Strategic Approaches to Overcome Barriers in Healthcare Service Supply Chains Using Fuzzy MCDM

Document Type : Research Paper

Authors

1 Division of Industrial Engineering and Management, Uppsala University, PO Box 534, Uppsala, Sweden.

2 Department of Business Management, University of Tehran, Tehran, Iran.

3 Department of Management, Ur. C., Islamic Azad University, Urmia, Iran.

10.22059/imj.2026.408629.1008278

Abstract

Objective: This study examines the challenges and strategic approaches to developing and sustaining medical tourism supply chains (MTSC), particularly in developing countries. Medical tourism is one of the fastest-growing sectors within the global tourism industry, generating significant economic impact through the cross-border movement of patients seeking medical care. Despite its growth potential, numerous barriers hinder the effective design and implementation of sustainable MTSCs, especially in emerging economies such as Iran. 
Methodology: The study uses the fuzzy Step-wise Weight Assessment Ratio Analysis (SWARA) to quantify the relative importance of various barriers to MTSC development. Subsequently, the fuzzy Weighted Aggregated Sum Product Assessment (WASPAS) method is used to prioritize strategic interventions to overcome the identified barriers. This hybrid fuzzy MCDM approach effectively handles the inherent uncertainty and subjectivity in expert evaluations, thereby providing a robust decision-making framework.
Results: Findings indicate that among the main barriers, the lack of technological support to facilitate supply chain activities constitutes the most critical hurdle faced by Iran’s medical tourism industry. The limited adoption and implementation of technological innovations restrict efficient coordination, information sharing, and overall supply chain sustainability. In response to these challenges, the study identifies "economic and incentives-based strategies" as the foremost approach for overcoming barriers in MTSCs. This strategy emphasizes the creation of financial incentives, subsidies, and economic policies to encourage innovation, infrastructure development, and enhanced stakeholder collaboration.
Conclusion: Policy implications suggest that governments and healthcare providers in developing countries should prioritize investments in technology and infrastructure, alongside devising incentive schemes tailored to the medical tourism sector. Collaboration among various stakeholders—including healthcare institutions, tourism agencies, technology providers, and policymakers—is critical to creating resilient supply chains that can adapt to evolving market demands and global health trends.

