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Disintermediation in medical tourism through blockchain technology: an analysis using value-focused thinking approach

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Medical tourism (MT) is a promising industry that has shown significant growth in the past few decades. Patients often travel abroad to seek treatment, conventional and otherwise due to a myriad of reasons. The reasons include but are not limited to rising costs in their home country, experimental treatments only available abroad or better standards of care. However, MT has also created room for intermediaries to grow. These intermediaries are known as medical tourism facilitators (MTF), and as the name suggests, they provide patients services to make their experience easier and more convenient. MTFs often under deliver on their claims to the detriment of the patient. Given the varying legal jurisdiction, the sensitive nature of the healthcare process, and the arduous process of seeking and claiming settlements, most medical tourists are unlikely to pursue cases where they have been cheated. To understand the system of MT and the key issues faced by stakeholders, we used Value Focussed Thinking (VFT). VFT assists to arrive at the fundamental objectives that need to be addressed for mitigating these problems of MT. Based on the findings of VFT; we present a linkage or equivalence between the fundamental objectives for mitigating the problems of MT through Blockchain Technology. We present our findings on how Blockchain Technology can assist to increase disintermediation, transparency, and trust by bringing in aspects of optimizing time and efforts; optimizing expense required to settle disputes, automating disbursement of payments and enforcing mutually accepted agreements among other benefits.

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We would also like to thank the various stakeholders who spoke to us and were extremely kind with their time. They were integral to the VFT aspect of our research methodology and we immensely value their contributions. We are also grateful to the anonymous reviewers for their constructive comments that helped us shape our article well.

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Correspondence to Shekhar Shukla.

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1.1 Questions asked to stakeholders as part of VFT interviews

1.1.1 For patient

  • Why overseas?

  • Why India (any country)?

  • How important is good accommodation for the patient?

  • How important is good accommodation for companions?

  • Would you ignore other foibles in your travel if proper treatment is delivered?

  • How off the actual cost turned out to be from your initial estimation?

  • List down a few things that would make you not travel to a foreign country again, for medical treatment.

  • Was language barrier an issue? How major?

  • Rank these items with respect to essentiality in your travel: (rate each item out of 10)

    1. (a)

      Proper treatment

    2. (b)

      Trust for the medical personnel

    3. (c)

      Trust for other personnel

    4. (d)


    5. (e)

      Complete cost of treatment

    6. (f)

      Local travel

    7. (g)

      The clarity in interaction with medical personnel

    8. (h)

      Clarity in interaction with other personnel

    9. (i)

      Physical security

    10. (j)


    11. (k)

      Local weather

    12. (l)

      Affordability of bringing along multiple companions

    13. (m)

      Availability of conventional tourist activities at the destination

  • Please mention any other factors positively/negatively affecting a patient’s experience. If possible, provide a rating of its impact out of 10

  • Did you have to go through any procedure that was not part of the initial package? How much did it inflate your final cost of treatment?

  • What would be a deal-breaker for you? (i.e. anything that would discourage you from availing treatment in a foreign country)

  • Was it important that your destination also serves as a tourist location? How important?

  • Is transparency in the procedure important?

  • What aspects, when improved, would result in a more transparent procedure?

  • Did a lower cost also lower the quality of your experience? If yes, which aspects exactly?

  • According to you, what changes can be made in the process that would make more patients opt for foreign treatments?

  • Would you return to this country for further treatment in this same procedure or a different procedure altogether?

1.1.2 For physicians/doctors/hospital or healthcare service providers denoted as medical providers in our research:

  1. 1.

    How many medical tourists have you treated?

  2. 2.

    In your opinion is medical tourism beneficial to the MTs

  3. 3.

    In your opinion is the process transparent enough

  4. 4.

    How do patients reach you?

  5. 5.

    The average cost for medical tourist?

  6. 6.

    How off the actual cost turned out to be from your initial estimation? For her patients.

  7. 7.

    Every year, is the trend increasing?

  8. 8.

    Sourcing medical history

  9. 9.

    Follow up treatment—who is responsible

  10. 10.

    What can be done to promote medical tourism?

  11. 11.

    Barriers in communication?

  12. 12.

    Have you ever dealt with MTFs?

  13. 13.

    Do you think MTFs act ethically?

  14. 14.

    Have you ever recommended treatment for patients for which they need to travel?

  15. 15.

    Do MTs complain about conditions in the destination country

  16. 16.

    Would you prefer a system that dispensed payment for patients as they went?

  17. 17.

    Would you prefer a system that makes stakeholders accountable?

  18. 18.

    Would you prefer a system that guarantees the integrity of medical records of an overseas patient?

  19. 19.

    Does she charge more to foreign patients?

  20. 20.

    Difference in cost?

1.1.3 For MFT

  1. 1.

    What countries do patients mostly come from?

  2. 2.

    Are the procedures opted by them emergency treatments or elective / non-emergency?

  3. 3.

    From an agent’s perspective, it is important that patients receive a detailed and fully transparent account of the transactions involved in the procedures?

  4. 4.

    According to you, is there a need to make the current system more transparent to the patients and other stakeholders involved?

  5. 5.

    What aspects of the system can be improved to increase levels of transparency?

  6. 6.

    From your experience, what are some deal-breakers for patients? (i.e. anything that discourages patients from pursuing the treatment)?

  7. 7.

    Can you list down all things that act as incentives for patients to pursue foreign medical treatment?

  8. 8.

    From your experience, rate these items in terms of essentiality in a patient’s travel: (rate on a scale of 10)

    • Proper treatment

    • Trust for the medical personnel

    • Trust for other personnel

    • Food

    • Complete cost of treatment

    • Local Travel

    • The clarity in interaction with medical personnel

    • Clarity in interaction with other personnel

    • Physical security

    • Accommodation

    • Local weather

    • Affordability of bringing along multiple companions

    • Availability of conventional tourist activities at the destination

  9. 8.

    Please mention any other factors positively/negatively affecting a patient’s experience. If possible, provide a rating of its impact out of 10.

  10. 9.

    Are patients willing to ignore other foibles in their travel if proper treatment is delivered?

  11. 10.

    Is it important that the destination also served as a tourist location for the patients? How important?

  12. 11.

    Are there different options/plans available for patients in cost terms? How do these different plans differ in terms of services provided?

  13. 12.

    Describe the distribution of patients opting for these different plans (are there more patients opting for the cheaper plans? or is the distribution uniform?)

  14. 13.

    Do the patients complain about the conditions in the destination country?

  15. 14.

    According to you, do patients leave the country satisfied and willing to return if treatment is required again?

  16. 15.

    According to you, what changes can be made in the process that would make more patients opt for foreign treatments?

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Parekh, J., Jaffer, A., Bhanushali, U. et al. Disintermediation in medical tourism through blockchain technology: an analysis using value-focused thinking approach. Inf Technol Tourism 23, 69–96 (2021).

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