Medical tourism research in Poland: a scoping review

Medical tourism in Poland is quite firmly anchored in science and business. This is evident both through the initiative-taking efforts of medical service institutions that effectively cater to travelers, and through research. The medical tourism market in Poland is influenced by several factors. On one hand, it is shaped by Poland’s domestic context, while on the other it is also sensitive to global dynamics. These external and internal factors contribute to its rapid evolution. Polish researchers find these processes particularly intriguing. Poland is considered one of the preferred and selected medical tourism destinations (MTDs) in Central and Eastern Europe (CEE) (Białk-Wolf, 2022a; Lubowiecki-Vikuk and Dryglas, 2019a), alongside Czechia, Slovakia, and Hungary (Lubowiecki-Vikuk and Kurkowiak, 2017).

The aim of this article is to map knowledge of and outline directions for the development of medical tourism research in Poland. The following research questions (RQs) were identified in relation to this aim:

In simple terms, medical tourism is understood as one of three interrelated forms of health tourism (e.g. Lubowiecki-Vikuk, 2012; Rab-Przybyłowicz, 2014), each of which has a health function (Białk-Wolf, 2022b; Borek, 2013; Klich, 2022; Rudzińska, 2017). In other words, health tourism is any kind of “travel of 24 h or more away from one’s place of residence in order to regenerate health (…), correct beauty, and undergo treatments and operations in clinics recruiting patients through tourism advertising” (Łęcka, 2003, pp. 174–175); and is an umbrella term for the three mentioned forms. The range of healthcare services provided in medical tourism may overlap with both therapeutic/spa tourism and wellness tourism (Dryglas, 2018).

An important feature of medical tourism is the invasive medical services provided to the patient/medical tourist (Lubowiecki-Vikuk, 2016b). However, medical tourists also use the services of psychologists or psychiatrists (Orzechowski, 2019; Rab-Przybyłowicz, 2016), which by their nature are not considered invasive services. Other non-invasive services in medical tourism include diagnosis, prevention, and rehabilitation (Lubowiecki-Vikuk and Dryglas, 2019b). The providers of medical tourism determine the framework of medical tourism. These are the locations where healthcare services are provided, typically encompassing private hospitals, medical centers, or individual medical practices. The latter, along with specialized clinics, can offer a form of medical tourism known as circumvention tourism (Bartłomiejczyk and Pollabauer, 2022), based on controversial medical services such as abortion, reproductive services (Sánchez et al., 2022), euthanasia, transplantation, or oncology services. In addition, there is still an ongoing debate and dilemma (e.g. Białk-Wolf and Arent, 2018; Biernat et al., 2020), on how to treat those medical tourists who use healthcare services by combining them, for example, with vacation (medication) or visits to friends and relatives’ (VFR). Overall, medical tourism serves various purposes, including seeking treatment, rehabilitation, undergoing controversial procedures, or pursuing in vitro procedures (IVF tourism). The inclusion of rehabilitation in this context is essential because, unlike therapeutic/spa tourism, it requires specialized training for its proper execution (Figure 1).

In the creation of niche tourism products, including medical tourism (Sánchez et al., 2022), changing consumer behavior requires that the polymotivation of tourists be considered (Khalilzadeh et al., 2024). The difficulty for researchers is, for example, that consumers of dental services who spend less than 24 h in another city/region/country still have to be still considered medical tourists. Although, from an economic point of view, a patient could be considered a medical tourist (Biernat et al., 2020; Kachniewska, 2018), formally this type of consumer is (or is not due to imprecise statistics) classified as a day visitor.

The above dilemmas in defining the medical tourism are not unique. Connell (2013) pointed out the problems of determining what medical tourism is in general. Connell’s reflections show that most definitions (the simplest explanations) are distorted, minimalist or underdetermined. In his view, “no agreed definition of medical tourism therefore exists and no loose umbrella term is wholly adequate” (Connell, 2013, p. 5). In our view, even formulating the defining member (definiendum) creates a dilemma. In addition to medical tourism, there are definiendums such as “(medical) health-care tourism,” “medical-health-wellness tourism,” “health tourism,” “global healthcare,” “mobile patient tourism,” “medical/medi wellness tourism,” “medical travel,” “surgical tourism,” and “tourism with health benefits.”

