**7. Conclusion**

**6. Recommendations for the application of the systemic** 

Non‐Accredited group 0.154 0.650 Accredited group 0.206 0.307

The implementation of the systemic competitiveness model goes through a greater syn‐ ergy between the objectives of the central government and the clinics of high complexity through spaces of dialog. Given that, the proposed model is based on involving nonstate agents and that the government adopts a more active role toward the international posi‐ tioning of the industry. De la Puente [14], Arias et al. [25] propose to expand the figure of clusters in health services in order to generate integral spaces of medical attention to for‐ eign patients in which the central government contributes with the improvement of exog‐ enous variables such as integral security, use of public spaces, and training programs for

**Statistical value P values**

According to the Productive Transformation Program [5], a successful case of creating a health cluster was the private "Travel Medic" initiative that, through the collaboration of related companies (hotels, clinics, financial support from public and private banks for investment in nontraditional sectors, and medical schools) was coordinated for the creation of technical

The Travel Medic Association was born from the initiative of six companies from the city of Manizales belonging to the health, hotel, and tourism sector, which were united in the

• To provide healthcare services based on physicians and nurses who speak English, high

• To internationalize the services for each of the founding companies as a strategy of expan‐

The Productive Transformation Program [5] also recommends the expansion of free‐tax zones as spaces with lower direct taxes in exchange for the settlement of clusters and clinics that are suitable for the attention of national and foreign patients accredited internationally by both

One notorious case is the permanent free‐tax zone located in the city of Barranquilla, which offers health services such as pediatric, vascular, and esthetic care for adults and newborns, cardio‐ pulmonary rehabilitation, preventive medicine program, preanesthetic and diagnostic services, among others. Inaugurated in 2013, has 112 beds, 164 offices, and specialized diagnostic centers.

technology, and competitive prices; in addition to first‐class hotel care;

**competitiveness model at national level**

138 Mobilities, Tourism and Travel Behavior - Contexts and Boundaries

the care of foreign patients.

**Table 4.** Normality test result.

training programs [31].

following objectives:

JCI and GHAP.

sion and growth in other markets.

Medical tourism in Colombia is a still incipient industry with prospects of growth in cities with greater adaptation of their clinics for the medical care of foreign patients. Under the cur‐ rent model of competitiveness, there are three administrative strategies that are implemented in an isolated way that although they focus on improving variables such as that the physicians and nurses speak English fluently or strengthen the strategic alliances between the national and foreign clinics so the industry has more international recognition, the role of the central government is limited and not focused on the industry needs.

Through a statistical analysis applied to patients who consumed medical procedures in accredited and nonaccredited clinics, it was found that those in which local governments act more actively to improve the quality of medical services and support the obtaining of interna‐ tional accreditations of health centers, have a higher quality of services offered than those that do not. In other words, the implementation of the systemic competitiveness model implies a better quality of medical procedures offered abroad.

The implementation of the proposed model is based on more than just the generation of spaces for investment in the construction of clinical infrastructure, such as a more active role of the central government so the exogenous variables that create a better quality of medical procedures such as security, adaptation of public spaces, and tax deduction incentives rise the quality of medical services offered abroad. In that sense, tax‐free zones, clusters, and the com‐ bination of medical procedures with tourist activities increase the possibilities of international positioning of the Colombian medical tourism.