Keywords

References

Abadi, F., Sahebi, I., Arab, A., Alavi, A., & Karachi, H. (2018). Application of best-worst method in evaluation of medical tourism development strategy. Decision Science Letters, 7(1), 77–86.
Agarwal, S., Kant, R., & Shankar, R. (2020). Evaluating solutions to overcome humanitarian supply chain management barriers: A hybrid fuzzy SWARA–Fuzzy WASPAS approach. International Journal of Disaster Risk Reduction, 51, 101838.
Aprigliano Fernandes, V., Pacheco, R. R., & Fernandes, E. (2021). How does air transport impact employment in typical tourist industry activities in Brazil? Current Issues in Tourism, 24(22), 3151–3164. https://doi.org/10.1080/13683500.2020.1863925
Armaitiene, A., Bertuzyte, R., & Vaskaitis, E. (2014). Conceptual Framework for Rethinking of Nature Heritage Management and Health Tourism in National Parks. Procedia - Social and Behavioral Sciences, 148, 330–337. doi:https://doi.org/10.1016/j.sbspro.2014.07.050
Belhadi, A., & Touriki, F. E. (2017). Prioritizing the solutions of lean implementation in SMEs to overcome its barriers. Journal of Manufacturing Technology Management.
Bouzon, M., Govindan, K., Rodriguez, C. M. T., & Campos, L. M. (2016). Identification and analysis of reverse logistics barriers using fuzzy Delphi method and AHP. Resources, Conservation and Recycling, 108, 182–197.
Bulatovic, I., & Iankova, K. (2021). Barriers to Medical Tourism Development in the United Arab Emirates (UAE). International Journal of Environmental Research and Public Health, 18(3), 1365.
Büyüközkan, G., Mukul, E., & Kongar, E. (2021). Health tourism strategy selection via SWOT analysis and integrated hesitant fuzzy linguistic AHP-MABAC approach. Socio-Economic Planning Sciences, 74, 100929. doi:https://doi.org/10.1016/j.seps.2020.100929
Chanin, O., Khunchumnan, P., Amphansookko, S., Thongyai, K., Rodneum, J., & Sriprasert, P. (2015). Guidelines on health tourism management for middle eastern tourists in Phuket province. Procedia computer science, 65, 1146–1153.
Crush, J., & Chikanda, A. (2015). South–South medical tourism and the quest for health in Southern Africa. Social Science & Medicine, 124, 313–320. doi:https://doi.org/10.1016/j.socscimed.2014.06.025
de la Hoz-Correa, A., Muñoz-Leiva, F., & Bakucz, M. (2018). Past themes and future trends in medical tourism research: A co-word analysis. Tourism Management, 65, 200–211. doi:https://doi.org/10.1016/j.tourman.2017.10.001
Drăghici, C. C., Diaconu, D., Teodorescu, C., Pintilii, R.-D., & Ciobotaru, A.-M. (2016). Health tourism contribution to the structural dynamics of the territorial systems with tourism functionality. Procedia Environmental Sciences, 32, 386–393.
Dryglas, D., & Salamaga, M. (2018). Segmentation by push motives in health tourism destinations: A case study of Polish spa resorts. Journal of Destination Marketing & Management, 9, 234–246. doi:https://doi.org/10.1016/j.jdmm.2018.01.008
Ferrer, M., & Medhekar, A. (2012). The factors impacting on the management of global medical tourism service supply chain. GSTF Journal on Business Review (GBR), 2(2).
Fraiz, J. A., de Carlos, P., & Araújo, N. (2020). Disclosing homogeneity within heterogeneity: A segmentation of Spanish active tourism based on motivational pull factors. Journal of Outdoor Recreation and Tourism, 30, 100294.
Gabor, M. R., & Oltean, F. D. (2019). Babymoon tourism between emotional well-being service for medical tourism and niche tourism. Development and awareness on Romanian educated women. Tourism Management, 70, 170–175. doi:https://doi.org/10.1016/j.tourman.2018.08.006
Ganesan, K., Annamalai, U., & Deivanayagampillai, N. (2019). An integrated new threshold FCMs Markov chain based forecasting model for analyzing the power of stock trading trend. Financial Innovation, 5(1), 1–19.
Ghasemian Sahebi, I., Arab, A., & Toufighi, S. P. (2020). Analyzing the barriers of organizational transformation by using fuzzy SWARA. Journal of Fuzzy Extension and Applications, 1(2), 88–103.
Gholami, M., Keshtvarz Hesam Abadi, A. M., Milady, S., & Gholami, M. (2020). A Systematic Review of the Factors Affecting the Growth of Medical Tourism in Iran. International Journal of Travel Medicine and Global Health, 8(1), 1–12. https://doi.org/10.34172/ijtmgh.2020.01
Godovykh, M., & Ridderstaat, J. (2020). Health outcomes of tourism development: A longitudinal study of the impact of tourism arrivals on residents’ health. Journal of Destination Marketing & Management, 17, 100462. doi:https://doi.org/10.1016/j.jdmm.2020.100462
Gupta, H., & Barua, M. K. (2018). A framework to overcome barriers to green innovation in SMEs using BWM and Fuzzy TOPSIS. Science of the Total Environment, 633, 122–139.