Polish researchers also face the challenge of defining medical tourism. Although the definition is dominated by the social science perspective, especially in the discipline of economics, the perspective of fields within the medical and health sciences is also emerging. Research on medical tourism in Poland was initiated at the beginning of the 21st century. During this period, a sub-market of health tourism began to emerge. This period (2003–2023) can be divided into two decades.

In the first decade of research (2003–2013), Polish researchers emphasized that medical tourism only concerns people who travel abroad to consume selectively specific services, e.g. plastic surgery and dental services (Klich, 2008). In one approach, Mruk (2009) suggested that medical tourism could refer to the migration of doctors. Subsequently, this aspect has not been followed up in research, which may be because the World Tourism Organization (UN Tourism) does not recommend the inclusion of for-profit travel in tourism. Similarly, saving a patient’s health (Białk-Wolf, 2010) was not included in further research on medical tourism. This aspect has dominated the analysis of mobile patient flows, e.g. in cross-border healthcare (Kowalska-Bobko et al., 2016). In contrast, Polish researchers have emphasized leisure aspects of medical tourism, i.e. opportunities to visit tourist facilities and attractions alone or with accompanying medical tourists. This aspect was later confirmed by foreign researchers (Baydeniz et al., 2024). Polish researchers representing disciplines of economics and/or management also highlighted the business dimension of medical tourism. They emphasized the organization and handling of medical tourism traffic, pointing to price and quality, and offshoring of medical services, as leading elements of the competitiveness of private hospitals/clinics and factors attracting medical tourists to Poland (e.g. Białk-Wolf, 2010; Liberska, 2012).

In the second decade of research (2014–2023), the definition of medical tourism by Polish researchers was also expanded. It was noted that medical tourism, in addition to foreign travel, can also include domestic travel or even, as Panasiuk (2017), pointed out, short distances from the country of residence. According to research in Poland, in addition to domestic medical tourists (Lubowiecki-Vikuk, 2021), citizens of neighboring countries, e.g. Germany, have used health services (e.g. Dryglas and Lubowiecki-Vikuk, 2019a; Lubowiecki-Vikuk and Rab-Przybyłowicz, 2015; Pforr et al., 2020). Polish medical tourism is of interest to residents of the United Kingdom, Denmark, Sweden, Norway, and other European, and non-European countries (e.g. Białk-Wolf et al., 2016; Boguszewicz-Kreft et al., 2019; Dryglas and Lubowiecki-Vikuk, 2019b). A considerable proportion of foreign medical tourists in Poland are Polish diaspora (e.g. Main, 2014; Mathijsen and Dziedzic, 2024).

The Polish researchers’ definitions of medical tourism cited in Table A1 sometimes present the inadequacy of definitions of medical tourism. Some definitions of medical tourism are too broad or too narrow, i.e. the scope of the definiens is wider or narrower than the scope of the definiendum. Sometimes they are even pseudo-definitions, i.e. explaining the issue by giving an example. Some of these definitions are vague, which does not contribute to the precision of the defining member (definiens) medical tourism. Over the past two decades, Polish researchers’ approach to explaining the concept of medical tourism has clearly evolved. Their explanations have become increasingly detailed, although certain elements continue to be duplicated.

Although the researchers’ perspectives on what medical tourism is point to the scientific disciplines represented, they do not really differ much from each other. It can be argued that there is a consensus among researchers that medical tourism is related to the movement of medical tourists to obtain medical services outside their place of permanent residence. Nuances in the definition arise when some researchers try to explain definies from the perspective of a medical tourist, whose intentions may vary. Researchers discuss the scope of medical services provided and their duration. Some Polish researchers focus on one or more aspects when defining medical tourism:

• (1)

  Economic – by pointing out the relationship between price and quality of medical services, constituting a sub-market and identifying the players in it.

• (2)

  Spatial – pointing out that medical tourism involves voluntary and temporary change of permanent residence. In this aspect, doubts still arise as to how much tourism is in “medical tourism” and how it differs from medical travel.

• (3)

  Organizational – referring to the material and technical conditions and service within healthcare and/or in connection with the tourism industry.

• (4)

  Marketing – highlighting the attributes of a medical tourism product or MTD.

