Document Type : Research Paper


1 Department of Industrial Engineering, Faculty of Technology and Engineering, East of Guilan, University of Guilan, Rudsar-Vajargah, Iran.

2 Department of Industrial Engineering, Iran University of Science and Technology, Tehran, Iran.


The aim of this paper is to propose a mathematical model for two dental centers in a competitive market of dental tourism. Dental tourists are looking for cheaper treatment with proper quality, and dental centers are looking to maximize their profits by providing services to tourists. Government also monitors dental centers by setting tariffs (subsidies or taxes). This problem is modeled and solved in the form of Stackelberg (or Leader-Follower) game. The government as the leader determines the amount of tariffs and then the dental centers as the followers simultaneously determine the price and quality level of their services. To solve the game, first the equilibrium values related to the price and quality level of the services of the dental centers have been calculated by Nash equilibrium. Then, according to the equilibrium values obtained for dental centers, the optimal amount of tariffs are calculated. Finally, to clarify the proposed model a numerical example is provided and sensitivity analysis is performed on some parameters. In this paper, for the first time a mathematical model is developed for pricing and determining the quality of services in a competitive market of dental tourism. The obtained results indicate that increasing the amount of subsidy will lead to a decrease in the prices of service provided by the dental centers. Moreover, by increasing the amount of subsidies allocated to the dental centers, the government can expand the dental tourism industry.