Hadian, M., Jabbari, A., Mousavi, S. H., & Sheikhbardsiri, H. (2021). Medical tourism development: A systematic review of economic aspects. International Journal of Healthcare Management, 14(2), 576–582.
Huang, X., Zhu, S., & Wang, J. (2021). Optimal Emission Reduction and Pricing in the Tourism Supply Chain Considering Different Market Structures and Word-of-Mouth Effect. Sustainability, 13(7), 3893.
Ilbahar, E., & Kahraman, C. (2018). Retail store performance measurement using a novel interval-valued Pythagorean fuzzy WASPAS method. Journal of Intelligent & Fuzzy Systems, 35(3), 3835–3846.
Ile, F. L., & Țigu, G. (2017). Medical tourism market trends-an exploratory research. Paper presented at the Proceedings of the International Conference on Business Excellence.
Johnston, R., Crooks, V. A., & Ormond, M. (2015). Policy implications of medical tourism development in destination countries: revisiting and revising an existing framework by examining the case of Jamaica. Globalization and health, 11(1), 1–13.
Jovanović, S., Janković–Milić, V., & Ilić, I. (2015). Health and Hygiene Importance for the Improvement of Tourism Sector Competitiveness in Serbia and the South-eastern Europe Countries. Procedia Economics and Finance, 19, 373–382. doi:https://doi.org/10.1016/S2212-5671(15)00038-6
Kabra, G., & Ramesh, A. (2015). Analyzing drivers and barriers of coordination in humanitarian supply chain management under fuzzy environment. Benchmarking: An International Journal.
Keršuliene, V., Zavadskas, E. K., & Turskis, Z. (2010). Selection of rational dispute resolution method by applying new step‐wise weight assessment ratio analysis (SWARA). Journal of business economics and management, 11(2), 243–258.
Keshavarz-Ghorabaee, M., Amiri, M., Zavadskas, E. K., Turskis, Z., & Antucheviciene, J. (2018). An extended step-wise weight assessment ratio analysis with symmetric interval type-2 fuzzy sets for determining the subjective weights of criteria in multi-criteria decision-making problems. Symmetry, 10(4), 91.
Kim, S., & Lee, W. S. (2019). Network text analysis of medical tourism in newspapers using text mining: The South Korea case. Tourism Management Perspectives, 31, 332–339.
Kou, G., Ergu, D., Lin, C., & Chen, Y. (2016). Pairwise comparison matrix in multiple criteria decision making. Technological and economic development of economy, 22(5), 738–765.
Kou, G., Peng, Y., & Wang, G. (2014). Evaluation of clustering algorithms for financial risk analysis using MCDM methods. Information Sciences, 275, 1–12.
Kumar, A., Ozdamar, L., & Zhang, C. N. (2008). Supply chain redesign in the healthcare industry of Singapore. Supply Chain Management: An International Journal.
Kusi-Sarpong, S., Gupta, H., Khan, S. A., Chiappetta Jabbour, C. J., Rehman, S. T., & Kusi-Sarpong, H. (2019). Sustainable supplier selection based on industry 4.0 initiatives within the context of circular economy implementation in supply chain operations. Production Planning & Control.
Labanauskaitė, D., Fiore, M., & Stašys, R. (2020). Use of E-marketing tools as communication management in the tourism industry. Tourism Management Perspectives, 34, 100652.
Langvinienė, N. (2014). Changing Patterns in the Health Tourism Services Sector in Lithuania. Procedia - Social and Behavioral Sciences, 156, 310-316. doi:https://doi.org/10.1016/j.sbspro.2014.11.194
Lee, C. G. (2010). Health care and tourism: Evidence from Singapore. Tourism Management, 31(4), 486–488. doi:https://doi.org/10.1016/j.tourman.2009.05.002
Lee, T. J., Lim, H., & Kim, D. (2020). Relationships between the motivation of medical tourists and the quality of medical services. International Journal of Tourism Research, 22(6), 693–710.
Loh, C.-P. A. (2015). Trends and structural shifts in health tourism: Evidence from seasonal time-series data on health-related travel spending by Canada during 1970–2010. Social Science & Medicine, 132, 173–180. doi:https://doi.org/10.1016/j.socscimed.2015.03.036
Lv, Z., & Jiang, L. (2023). Is tourism effective in mitigating the shadow economy in developing countries? Evidence from China. Asia Pacific Journal of Tourism Research, 28(2), 101–110. https://doi.org/10.1080/10941665.2023.2207689
Mahdiraji, H. A., Zavadskas, E. K., Arab, A., Turskis, Z., & Sahebi, I. G. (2021). Formulation of Manufacturing Strategies Based on an Extended Swara Method With Intuitionistic Fuzzy Numbers: An Automotive Industry Application. Transformations in Business & Economics, 20(2).
Majeed, S., Lu, C., & Javed, T. (2017). The journey from an allopathic to natural treatment approach: A scoping review of medical tourism and health systems. European Journal of Integrative Medicine, 16, 22-32.