Definitions are not the most important in science (e.g. Butler, 2023). However, it is important to try to explain what this medical tourism is. It is unlikely that the formulation of a standard, explicit or contextual definition of medical tourism will be expected (Connell, 2013). The issue of medical tourism is strongly linked to practice (Białk-Wolf, 2019, 2022a) and is constantly changing, which also influences the scope of medical services provided, their accessibility, the type of medical tourism providers, etc. The complex and entropic nature of medical tourism (Lubowiecki-Vikuk, 2021) requires researchers to define the criteria for the ontological and epistemological assumptions of medical tourism. This was attempted in the first decade of research. With the development of more mature projects (second decade), the efforts of Polish researchers are noticeable. However, they are still based on a conventional and practical understanding of medical tourism. Although most of the research approaches are interdisciplinary in nature, which should be seen as an asset, it makes it more difficult to understand the nature of medical tourism. At present, Polish and international researchers (e.g. Mason, 2023; Puczkó, 2022) are unable to reach a consensus on the definition of medical tourism, which makes it difficult to set directions for research approaches.

Bibliometrics is used the most for performance analysis and science mapping (Donthu et al., 2021; Lim et al., 2022). Although it is increasingly being used to review the literature on medical tourism (e.g. Asa et al., 2024; Campra et al., 2022), to date it has not been extended to include analysis of Polish scientific studies. To date, bibliometric analyses in the field of medical tourism have typically covered one or two international databases (Scopus and/or Web of Science, WoS) and focused on articles written exclusively in English. It seems important that the bibliometric analysis refers to relevant scientific publications, i.e. articles, monographs, chapters, or dissertations written in a language other than English.

The first step was to search for publications in the international databases Scopus, WoS and Google Scholar. The query was formulated with the keyword “medical tourism,” and the authors’ origin was restricted to “countries/regions: Poland.” In this way, a total of 72 publications were identified (after removing duplicates). At this stage, after reviewing the abstracts of the articles, 23 publications on topics unrelated to medical tourism were excluded from the results. In the next stage, additional databases were searched, such as BazEkon, Nauka Polska (Polish Science) and Biblioteka Nauki (Library of Science), using keywords in both English “medical tourism,” and Polish “turystyka medyczna.” Business guides were excluded. The result was 97 articles, which were included in the further analysis of the bibliographic data of the publications. Content analysis was conducted using VOSviewer, a robust tool for visualizing and analyzing complex bibliometric and scientometric data. VOSviewer facilitates the exploration of scholarly literature and research landscapes by creating insightful visual representations of relationships between documents, authors, keywords, and other relevant elements.

In the search of the databases, only scientific publications published up to the year 2023 were accepted for the bibliometric analysis.

A bibliographic search of the scientific output of Polish medical tourism researchers yielded 97 publications. In the years 2003–2023, numerous articles, five monographs, and chapters and conference papers were published. Open access publications include four doctoral theses and two industry reports signed by a Polish government organization and a local government authority. In the early years of the reference period, including a four-year break (2004–2007), there were no more than two publications (Figure 2). Only from 2012 onwards did the annual number of publications start to increase, reaching 11 in 2015 and a peak of 12 in 2019.

Articles by Polish researchers can be found in a wide variety of journals, both Polish and foreign. Individual articles were published for example in Tourism Management, Tourism Review, Globalization and Health, and the Journal for East European Management Studies. Most articles by Polish researchers were published in journals such as:

• (1)

  Ekonomiczne Problemy Usług-Economic Problems of Services (University of Szczecin Press) – five articles.

• (2)

  Folia Turistica (University of Physical Education in Krakow) – four articles.

• (3)

  Health Policy (Elsevier) and Rozprawy Naukowe Akademii Wychowania Fizycznego we Wrocławiu-Scientific Treatises of University School of Physical Education in Wrocław – three articles in each journal.

Considering the number of authors who published their own research results (empirical or theoretical), 104 individuals were identified who were affiliated with a Polish university or other institution active in the field of medical tourism. Figure 3 clearly shows the largest bubble, which means that Lubowiecki-Vikuk is the most prolific author. The authors were grouped into 38 clusters, including eight double clusters (with two co-authors) and 18 single clusters (with one author) (Figure 3).

