Assessment of Medical Tourism Barriers In Tabriz City

Abstract
 In recent years, the tourism industry has become one of the most lucrative industries in the world and there is intense competition among many countries to attract tourists. Meanwhile, medical tourism, as one of the indicators of health tourism, is a growing phenomenon in the 21st century, which has one of the fastest developments in the tourism market. It also has high economic and social benefits for the destination country and city. Tabriz is a university city and one of the educational and research hubs of the country in medical sciences and welcomes medical tourists from countries in the region that face obstacles and challenges in this industry. The research method of the present study is descriptive-analytical and the method of data collection is documentary and field information. The statistical population of this study consists of the staff of the General Directorate of Cultural Heritage and Handicrafts of East Azerbaijan Province, professors of the Faculty of Planning and Environmental Sciences of Tabriz University and physicians and specialists of public and private medical centers in Tabriz. In three weeks, 70 questionnaires were completed, of which 67 were suitable for use; The reliability and validity of the questionnaires were calculated using Cronbach's alpha coefficient and analyzed by structural equation modeling with partial least squares (PLS-SEM). The evaluated variables, barriers to medical tourism were extracted from the summary of previous studies. The results showed that the barriers to medical tourism in Tabriz according to the path coefficients of the variables are: Language, communication and advertising barriers with a path coefficient of 0.271 in the first place has the greatest impact on the lack of development of medical tourism and the rest respectively Barriers to specialized manpower with a coefficient of 0.230, barriers to policy-making, legislation and monitoring and evaluation with a coefficient of 0.205, economic barriers with a coefficient of 0.189, barriers to facilities and infrastructure with a coefficient of 0.187 are in the next ranks. The results of this study show that except for the variable of manpower barriers, other variables have a role in the lack of development of medical tourism in Tabriz.
Extended Abstract
Introduction
In recent years, the tourism industry has become one of the most lucrative industries in the world, and there is intense competition among many countries to attract tourists. Meanwhile, medical tourism, as one of the indicators of health tourism, is a growing phenomenon in the 21st century, which has one of the fastest developments in the tourism market. It also has high economic and social benefits for the destination country and city. In 2017, all statistics and reports, including the World Health Organization forecast, indicate the growing growth of medical tourism in the world. Various sources estimate the global medical tourism revenue between $10.5 billion in 2012 to $32 billion in 2019 and forecast to reach $3 trillion by 2025. The Medical Tourism Association also estimated the global medical tourism revenue in 2016 at $100 billion. Currently, the main reasons for patients traveling to Iran are related to the quality of health services, low costs of medicine and treatment compared to other countries in the region, access to advanced and new equipment, the presence of specialists and efficient staff in the field of health, similar culture and language and lack of equipment and specialized forces in the country of origin. In the fourth and fifth development plans of Iran in the field of health, active presence in global markets due to the growing growth of globalization as the main approach with the aim of job creation, quality growth in the health sector and approaching global standards, earn and currency exchange to the country and supporting economic growth and becoming a health tourism hub in the region is considered.
Tabriz is a university city and one of the educational and research hubs of the country in medical sciences, and welcomes medical tourists from countries in the region which faces obstacles and challenges in this industry.
 
Methodology
The research method of the present study is descriptive-analytical and the method of data collection is documentary and field information. The statistical population of this study consists of the staff of the General Directorate of Cultural Heritage and Handicrafts of East Azerbaijan Province, professors of the Faculty of Planning and Environmental Sciences of Tabriz University and physicians and specialists of public and private medical centers in Tabriz. In three weeks, 70 questionnaires were completed, of which 67 were suitable for use; The reliability and validity of the questionnaires were calculated using Cronbach's alpha coefficient and analyzed by structural equation modeling with partial least squares (PLS-SEM). The evaluated variables, barriers to medical tourism, were extracted from the summary of previous studies.
 
Results and discussion
Rejecting the effect of human power barriers on the lack of development of medical tourism: According to the confidence interval obtained from the evaluation results of the medical tourism barriers evaluation model in Table (4-27) is equal to 0.054; there is no significant relationship between the variable of human power barriers and the lack of development of medical tourism.
No rejection of the effect of economic barriers on the lack of development of medical tourism: According to the confidence interval obtained from the evaluation results of the medical tourism barriers evaluation model in Table (4-27), it is equal to 0.026; there is a significant relationship.
No rejection of the effect of barriers to policy-making, legislation, monitoring, evaluation on the lack of development of medical tourism:
 According to the confidence interval obtained from the evaluation results of the medical tourism barriers evaluation model in Table (4-27), it is equal to 0.028; there is a significant relationship between the variables of barriers to policy-making, legislation, monitoring, evaluation and underdevelopment of medical tourism.
No rejection of the effect of language barriers, communication, advertising on the lack of development of medical tourism:
According to the confidence interval obtained from the evaluation results of the medical tourism barriers evaluation model in Table (4-27), it is equal to 0.020; there is a significant relationship between the variables of language barriers, communication, advertising and lack of development of medical tourism.
No rejection of the effect of barriers of facilities and infrastructure on the lack of development of medical tourism:
 According to the confidence interval obtained from the evaluation results of the medical tourism barriers evaluation model in Table (4-27), it is equal to 0.021; there is a significant relationship between the variable barriers of facilities and infrastructure and the lack of development of medical tourism.
 
Conclusions
The results of this study show that except for the variable of manpower barriers, other variables have a role in the lack of development of medical tourism in Tabriz. Also, the results of the collected data showed that economic barriers, policy barriers, legislation, monitoring, evaluation, language barriers, communications, advertising, barriers to facilities and infrastructure effectively affect the lack of development of medical tourism (Hypothesis 1, 2, 4, 5‌). This is important according to the researches of experts such as Nagarjan (2004), Ye et al. (2008), Asnov and Rekrojipol (2011), Chen et al. (2012), Rokni et al. (2017), Verolava and Zhurbendze (2018), Haghighi Kafash Et al. (2010), Sadrmomtaz and Agha Rahimi (2010), Turani et al. (2011), Delgoshaei et al. Azizi and Zahedi (2015), Karami et al. (2015), are confirmed. Contrary to the results of previous studies, the results of this study showed that human power barriers have no effect on the lack of development of medical tourism (Hypothesis 3).