**6. Recommendations for the application of the systemic competitiveness model at national level**

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 the care of foreign patients.

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 training programs [31].

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 following objectives:


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 JCI and GHAP.

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. This has accelerated the consumption of healthcare services of foreign patients and increased the quality of medical procedures through international accreditations different from JCI and GHAP.

On the other hand, the healthcare cluster located in the free‐tax zone in Barranquilla has an international support office for patients who want to know more about the medical procedures offered, which provides information on the requirements that the government of Colombia demand to grant a visa to consume medical procedures in the country, and facilitate the communication between the physician in the country of origin who know the health situation of the patient with the physician in Barranquilla in charge of the medical procedure.