Malviya, R. K., & Kant, R. (2018). Prioritising the solutions to overcome the barriers of green supply chain management implementation: a hybrid fuzzy AHP-VIKOR framework approach. Journal of Decision Systems, 27(4), 275–320.
Mardani, A., Nilashi, M., Zakuan, N., Loganathan, N., Soheilirad, S., Saman, M. Z. M., & Ibrahim, O. (2017). A systematic review and meta-Analysis of SWARA and WASPAS methods: Theory and applications with recent fuzzy developments. Applied Soft Computing, 57, 265–292.
Masoomi, B., Aghajani, H., Jafarnejad, A., & Movahedi, M. M. (2023). Expert oriented hybrid approach for modeling coordination motivators in humanitarian supply chain: Managerial implications to actors’ coordination enhancement. International Journal of Disaster Risk Reduction, 97, 104013.
Masoomi, B., Sahebi, I. G., Fathi, M., Yıldırım, F., & Ghorbani, S. (2022). Strategic supplier selection for renewable energy supply chain under green capabilities (fuzzy BWM-WASPAS-COPRAS approach). Energy Strategy Reviews, 40, 100815.
Masoomi, B., Sahebi, I. G., Gholian-Jouybari, F., Mejia-Argueta, C., & Hajiaghaei-Keshteli, M. (2024). The role of internet of things adoption on the sustainability performance of the renewable energy supply chain: A conceptual framework. Renewable and Sustainable Energy Reviews, 202, 114610.
Masoomi, B., Sahebi, I. G., Kumar, A., Ghobakhloo, M., & Iranmanesh, M. (2025). Industry 5.0 and opportunities for promoting supply chain sustainability: the study of the renewable energy industry. Technology in Society, 103023.
Mathijsen, A. (2019). Home, sweet home? Understanding diasporic medical tourism behaviour. Exploratory research of Polish immigrants in Belgium. Tourism Management, 72, 373–385.
Medical Tourism Magazine. (2020). Nuclear Questions AsideIran Opens Arms to Medical Tourism. Medical Tourism Magazine.
Mishra, A. R., & Rani, P. (2018). Interval-valued intuitionistic fuzzy WASPAS method: application in reservoir flood control management policy. Group Decision and Negotiation, 27(6), 1047–1078.
Mishra, A. R., Rani, P., Pardasani, K. R., & Mardani, A. (2019). A novel hesitant fuzzy WASPAS method for assessment of green supplier problem based on exponential information measures. Journal of cleaner production, 238, 117901.
Moghadam, M. R. S., Sahebi, I. G., Masoomi, B., Azzavi, M., Anjomshoae, A., Banomyong, R., & Ractham, P. (2022). Modeling IoT enablers for humanitarian supply chains coordination.
Momeni, K., Janati, A., Imani, A., & Khodayari-Zarnaq, R. (2018). Barriers to the development of medical tourism in East Azerbaijan province, Iran: A qualitative study. Tourism Management, 69, 307–316. doi:https://doi.org/10.1016/j.tourman.2018.05.007.
Nilashi, M., Samad, S., Manaf, A. A., Ahmadi, H., Rashid, T. A., Munshi, A., . . . Hassan Ahmed, O. (2019). Factors influencing medical tourism adoption in Malaysia: A DEMATEL-Fuzzy TOPSIS approach. Computers & Industrial Engineering, 137, 106005. doi:https://doi.org/10.1016/j.cie.2019.106005
Patil, S. K., & Kant, R. (2014). A fuzzy AHP-TOPSIS framework for ranking the solutions of Knowledge Management adoption in Supply Chain to overcome its barriers. Expert systems with applications, 41(2), 679–693.
Perçin, S. (2019). An integrated fuzzy SWARA and fuzzy AD approach for outsourcing provider selection. Journal of Manufacturing Technology Management.
Prajapati, H., Kant, R., & Shankar, R. (2019). Prioritizing the solutions of reverse logistics implementation to mitigate its barriers: A hybrid modified SWARA and WASPAS approach. Journal of cleaner production, 240, 118219.
Prakash, C., & Barua, M. (2015). Integration of AHP-TOPSIS method for prioritizing the solutions of reverse logistics adoption to overcome its barriers under fuzzy environment. Journal of Manufacturing Systems, 37, 599–615.
Qureshi, M. I., Hassan, M. A., Hishan, S. S., Rasli, A. M., & Zaman, K. (2017). Dynamic linkages between sustainable tourism, energy, health and wealth: Evidence from top 80 international tourist destination cities in 37 countries. Journal of Cleaner Production, 158, 143–155. doi:https://doi.org/10.1016/j.jclepro.2017.05.001
Raoofi, S., Khodayari-Zarnaq, R., Ghasemyani, S., Hamidi, H., & Vatankhah, S. (2021). Barriers of medical tourism development in Iran. Anatolia, 1–13.
Ridderstaat, J., Singh, D., & DeMicco, F. (2019). The impact of major tourist markets on health tourism spending in the United States. Journal of Destination Marketing & Management, 11, 270–280. doi:https://doi.org/10.1016/j.jdmm.2018.05.003
Rokni, L., Turgay, A., & Park, S. H. (2017). Barriers of developing medical tourism in a destination: A case of South Korea. Iranian journal of public health, 46(7), 930.