Among the remaining 12 clusters, there were six clusters with a number of co-authors of six or more; two clusters were formed by co-authors from the field of medical sciences and four from the field of social sciences (economics or management). The last three clusters of connections between medical tourism researchers in Poland in the years 2003–2023 are created by Polish authors, including transcultural researchers – leaders collaborating with foreign researchers in the second decade of the analyzed period. Some clusters indicate the interdisciplinary nature of the collaboration between the authors. In addition to representatives of economics and management disciplines, there are also researchers from fields such as biology, health sciences, physical culture, pharmaceutical sciences, and sociology. One of the clusters under Dziedzic’s leadership had strong inter-university co-operation at national level.

Lubowiecki-Vikuk (SGH Warsaw School of Economics), Rab-Przybyłowicz (independent researcher), Białk-Wolf (Proturmed Foundation) and Boguszewicz-Kreft (WSB Merito University Gdansk) are among the leading Polish authors. According to the H-index of the Scopus database, three of the authors have a moderate international reputation, i.e. Lubowiecki-Vikuk – 9, Boguszewicz-Kreft – 5, Białk-Wolf – 2 and Dziedzic – 2.

Table 1 presents the most frequently cited publications according to Publish or Perish. Taking into consideration additional international scientific databases, they show that the most frequently cited article by a Polish researcher is the text by Mathijsen (2019). Other authors noted the first monograph in Poland on the development of a medical tourism product (Rab-Przybyłowicz, 2014). The monograph authored by Rab-Przybyłowicz was based on her doctoral thesis (Rab-Przybyłowicz, 2013). This thesis included an analysis of the development of medical tourism in Szczecin. Szczecin, along with its surrounding area in the West Pomeranian Voivodeship, holds a unique position concerning the advancement of medical tourism and its influence on structural changes within health tourism. This assertion is further supported by another dissertation (Biernacka, 2022).

Based on the visualizations generated by VOSviewer, five thematic clusters can be identified from the literature on medical tourism in Poland (Figure 4). Each cluster represents a distinct thematic area, and the use of different colors helps delineate specific discussion topics. This approach facilitates a deeper understanding of the prevalent issues within scientific discourse related to medical tourism in Poland.

The globalization and the legal frameworks facilitating cross-border treatment constitute key aspects within the first cluster “Global aspects of medical tourism” (red) of achievements in Polish research on medical tourism. This cluster pertains to legal and organizational aspects, encompassing terms such as “care,” “directive,” “implementation,” “treatment,” “health,” and “patient.” Additionally, it addresses issues related to “globalization” and “government.” This suggests that Polish literature delves into the legal framework of medical tourism, including the implementation of EU directives and the feasibility of cross-border healthcare concepts within the Polish context. The cluster directs attention to the benefits and challenges faced by patients seeking treatment outside their country of residence. Furthermore, it underscores the role of the state and globalization as factors supporting the development of Poland as an MTD. Healthcare system deficiencies play a significant role in shaping the landscape of medical tourism.

Kowalska-Bobko et al. (2016) as well as Sztorc (2017) deal with the implementation of the cross-border directive in Poland. They stated that the implementation of legislation regarding cost reimbursement and prior authorization in Poland is highly restrictive. Its primary objectives are either to delay public payer expenses or to discourage patients from seeking care abroad or domestically. Unfortunately, the Polish government and the Ministry of Health, as key stakeholders, appear to have neglected the potential financial advantages that could arise from promoting Poland as a health tourism destination. Meanwhile, patients and healthcare providers had limited influence on the policy-making process. The low uptake of the directive and the limited awareness surrounding it was confirmed. However, its relevance to medical tourism in Europe remains marginal (e.g. Azzopardi-Muscat et al., 2018). Research by Matulka-Kacprzak (2019) on medical tourism also commenced with the cross-border directive, which allowed Poles to seek treatment funded by the Polish healthcare system in other countries. The study investigates how foreign treatment for Poles enhances accessibility, particularly in the context of cataract removal services. These services were previously difficult to obtain through treatment reimbursed by the National Health Fund in Poland. Similarly, Pforr et al. (2020) and Białk-Wolf (2022b) explore the effects of medical tourism on the national healthcare system. Dziedzic (2018) identifies two distinct approaches in the development of medical tourism. In the first approach, the private sector takes the lead, with the government assuming a coordinating role during the advanced stage of development. In contrast, the second approach involves the government taking the initiative in developing medical tourism and playing an active leadership role from the early stages.

