Risk Factor Management in Medical Tourism Organizations
Authors: Banevičius Šarūnas 
Published: December 2020

Tourism, as the third largest export sector in the world, is of great importance to global communities (UNWTO, 2018). Global Wellness Institute (2018) until 2022 predicted for the medical tourism industry an average of ≈8% of annual growth; however, with one of the highest risks, i.e. disease risk (in this case COVID-19), since April 6 2020, 96% of the world’s countries have travel restrictions:

About 43 percent of states have closed all or part of their borders.
About 21 percent of states have introduced travel bans for passengers from certain countries affected by COVID-19.
About 27 percent of states have suspended all or part of their international flights to their
The remaining 9% of states have applied the following travel restrictions: (i) the requirement to immediately dissociate or quarantine, normally within 14 days since the arrival at destination; (ii) annulment or revocation of the visa upon arrival; (iii) travel bans for passengers arriving from certain regions (UNWTO, 2020).

As a result, the tourism industry, alongside with medical tourism, is experiencing a major recession and the GWI (2018) forecast for 2022 loses its meaning.
As a new form of tourism, medical tourism has become one of the fastest growing sectors of the tourism industry. Medical tourism can be defined as a “purposeful trip abroad to receive medical care” (Keckley and Underwood, 2008). Medical tourism can be viewed from two perspectives (Plianbangchang, 2018):

Reactive means medical care that pays special attention to the treatment or elimination of existing diseases; Rehabilitation of the disabled is a conventional medicine that is sometimes called the sickness
Proactive approach to health ensures/preserves the well-being, these services are focused on health promotion and disease

Heung et al. (2011), Ganguli and Ebrahim (2017), Tham (2018), Nilashia et al. (2019) found that the development of medical tourism in Australia, Hong Kong and Singapore is mainly influenced by the following factors: competence/human capital, infrastructure and superstructure, government approach/policy/regulation, the range of developed services, communication between different market segments, investment opportunities, lack of strategic planning, underdeveloped public-private partnerships and international cooperation, shortcomings in marketing and branding strategies, lack of a unified accreditation and certification system. However, the authors did not single out and assess one of the most important phenomena hindering development – the consequences caused by risk factors.
Lithuanian researchers studied the risk in various aspects: patient safety, adverse event management, risk factor management and assessment (Kaleininkaitė and Trumpaitė, 2007; Buškevičiūtė and Leškevičiūtė, 2008; Kanapeckienė and Jurkuvėnas, 2009; Staliūnienė,
2009; Mekšriūnaitė and Rudaitis, 2013; Paškevičius, 2014; Stasytytė and Aleksienė, 2016; Jankauskienė and Kostereva, 2019; Babinskas and Kanapeckienė, 2019, etc.), however, the management of tourism risk factors has not been sufficiently studied yet.
The following authors have examined the risk management of medical tourism in foreign literature: Wybo, 2004; Camillo, 2015; Mutalib et al., 2016; Winsena et al., 2016; Hasan et al., 2017; Plianbangchang, 2018; Ravulakollu et al., 2018; Nilashia et al., 2019; Lubowiecki-Vikuk and Dryglas, 2019; Hyder et al., 2019.
The problem of the research is how to effectively manage the risk factors of medical tourism.
The aim of the research is to develop a management model after analysing the risk factors of medical tourism. Objectives of the study: (1) to define medical tourism risk factors; (2) to analyse risk management algorithms.
Research methods: comparative logical analysis of scientific literature, modelling, generalization.
Medical tourism organizations can be called complex socio-technical organizations that operate in a complex dynamic environment. As a result, these organizations are exposed to external and internal risk factors that need to be identified, analysed, assessed, prioritized, and managed. In this work, the author solved the problem: how to effectively manage the risk factors of medical tourism. During the analysis of the performed scientific literature, it was found that we can ensure a successful risk cleaning process by keeping with the following consistency: risk analysis, anticipation of possible accidents/factors, strategic planning, ensuring control and feedback, risk profiling, during which all possible risk factors are classified and prioritized.
The risk of medical tourism involves two stages: first, when patients are abroad and second, when patients leave the hospital and return to their place of residence.
Lack of information and insufficient communication between the doctor abroad and in the home country is another negative effect of medical tourism as the continuity of patient care is interrupted. Health information is not transferred from foreign hospitals to the home country, which can lead to several consequences, such as the inability to identify potential complications in a timely manner and the toxicity caused by the drugs used (Carrera and Lunt, 2010).
Cammillo (2015) has attributed the emergence of medical tourism risk to the lack or scarcity of strategic managementskillsatthedestination.Strategicmanagement is a dynamic process in which the current situation is constantly assessed and each step is planned/forecasted. This requires a strong understanding of the organization as well as an understanding of the global environment in which the organization operates. This includes situation analysis SWOT. In this context, strategic management is forced to include risk assessment, risk management, crisis management and prevention strategies, and effective interdepartmental communication. The above-mentioned author singles out the following risk factors that have to be assessed during strategic risk management: 1. Human error; 2. Office error; 3. Trust in the wrong person; 4. Unauthorized procedures; 5. Unlimited access to electronic data; 6. Unrestricted access for third parties; 7. Improper maintenance; 8. Insufficient control; 9. Misuse of confidential information; 10. Errors of court; 11. Improper standard operating procedures.
Conclusions

After examining the risk factors of medical tourism, they can be divided into two categories: external and internal risk Based on the research of tourism risk aspects conducted by researchers in recent years, tourist/patient risk perceptions are often summarized from five to seven aspects. Five aspects of risk covered financial/economic risk, psychological risk, operational risk, equipment or technical risk, health risk, accident/physical risk and social risk. In addition to these dimensions, six dimensions of risk included one more risk, i.e. time risk, and seven aspects of risk included loss of opportunity.
After analysing risk management systems/algorithms/ models, it was determined that the most significant preconditions for a successful medical tourism risk management process are the following: risk analysis/ forecasting; identification of accidents/factors; strategic planning; ensuring control and feedback; risk profiling, during which all possible risk factors are classified and