**1. Introduction**

The international medical tourism is the voluntary mobility of patients to foreign countries searching affordable and high‐quality treatments. The growing need to meet the demand for medical procedures outside the country of origin due to local market failures has increased the international mobility, through agreements between insurance companies and the travel of particular patients who seek healthcare procedures in many cases without knowing the legal and physical risks. The travel of patients also obeys to competitive advantages that each country develops and that patients can identify. The travel to developing countries is due to the low prices and lower legal restriction of medical procedures against developed countries.

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2018 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

In the case of Colombia, the patients come mainly from the United States, Canada, Aruba, the Antilles, and Panama looking for procedures in cardiology, urology, orthopedics, and cosmetic surgery at lower prices than in their countries of origin. The private sector has been the main protagonist of the industry growth limiting the role of the central government to a regulator of medical services that are offered to national and foreign patients. The dynamics of the local industry has followed the model of Porter [1] in which competitiveness is an end in itself and the government has a limited role in the industry's international competitiveness. However, under the current model, the medical industry has not had enough incentives or spaces to position its offer of medical procedures abroad. The shortage of stimuli ranges from the limited tax and nontax incentive's policy for the construction of clinics of high complexity, to limited spaces for dialog between the central government and the health sector operators.

This chapter analyzes the role of the central government of Colombia in the promotion and posi‐ tioning of medical tourism based on the Porter model and proposes the application of the sys‐ temic competitiveness model of associative character based on Rugman and Cruz [2] approach as an alternative view for the integral improvement of the industry. This study based on a mixed method begins with the dynamic's description of Colombian medical tourism industry. Next, the main theories of competitiveness are detailed from the traditional view of Porter to the alter‐ native approaches of competitiveness with an associative character. Then, the role of the central government in the promotion and strengthening of the national industry through the efficiency of executive orders under the traditional competitiveness model is studied.

Also, the potential effects of the implementation of the systemic competitiveness approach in the Colombian medical tourism are analyzed through an experiment that compares the perception of quality of medical services to 200 foreign patients, of whom 100 were attended in clinics with public support of the local governments following the systemic competitive‐ ness approach, and the other 100 were attended in clinics that do not have such support. The purpose of this experiment is to identify if a governmental support for the promotion and positioning of medical services in Colombia improves the perception of quality by foreign patients. This chapter ends by mentioning some recommendations for the national govern‐ ment to improve the Colombian medical tourism from a systemic competitiveness perspective that integrates more agents in the industrial dynamic. The general objective of this research is to analyze the role of the national authority in the promotion and improvement of medical services through the vision of systemic competitiveness as a more efficient form of sectorial development.

The specific objectives are to study the actions of the central government to develop the sector and determine through a statistical experiment if the application of systemic competitiveness approach improves the perception of quality of foreign patients. The hypothesis that will be verified is that the implementation of the vision of systemic competitiveness improves the industry from a more active role of the national government. The instruments for conduct‐ ing this study were a survey of quality perception to 200 foreign patients who consumed medical procedures in accredited and nonaccredited clinics, executive orders of the central government of Colombia that establish the route map of the industry and consulting reports describing the international medical tourism market and the Colombian case.

This research contributes to analyze the Colombian medical tourism industry under the tradi‐ tional vision of competitiveness of Porter and determine the role of the national government in the improvement of healthcare services for foreign patients through the systemic competi‐ tiveness approach based on a mixed methodology.