The second cluster “Medical tourist” (yellow) comprises studies that have extensively explored the consumer perspective and behavior within the medical tourism market. Boguszewicz-Kreft (2017) has identified five significant research gaps within the domain of medical tourism: the quantity and direction of international movements, the characteristics of consumers, consumers’ behavior and experience in the market of medical tourism, the contributions of different stakeholders in decision-making processes, and ethical and legal considerations. Her later work addresses and explores several of these research gaps. Boguszewicz-Kreft et al. (2019) discovered that the willingness to purchase medical services varies based on the country of service origin, the country’s influence, and the consumer’s background. However, this study had limitations, including a sample of 264 young respondents (students) from three countries, whose health needs may not have reflected real-world demand for medical services. The theory of planned behavior, which predicts human behavior based on intentions, was validated by Boguszewicz-Kreft et al. (2020) on the medical tourism market. Notably, a consumer’s country of origin significantly influences their intention to use medical tourism services. Furthermore, risk perception plays a crucial role (Boguszewicz-Kreft et al., 2022). Respondents’ attitudes toward medical tourism services correlate strongly with the perceived risk. This correlation is moderated by risk awareness, risk aversion, and gender. It can be assumed that the age and experience of respondents could impact the research outcomes in the field of medical tourism. Kordasiewicz (2022) asserts that a multidimensional approach to the client—considering their expectations and requirements—is decisive for the success of medical services. This study examines organizational maturity, emphasizing how important it is for medical tourism. The experiences of individual purchasers of medical tourism services and their links to marketing factors are a subject addressed in Lubowiecki-Vikuk’s (2021) monograph. This made it possible to identify segments on the Polish medical tourism market (Lubowiecki-Vikuk, 2021, 2024a) that refer to the publications of international researchers.

The consumer perspective is also the starting point of Main’s (2014) research, who argues that the principal reasons for medical travel to Poland of Polish women migrants are the lower costs of private treatment, the easy access to specialized healthcare, and personal comfort derived from linguistic and cultural competency. Mathijsen (2019) found a similar approach when researching the Polish diaspora in Belgium. Four motivational factors affect these behaviors: time availability, relative cost, shopping for the best quality, and cultural affinity. The Polish diaspora was also the subject of a quantitative study by Mathijsen and Dziedzic (2024). Contrary to previous research suggesting that diasporic medical tourism responded mostly to cultural factors, this research confirmed that both commercial and non-commercial factors were important for behavioral intention.

The next cluster “Development of medical tourism” (blue) encompasses papers that describe medical tourism as a form of health tourism, emphasizing the factors contributing to its development. These papers rely on illustrative examples and draw from global literature. Among the earliest studies on this topic, dating back to 2010 (Białk-Wolf, 2010), the level of knowledge at that time can be observed. Subsequent papers frequently reference this foundational work (Wiśniewska, 2020). The most recent study, conducted in 2020, further contributes to our understanding of medical tourism. The monograph of Biernat et al. (2020) provides valuable insights for policymakers, healthcare professionals, and researchers interested in understanding the multifaceted nature of medical tourism. They emphasize a crucial fact, that there are no uniform definitions and international measurement standards that hinder the assessment of the magnitude of this trend and any comparisons between individual countries.

Additionally, research related to innovation can also be incorporated within this domain. In line with expectations, the financial impact of innovations is a crucial measure when assessing the effects of health tourism. This finding emerged from research on the innovativeness of health tourism services (Panfiluk and Szymańska, 2017).

An interesting area of research in this cluster is the work that highlights the controversial aspects of medical tourism. Although not grounded in primary data, these considerations are intriguing from a theoretical standpoint (Kowalska, 2016). Research has shown that the most important factors in the development of controversial aspects of medical tourism are regulations, advances in the field of transport and information and communication technology, medical developments, and lifestyle changes. The most significant areas of controversy concern abortion tourism, transplant tourism, euthanasia tourism, and reproductive tourism (Machnik and Lubowiecki-Vikuk, 2020). However, in addition to the areas mentioned, other manifestations of medical tourism, such as dental, surgical, or pharmaceutical tourism, can also be observed due to economic, religious, cultural, social, and moral factors (Lubowiecki-Vikuk, 2024a). A separate area is devoted to articles addressing current trends in medical tourism (Borek et al., 2023; Rab-Przybyłowicz, 2016; Sánchez et al., 2022), while, given the dynamic situation in the market, they are relevant for a limited time.

