Presenting a process model for strategic management of health tourism marketing

Introduction and Research Aims: Health tourism, as a dynamic and high-growth segment of the global tourism industry, represents a significant source of revenue and socio-economic development. Countries with competitive advantages in medical expertise and cost structures, such as Iran, are uniquely positioned to capitalize on this burgeoning market. However, the inherent complexity of health tourism—characterized by a multitude of stakeholders including ministries of health, tourism, foreign affairs, parliament, and private service providers—presents a formidable challenge for traditional marketing approaches. Existing literature has often been fragmented, focusing on isolated aspects such as the marketing mix (Ahmadi et al., 2022), the impact of specific variables on satisfaction (Saberi et al., 2023), or limited conceptual models (Bagheri et al., 2023). A critical gap exists in the form of a comprehensive, integrated, and process-oriented model that captures the dynamic, multi-level strategic marketing management required for success in this sector.
This research aims to address this gap by answering the central question: What is the process model for strategic marketing management in the health tourism industry? The primary objective is to develop a holistic paradigm model that elucidates the causal conditions, core phenomenon, contextual and intervening conditions, strategies, and consequences of strategic health tourism marketing, with a specific focus on the Iranian context as an emerging destination.
Methodology: Given the exploratory nature of the research question and the lack of a comprehensive existing theoretical framework, this study adopted a qualitative approach using the systematic grounded theory strategy as proposed by Corbin and Strauss (2015). This methodology is particularly apt for developing a process-based model from rich, empirical data.

Data Collection: Data were collected through semi-structured interviews with 16 experts in the fields of strategic management, marketing, and health tourism. The participants were purposively selected via snowball sampling and represented a diverse range of stakeholders from macro (e.g., policymakers in parliament, ministries), meso (e.g., university researchers, DMO managers), and micro (e.g., hospital and clinic managers) levels. Data collection continued until theoretical saturation was achieved.
Data Analysis: The analysis followed the three-stage coding process of grounded theory:

Open Coding: Interview transcripts were meticulously analyzed, leading to the extraction of 247 initial concepts.
Axial Coding: These concepts were grouped into categories and subcategories, establishing relationships between them. This process was guided by constant comparison.
Selective Coding: A core category was identified, and all other categories were systematically integrated around it to form the final paradigm model. Trustworthiness was ensured through member checking, peer debriefing, and coder agreement (87%).


Findings: The Emergent Paradigm Model: The analysis culminated in a robust paradigm model comprising six core dimensions:

Causal Conditions: Five key categories drive the need for strategic marketing management:

Macro-level Policymaking: (National development plans, international relations, impact of sanctions).
Regional Competition: (Perceived pressure from rivals like Turkey, market share analysis).
Tourist Needs: (Demand for personalized services, comprehensive travel packages).
Host Community Needs: (Economic development, job creation, sustainable development).
Limited Resources & Industry Sustainability: (Environmental constraints, need for technological investment).

Core Phenomenon: Strategic Health Tourism Marketing Management
This is identified as the central process, encompassing: defining mission/vision, analyzing the external and internal environment (industry, competitors, customers, internal capabilities), setting SMART goals, and formulating and selecting alternative strategies.
Contextual Conditions: These are the environmental factors that facilitate or hinder strategy implementation:



Suitable Structure: (Effective organizational structures, inter-sectoral coordination).
Research & Development: (Interaction with research centers, specialized symposiums).
Culturalization: (Public awareness and acceptance of health tourists).
Infrastructure: (Medical facilities, general tourism infrastructure, digital systems).
Internal Marketing & Training: (Educating staff and the community).



Intervening Conditions: These mediating variables critically influence the success of strategies:



Coordination and Integration: (The most critical factor, involving the elimination of siloed operations and parallel work among ministries and organizations).
Investment Development: (Facilitating domestic and international investment).
Strategic Network Value Management: (Managing relationships with all actors in the value chain).
Comprehensive Competitive Intelligence System: (Monitoring competitors, technologies, and market trends).
Marketing Information System: (Systematic data collection and analysis).



Strategies (Actions/Interactions): Seven key strategic categories were identified:



Effective STP Execution: (Segmentation, targeting, and positioning).
Appropriate Marketing Mix Determination: (Personalized pricing, diverse promotional activities).
Branding and Trust-Building: (Developing a national medical brand, obtaining international accreditations).
Networking: (Forming strategic alliances and partnerships).
Budgeting and Resource Allocation.
Strategy Implementation: (Leadership, organizing, conflict management).
Control and Evaluation: (Continuous performance monitoring).



Consequences: Successful implementation of the model leads to significant outcomes:



Economic Development & Sustainable Income: (Increased revenue, job creation, poverty reduction).
Increased Social Welfare: (Improved healthcare infrastructure and quality of life for citizens).
Development of the Health Tourism Ecosystem: (A more robust and patient-centric system).
Enhanced National Security: (Through indirect "health diplomacy" and regional cooperation).
Improved Customer Experience & Word-of-Mouth: (Leading to loyalty and advocacy).


Discussion and Conclusion: This study makes several significant contributions to the theory and practice of health tourism marketing. The proposed model moves beyond the fragmented, factor-oriented approaches of previous research by presenting a dynamic, multi-level, and process-oriented framework.

Theoretical Implications: The model's primary theoretical innovation is its integration of macro-level governance and diplomacy as fundamental causal conditions, not merely as peripheral environmental factors. It demonstrates that success in health tourism marketing is not solely dependent on operational marketing tactics but is fundamentally contingent upon a synergistic alignment between macro-policy, meso-level strategic coordination, and micro-level execution. The identification of "Coordination and Integration" as a pivotal intervening condition provides a profound explanation for the failure of many isolated marketing efforts in this sector.
Practical Implications (Recommendations):

At the Macro Level: Establish a joint "Health Diplomacy Taskforce" between relevant ministries. Develop a unified "National Health Tourism Marketing Strategy."
At the Meso Level: Launch an integrated "e-Visa for Health" system and create a "National Health Tourism Brand Development Center."
At the Micro Level: Design integrated "Health-Tourism Combo Packages" and implement a "Health Tourist Experience Management System."

Comparison with Existing Literature: While confirming the importance of known factors like service quality and branding, this model places them within a broader causal chain. It addresses a critical gap in studies like Pashaeifar et al. (2022) by incorporating multi-level governance and in Smith & Hung (2023) by specifically highlighting the role of health diplomacy and institutional coordination within the unique context of Iran.

In conclusion, this research provides a comprehensive roadmap for policymakers, DMOs, and marketing managers in the health tourism industry. The grounded theory approach ensures that the model is deeply rooted in the realities and complexities of the sector. Future research can quantitatively test the relationships within this model using Structural Equation Modeling (SEM) or conduct comparative studies in other emerging health tourism destinations.