Main Subjects

  1. Connell, J. (2013). Contemporary medical tourism: conceptualisation, culture and commodification. Tourism management34, 1-13.
  2. Allied Market Research. (2020). Medical tourism market by treatment type: global opportunity analysis and industry forecast, 2019–2027. Retrieved from
  3. Ghosh, T., & Mandal, S. (2019). Medical tourism experience: conceptualization, scale development, and validation. Journal of travel research58(8), 1288-1301.
  4. Lwin, H. N. N., Punnakitikashem, P., & Thananusak, T. (2021). The level and determinants of international patient satisfaction with dental tourism in Bangkok, Thailand. Cogent business & management8(1), 1898316.
  5. Medical Tourism Association (2020). Medical tourism index. Retrieved from
  6. Cavmak, D., & Cavmak, S. (2020). Using AHP to prioritize barriers in developing medical tourism: case of Turkey. Int J Travel Med Glob Health8(2), 73-79.
  7. Goodrich, J. N., & Goodrich, G. E. (1987). Health-care tourism—an exploratory study. Tourism management8(3), 217-222.
  8. Milstein, A., & Smith, M. (2006). America's new refugees—seeking affordable surgery offshore. New England journal of medicine355(16), 1637-1640. DOI: 1056/NEJMp068190
  9. Connell, J. (2006). Medical tourism: sea, sun, sand and… surgery. Tourism management27(6), 1093-1100.
  10. Sarwar, A. A., Manaf, N. A., & Omar, A. (2012). Medical tourist’s perception in selecting their destination: a global perspective. Iranian journal of public health41(8), 1-7.
  11. Musa, G., Doshi, D. R., Wong, K. M., & Thirumoorthy, T. (2012). How satisfied are inbound medical tourists in Malaysia? a study on private hospitals in Kuala Lumpur. Journal of travel & tourism marketing29(7), 629-646.
  12. Ahmadimanesh, F., Paydar, M. M., & Asadi-Gangraj, E. (2019). Designing a mathematical model for dental tourism supply chain. Tourism management75, 404-417.
  13. Zarei, A., & Maleki, F. (2019). Asian medical marketing, a review of factors affecting Asian medical tourism development. Journal of quality assurance in hospitality & tourism20(1), 1-15.
  14. Nilashi, M., Samad, S., Manaf, A. A., Ahmadi, H., Rashid, T. A., Munshi, A., ... & Ahmed, O. H. (2019). Factors influencing medical tourism adoption in Malaysia: a DEMATEL-fuzzy TOPSIS approach. Computers & industrial engineering137, 106005.
  15. Ashiti, S., & Moshkun, C. (2021). Dental tourists: treat, re-treat or do not treat? British dental journal230(2), 73-76.
  16. Lunt, N., Horsfall, D., & Hanefeld, J. (2016). Medical tourism: a snapshot of evidence on treatment abroad. Maturitas88, 37-44.
  17. Bies, W., & Zacharia, L. (2007). Medical tourism: outsourcing surgery. Mathematical and computer modelling46(7-8), 1144-1159.
  18. Smith, P. C., & Forgione, D. A. (2007). Global outsourcing of healthcare: a medical tourism decision model. Journal of information technology case and application research9(3), 19-30.
  19. Bagga, T., Vishnoi, S. K., Jain, S., & Sharma, R. (2020). Medical tourism: treatment, therapy & tourism. International journal of scientific & technology research9(3), 4447-4453
  20. Çapar, H., & Aslan, Ö. (2020). Factors affecting destination choice in medical tourism. International journal of travel medicine and global health8(2), 80-88. DOI: 34172/ijtmgh.2020.13
  21. Ghasemi, P., Mehdiabadi, A., Spulbar, C., & Birau, R. (2021). Ranking of sustainable medical tourism destinations in Iran: an integrated approach using fuzzy SWARA-PROMETHEE. Sustainability13(2), 683.
  22. Hunjet, A., Kustelega, L., & Kozina, G. (2018). Development of dental tourism in Croatia. 35th international scientific conference on economic and social development – "sustainability from an economic and social perspective" (pp. 307-325). Lisbon.
  23. Peručić, D. (2019). Limitations and development opportunities of dental tourism: the case of Croatia. Ekonomski vjesnik32(1), 93-104.
  24. Nexhipi, O. (2018). Medical tourism management challenges-the case of dental tourism in Albania. European journal of interdisciplinary studies4(1), 80-86.
  25. Akbar, F. H., Pasinringi, S., & Awang, A. H. (2019). Factors affecting dental center service quality in Indonesia. Pesquisa brasileira em odontopediatria e clínica integrada19.
  26. Wang, J. H., Feng, H., & Wu, Y. (2020). Exploring key factors of medical tourism and its relation with tourism attraction and re-visit intention. Cogent social sciences6(1), 1746108.
  27. Uğurluoğlu, Ö., Ürek, D., & Demir, İ. B. (2019). Evaluation of individuals’ satisfaction with health care services in Turkey. Health policy and technology8(1), 24-29.
  28. Aljumah, A., Nuseir, M. T., & Islam, A. (2020). Impacts of service quality, satisfaction and trust on the loyalty of foreign patients in Malaysian medical tourism. International journal of innovation, creativity and change11(2), 451-467.
  29. Jaleel, A. A., Khatibi, A., & Azam, S. M. (2021). Structural equation modelling the interrelationships between service quality, customer satisfaction and behavioural intention among Maldivians seeking medical tourism services. International journal of innovation, creativity and change, 15(3). DOI: 53333/IJICC2013/15308
  30. Sangeetha, S. (2021). Service quality of medical tourism in tamilnadu. PalArch's journal of archaeology of egypt/egyptology18(4), 5742-5748.
  31. Park, J. K., Ahn, J., Han, S. L., Back, K. J., & An, M. (2020). Exploring internal benefits of medical tourism facilitators’ satisfaction: customer orientation, job satisfaction, and work performance. Journal of healthcare management65(2), 90-105. DOI: 1097/JHM-D-18-00168
  32. Mahmud, M. S., Rahman, M. M., Lima, R. P., & Annie, E. J. (2020). Outbound medical tourism experience, satisfaction and loyalty: lesson from a developing country. Journal of hospitality and tourism insights, 4(5), 545-564.
  33. Asgarnezhad Nouri, B., Nemati, V., & Abbasgholizadeh, N. (2019). The effect of perceived value on the destination image, satisfaction and loyalty of medical tourists: a case study in Ardabil. Journal of health10(1), 34-49.
  34. Akbar, F. H., Pasiga, B. D., Samad, R., Rivai, F., Abdullah, A. Z., Pasinringi, S. A., ... & Pratiwi, D. (2020). The relationship between service quality, culture similarity to satisfaction and loyalty of medical (dental) tourism. Systematic reviews in pharmacy11(12), 19-30.
  35. Luo, J. Y. N., Liu, P. P., & Wong, M. C. M. (2018). Patients’ satisfaction with dental care: a qualitative study to develop a satisfaction instrument. BMC oral health18(1), 1-10.
  36. Robustin, T. P., Andi, R., Suroso, I., & Yulisetiarini, D. (2018). The contribution of tourist attraction, accessibility and amenities in creating tourist loyalty in Indonesia.  Bus. Econ. Review3(4), 92-98.
  37. Elrod, J. K., & Fortenberry, J. L. (2018). Establishing Good Samaritan programs in healthcare institutions: a method for enhancing patient experiences and increasing loyalty. BMC health services research18(3), 9-16.
  38. Jiang, H., Pang, Z., & Savin, S. (2020). Performance incentives and competition in health care markets. Production and operations management29(5), 1145-1164.
  39. Brekke, K. R., Siciliani, L., & Straume, O. R. (2017). Hospital mergers with regulated prices. The Scandinavian journal of economics119(3), 597-627.
  40. Brekke, K. R., Siciliani, L., & Straume, O. R. (2017). Horizontal mergers and product quality. Canadian journal of economics/revue canadienne d'économique50(4), 1063-1103.
  41. Badri, S. A., Ghazanfari, M., & Shahanaghi, K. (2014). A multi-criteria decision-making approach to solve the product mix problem with interval parameters based on the theory of constraints. The international journal of advanced manufacturing technology70(5), 1073-1080.
  42. Edalatpanah, S. A. (2019). A data envelopment analysis model with triangular intuitionistic fuzzy numbers. International journal of data envelopment analysis7(4), 47-58. (In Persian).
  43. Soltani, M. R., Edalatpanah, S. A., Sobhani, F. M., & Najafi, S. E. (2020). A novel two-stage DEA model in fuzzy environment: application to industrial workshops performance measurement. International journal of computational intelligence systems13(1), 1134-1152.
  44. Badri, S. A., Daghbandan, A., Aghabeiginiyay Fatalaki, Z., & Mirzazadeh, M. (2021). Flow shop scheduling under Time-Of-Use electricity tariffs using fuzzy multi-objective linear programming approach. Journal of mathematical modeling9(2), 215-227. DOI: 22124/jmm.2020.16104.1406
  45. Peykani, P., Hosseinzadeh Lotfi, F., Sadjadi, S. J., Ebrahimnejad, A., & Mohammadi, E. (2021). Fuzzy chance-constrained data envelopment analysis: a structured literature review, current trends, and future directions. Fuzzy optimization and decision making, 1-65.
  46. Peykani, P., Mohammadi, E., & Emrouznejad, A. (2021). An adjustable fuzzy chance-constrained network DEA approach with application to ranking investment firms. Expert systems with applications166, 113938.
  47. Peykani, P., Mohammadi, E., Saen, R. F., Sadjadi, S. J., & Rostamy‐Malkhalifeh, M. (2020). Data envelopment analysis and robust optimization: a review. Expert systems37(4), e12534.
  48. Peykani, P., Mohammadi, E., Jabbarzadeh, A., Rostamy-Malkhalifeh, M., & Pishvaee, M. S. (2020). A novel two-phase robust portfolio selection and optimization approach under uncertainty: a case study of Tehran stock exchange. Plos one15(10), e0239810.