Destination management and the state of medical tourism in various regions fall within the scope of the fourth cluster (green) “Poland as a medical tourism destination.” Most studies analyze Poland as an MTD. Among those that focus on individual regions, the largest number of studies concentrate on the West Pomeranian Voivodeship (Biernacka, 2022; Rab-Przybyłowicz, 2013). Additionally, two studies specifically explore the Pomeranian Voivodeship (Białk-Wolf, 2014, 2019). When considering the first area, it is worth noting works assessing Poland’s attractiveness in the opinion of foreign tourists (Dryglas and Lubowiecki-Vikuk, 2019a, b). The study’s findings indicate that tourists from Western Europe are currently more interested in utilizing medical services in CEE countries than in the past. Out of CEE countries, Poland was the most frequently chosen destination for medical tourism (MTD). Associations with Poland as an MTD are influenced by socio-demographic factors such as age and nationality. Before visiting Poland, the respondents perceived the country through the prism of medical attributes, whereas after the visit, they perceived it through the prism of non-medical attributes. The study conducted by Kachniewska (2018) on motivators of participation in inbound medical tourism to Poland revealed that variations in patients’ motivating factors significantly impact their attitudes toward the role and quality of tourism agents’ services. The research identified three primary components—treatment-related, economic, and travel-related—that explain patients’ motivation to travel for medical treatment. Lubowiecki-Vikuk and Dryglas (2019a) showed that foreign patients express an interest in medical tourism services which are not limited to major cities but extend to locations within 100 kilometers of an airport. All CEE countries can also be regarded as destinations. The results indicated that the chosen destinations and medical services vary depending on gender, age, and nationality (Lubowiecki-Vikuk and Dryglas, 2019b).

The cooperation in the regions is discussed in the context of clusters (e.g. Haberla and Kuźmińska-Haberla, 2015). These works represent theoretical reflections on the advantages of this form of cooperation, which are difficult to deny. However, the conclusions they contain appear to diverge from the actual actions of medical institutions in Poland, as these institutions have not yet taken concrete steps in this direction.

Polish authors’ studies infrequently incorporate case studies of medical tourism development in other countries. However, the study by Bajgier-Kowalska et al. (2016) on South Korea stands out as an exception. When examining the international determinants of medical tourism development in South Korea, particular emphasis is placed on government support. Strategic intervention through promotional tools can make MTDs more competitive. South Korea, an intriguing country, is becoming increasingly important in the field of medical tourism. This article serves as the basis for identifying the fifth cluster, “Medical tourism destinations worldwide”, of medical tourism research among Polish authors. This cluster is highlighted in purple.

The number of publications by Polish researchers over the 20 years analyzed is at a similar level to other countries, such as China. The increase in publications is visible in the second decade of this period (2014–2023), especially in 2019, as in the case of Chinese medical tourism researchers (Li et al., 2023; Zhong et al., 2023). Comparable results were obtained from the analysis of bibliographic data of international publications, except that, apart from 2017 and the 2019, the highest increase in publications was recorded in 2021 (Dhakate et al., 2023; Habibi et al., 2022). It can be assumed that the COVID-19 pandemic and the consequences (e.g. lockdown, limited or suspended tourist traffic, sanitary regime and limited work of doctors) severely limited the possibilities of Polish researchers to conduct empirical research, which could have resulted in a decline in the number of publications after 2020.

Polish medical tourism researchers rarely publish research results in international scientific journals, which certainly translates into a small number of citations. On the one hand, there is a need for closer international cooperation, especially in the years 2014–2023, and for joint research in which medical tourism in Poland will be a context for solving serious scientific problems. On the other hand, not all of the published articles are considered to make a serious contribution to medical tourism research. Some published studies appear to be fragmentary or causal in nature (Lubowiecki-Vikuk, 2016a). They are not supported by robust conclusions derived, for example, from a systematic literature review, or the methodology is quite sparse.

Polish medical tourism researchers come from the fields of economics, management, or medicine and health sciences. This is a worldwide manifestation of collaboration between researchers in the health sciences and other researchers in tourism research (Wen et al., 2024). Considering international and leading researchers in this field, and geographers (e.g. Valorie A. Crooks, John Connell and Meghann Ormond) who study the spatial dimension of medical tourism in the socio-economic context, Polish researchers emphasize more the business or health dimension of medical tourism. These two dimensions may be an appropriate direction for further research on medical tourism, where the research gap will concern economics, management or health sciences, and the context will be the conditions for the development of medical tourism in Poland.

