The purpose of this chapter is to review the literature on health services internationalization and to identify the most addressed themes using the Scopus platform. Six articles were analyzed in detail and contributed to the results and discussion. The literature was found to highlight the internationalization of medical services mainly in developed countries. However, emerging countries have felt the need to adapt their services to international competitiveness. The potential of these initiatives has encouraged governments to restructure their hospital infrastructure. This growth, in the countries of origin, is a consequence of outdated, slower, and overloaded services and the difficulty of access to alternative treatments. This study summarizes the reasons, motives, and decision-making processes that lead patients to opt for services outside their home country.
TopIntroduction
Business internationalization is a phenomenon often related to entering international markets, which involves a process of growing international presence (Moreira, 2009; Ribau, Moreira, & Raposo, 2018a). Although most studies on internationalization analyze how firms exploit their competitive advantages abroad (Ribau et al., 2018a; 2018b), involving what is traditionally known as outward internationalization processes, inward internationalization processes, also known as reverse internationalization, has been largely overlooked (Alves, Rodrigues, Gonçalves, Conceição, & Moreira, 2021; Moreira, Ferreira, & Silva, 2018), as this involves importing raw materials, components and machinery, as well as the service activities provided in the country where the firm is located. Here, clients come from abroad, as occurs in the hotel industry, educational services or the health industry (Karlsen, Silseth, Benito, & Welch, 2003; Moreira, Brandão, Longa, Campolargo, & Lopes, 2019).
The growing socio-economic globalization process has led to a greater flow of international trade, where large companies are no longer the main international players, with small and medium-sized companies (SMEs) playing an increasingly prominent role (Dicken, 2015; Grünig, & Morschett, 2017). It is also important to emphasize that if traditional industrial firms were among the main international players, service firms have been increasing their participation in the international arena (Grünig, & Morschett, 2017; Ietto-Gillies, 2012).
Although internationalization has been a growing investment in various industrial and service sectors, the health area is seen as an asset with economic potential given the growth in the international provision of health treatments (Lagerström & Lindholm, 2020).
Health is an area of great importance in social terms and, therefore, there is a need to ensure that its services have quality, are efficient and effective. Internationalization in this sector has been growing, mainly due to investment by private companies (Holden, 2005) and in emerging countries, where healthcare is characterized as being more invasive and with high technology (Novo, 2014).
The internationalization of health services is linked to the concept of medical tourism, which has been gaining relevance in different countries, offering a wide range of treatments, for example, cosmetic surgery, transplants, sex changes, massages and dental treatment (Novo, 2014).
If internationalization is not a new topic, with several theories having been developed and applied to different internationalization processes (Ietto-Gillies, 2012, Ribau et al., 2015; 2018a; 2018b), the internationalization of healthcare companies is something relatively unexplored academically. Thus, this chapter aims to investigate the internationalization of health firms. To do so, the systematic literature review method will be used, resorting to the SCOPUS academic database, in order to assess the themes/topics dealt with most. It is hoped that this review will contribute to future studies: highlighting numerous reasons why patients choose services abroad; assessing communication strategies to enhance the service or for those who want to enter this type of market; clarifying the differences between markets with and without prior experience; and also making explicit the entire decision-making process that focuses on the patient when entering a foreign destination.