraser University, Burnaby, Canada; Rrj1@sfu.ca.
authors.forename: Rory
authors.initials: R
authors.lastname: Johnston
authors.affiliation: Department of Geography, Simon Fraser University, Burnaby, Canada.
authors.forename: Valorie A
authors.initials: VA
authors.lastname: Crooks
authors.affiliation: Department of Anthropology, University of Denver, Denver, CO, USA.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Cerón
authors.affiliation: Faculty of Medicine, University of Ottawa, Ottawa, Canada.
authors.forename: Ronald
authors.initials: R
authors.lastname: Labonté
authors.affiliation: Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Snyder
authors.affiliation: Instituto Nacional de Salud Pública, Cuernavaca, México.
authors.forename: Emanuel O
authors.initials: EO
authors.lastname: Núñez
authors.affiliation: Centro de Estudios para la Equidad y Gobernanza en los Sistemas de Salud, Guatemala, Guatemala.
authors.forename: Walter G
authors.initials: WG
authors.lastname: Flores
keywords: Caribbean; Central America; health services research; medical tourism; qualitative methods