Theoretical Framework

Theoretical Framework

DOI: 10.4018/978-1-5225-2694-0.ch002


The working together of tourism industry, governmental agencies, and assisted reproduction facilities is critical to the success of reproductive tourism business. If we have to draw up a theory of reproductive tourism, similarly, it has to come from multidisciplinary perspectives that include healthcare research, tourism and hospitality research, consumer behavior research, public policy research, among others. This chapter is an attempt to bring together ideas from different contributory areas to weave together a theory of reproductive tourism. The nuanced business environment of Greece, our destination of special focus, for reproductive tourism will also be discussed.
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This research analyzed reproductive tourism in Greece from a business perspective and aims at clarifying the shortcomings it encounters so far, as well as highlighting opportunities for improvements. The main sources for this research are contained in the literature review presented below and the field study consisting of interviewing a representative number of clients and professionals. In this regard, the literature review aims at reviewing the studies existing so far. It is structured according to the different aspects of reproductive tourism, meaning that it is organized in line with the specific topics to be addressed at. The topics include tourism in general, health and medical tourism, issues of financing and reimbursement as well the European legislative mosaic, as the researcher has put it. In the final two sections, the literature review is turning more closely to the medical tourism sector in Greece and the particular obstacles and opportunities it is confronted with. Most sections start with introductory or explanatory remarks because of the complexity and technicality of the topics addressed. A summary of this literature review will put together key insights and prepare the ground for the presentation of the field study in chapter 4.

A short overview of the topics is addressed in the literature review. It is intended to show that a broad approach is needed as groundwork for focusing on the key theme of reproductive tourism in Greece and the options for its improved performance. At the outset, key figures for tourism are presented. The development of tourism in general is addressed and trends visible in this decade are shown, taking a vision 2020 as focal point.

Subsequently, this perspective focuses further on health and medical tourism. An overview is given about who the travelers are and which aims they intend to achieve. After looking at these broader contexts, the necessary background is created to turn to the key theme of this study, which is reproductive and medical tourism.

The area of reproductive tourism will be looked at from different perspectives: figures, demographic relevance and its economic impact. In this respect, Assisted Reproduction Technologies (ART) are dealt with in more detail. Female and male fertility are relevant in this respect, both linked to a broad area of medical application addressed in this chapter. Then the chapter moves beyond the medical aspects of reproductive tourism. It first turns to the demographic relevance of assisted reproduction. Then the costs are looked at from a lifecycle perspective, indicating that cost of AR is, on balance, more than matched by the gain from an additional newborn in European societies. On the other hand, the costs of multiple pregnancies, which originate disproportionately from assisted conception, are taken into account, as well as the important non-cost issue of health hazards resulting from ART.

Conforming to the business perspective of this study, the literature review continues by showing worldwide turnover in the AR sector by drawing on the studies and estimates available so far. The reader is shown that the AR business generally rests on two legs: facilities and drugs, meaning specialized clinics and fertility centers on one hand and the pharmaceutics industry on the other. They both constitute pillars of what, in respect to fertility tourism, is termed cross-border reproductive care (CBRC). Conditions and drivers for CBRC will therefore be discussed, citing studies presenting figures on cross-border travel as well as analyzing the interests and incentives of patients.

After this, the complex legal situation surrounding reproductive tourism is addressed, with a focus on Europe in order not to over-extend the scope of this study. The European situation being very complex in itself, it was termed a legislative mosaic (Gianaroli, 2011). A closer look at the peculiarities of legislation is useful from a business perspective because it provides insights about different incentives for CBRC. In this multi-layered pattern, reimbursement issues act as a strong driver for CBRC.

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