Sahebi, I. G., Edalatipour, A., Dabaghiroodsari, M., Hasheminasab, S. M. H., Masoomi, B., & Kamali, S. E. (2025). Navigating the AI-powered transformation of renewable energy supply chains: A strategic roadmap to digitainability. Energy for Sustainable Development, 85, 101663.
Sahebi, I. G., Masoomi, B., Gholian-Jouybari, F., & Hajiaghaei-Keshteli, M. (2025). Overcoming challenges in the path to a hydrogen economy for energy supply chain transition. Applied Energy, 393, 126084.
Sarkis, J., Zhu, Q., & Lai, K.-h. (2011). An organizational theoretic review of green supply chain management literature. International journal of production economics, 130(1), 1–15.
Savaşan, A., Yalvaç, M., & Tuncel, E. (2017). Statistical reasoning for developing an attitude scale for health tourism stakeholders in North Cyprus context. Procedia Computer Science, 120, 196–203. doi:https://doi.org/10.1016/j.procs.2017.11.229
Sayili, M., Akca, H., Duman, T., & Esengun, K. (2007). Psoriasis treatment via doctor fishes as part of health tourism: A case study of Kangal Fish Spring, Turkey. Tourism Management, 28(2), 625–629. doi:https://doi.org/10.1016/j.tourman.2006.08.010
Shaaban, N., Nojavan, M., & Mohammaditabar, D. (2019). A fuzzy hybrid approach for ranking and allocation of flare gas recovery methods: A case study of refineries in Iran. Kybernetes.
Skountridaki, L. (2017). Barriers to business relations between medical tourism facilitators and medical professionals. Tourism Management, 59, 254-266.
Suess, C., Baloglu, S., & Busser, J. A. (2018). Perceived impacts of medical tourism development on community wellbeing. Tourism Management, 69, 232–245. doi:https://doi.org/10.1016/j.tourman.2018.06.006
Szymańska, E. (2015). Construction of the Model of Health Tourism Innovativeness. Procedia - Social and Behavioral Sciences, 213, 1008–1014. doi:https://doi.org/10.1016/j.sbspro.2015.11.518.
Tadić, S., Zečević, S., & Krstić, M. (2018). Assessment of the political city logistics initiatives sustainability. Transportation research procedia, 30, 285–294.
Tapper, R., & Font, X. (2004). Tourism supply chains. Report of a Desk Research Project for the Travel Foundation. Tourism supply chains. Report of a Desk Research Project for the Travel Foundation.
Trabandt, M., Lasarov, W., & Viglia, G. (2024). It’s a pleasure to stay sustainably: Leveraging hedonic appeals in tourism and hospitality. Tourism Management, 103, 104907. https://doi.org/10.1016/j.tourman.2024.104907
Turskis, Z., Goranin, N., Nurusheva, A., & Boranbayev, S. (2019). A fuzzy WASPAS-based approach to determine critical information infrastructures of EU sustainable development. Sustainability, 11(2), 424.
Turskis, Z., Zavadskas, E. K., Antucheviciene, J., & Kosareva, N. (2015). A hybrid model based on fuzzy AHP and fuzzy WASPAS for construction site selection. International Journal of Computers communications & control, 10(6), 113-128.
Wamboye, E. F., Nyaronga, P. J., & Sergi, B. S. (2020). What are the determinant of international tourism in Tanzania? World Development Perspectives, 17, 100175. doi:https://doi.org/10.1016/j.wdp.2020.100175
Wamboye, E. F., Nyaronga, P. J., & Sergi, B. S. (2020). What are the determinants of international tourism in Tanzania? World Development Perspectives, 17, 100175.
Yadav, G., Seth, D., & Desai, T. N. (2018). Prioritising solutions for Lean Six Sigma adoption barriers through fuzzy AHP-modified TOPSIS framework. International Journal of Lean Six Sigma.
Yu, K., Gong, R., Li, R., Hu, S., & Luo, Y. (2018). Discussing the Performance of Medical Ecology System in Tourism Development with Data Envelopment Analysis. Ekoloji, 27(106), 793–798.
Zarbakhshnia, N., Soleimani, H., & Ghaderi, H. (2018). Sustainable third-party reverse logistics provider evaluation and selection using fuzzy SWARA and developed fuzzy COPRAS in the presence of risk criteria. Applied Soft Computing, 65, 307–319.
Zavadskas, E. K., Antucheviciene, J., Hajiagha, S. H. R., & Hashemi, S. S. (2014). Extension of weighted aggregated sum product assessment with interval-valued intuitionistic fuzzy numbers (WASPAS-IVIF). Applied Soft Computing, 24, 1013–1021.
Zavadskas, E. K., Turskis, Z., Antucheviciene, J., & Zakarevicius, A. (2012). Optimization of weighted aggregated sum product assessment. Elektronika ir elektrotechnika, 122(6), 3-6.
Zolfani, S. H., & Saparauskas, J. (2013). New application of SWARA method in prioritizing sustainability assessment indicators of energy system. Engineering Economics, 24(5), 408–414.
 
Industrial Management Journal
Volume 18, Issue 1
2026
Pages 136-161

Files

Share

How to cite

Statistics