Bibliometrics is no substitute for extensive reading (e.g. Donthu et al., 2021) on medical tourism research (Campra et al., 2022; Dhakate et al., 2023). When focusing on the content analysis of articles, certain regularities can be observed. The content analysis of the articles reveals that medical tourism, as a research topic, is approached in two distinct ways. On one hand, authors examine this tendency itself; on the other hand, they utilize medical tourism as an illustrative example in other contexts. The second approach entails several risks, but this does not automatically imply that the research lacks value. As emphasized by Matulka-Kacprzak (2019), medical tourism is highly complex. These connections are evident in the works of Klich (2022) and Białk-Wolf (2022b). However, studying the trends in this domain in isolation from the broader context and practice may yield inconclusive results. It is crucial to consider factors such as the medical industry, tourism, cultural context, ethics, research methodology, and the specific role of respondents’ experiences.

The lack of definitional consistency is not merely a theoretical concern; it results in specific variations in research outcomes and has practical implications. Relying on inaccurate data leads to false or, at the very least, inadequate conclusions. Quoting unverified sources is also a problem. Additionally, data related to the number of tourists presents a well-recognized challenge (Białk-Wolf and Arent, 2018). The next important observation is that most of the research focuses on medical inbound tourism. However, there are exceptions. For instance, Matulka-Kacprzak (2019) and, to some extent, Klich (2022) and Białk-Wolf (2022b), address this phenomenon by considering international flows.

Directions for further research follow directly or indirectly from the clusters identified, with some overlap.

In line with the trend of research on the tourism economy in the context of sustainable development, Polish researchers also discuss sustainable health tourism (Szromek et al., 2023), including medical tourism (Lubowiecki-Vikuk and Machnik, 2020; Machnik and Lubowiecki-Vikuk, 2020; Wiśniewska, 2021). They try to create conceptual models of sustainable medical tourism based on innovation, embedding the development of medical tourism and its products in social, economic, and environmental conditions. At the present stage, this topic has not been sufficiently researched by Polish economists and requires further serious study. This is important because, for example, the Polish medical tourism business can be a framework for discussions in this direction. Poland is a specific context of (contested) ethical, moral, religious, economic, legal, and socio-cultural obligations of entities operating in the medical tourism market to maintain a balance between medical tourists, the local community, employees of the medical tourism industry, and the environment. Many questions arise, such as to what extent does the medical tourism industry contribute to health inequalities in society? How is the medical tourism industry moving towards a more sustainable and resilient industry?

The second direction of medical tourism research is the experience of a medical tourist (Dabaghi et al., 2022). Polish researchers representing the management discipline also began to try to resolve this issue (Lubowiecki-Vikuk, 2021, 2022). This is a forward-looking direction, as the components of a medical tourist’s holistic experience may constantly change (e.g. touchpoints), especially if the stages before, during and after the experience are considered (Cham et al., 2022). Moreover, emotions would need to be captured in the holistic medical tourist experience (e.g. Rasoolimanesh et al., 2025). The transformation of experience is an additional factor in answering the question: How will the components of a medical tourist’s holistic experience change over time, and how can this experience be measured taking into account the medical tourist’s emotions? To what extent does the measurement of the holistic experience of medical tourists and their emotions translate into effective customer experience management?

The third area of emerging issues in medical tourism research is “perceived value” (Chhabra et al., 2021) and “destination image” (Cham et al., 2022). The image of Poland as a MTD and the attributes of this image were analyzed both from the perspective of medical tourists’ opinions, including from Germany and the UK (Dryglas and Lubowiecki-Vikuk, 2019a), as well as from the perspective of international medical tourism experts (Lubowiecki-Vikuk, 2021). Other studies focused on the perception of the city of Krakow as a MTD, which resulted in the recognition of medical tourism as a strategic tourism product of Krakow (Lubowiecki-Vikuk and Dryglas, 2019a). However, knowledge among domestic and foreign medical tourists about the role of brand image and trust in the hospital/clinic brand and the Polish MTD is still limited. However, “perceived value,” exclusively as a benefit in the form of value for money (affordability), was the subject of research on the determinants of diasporic medical tourism using the example of Polish people living in Belgium (Mathijsen and Mathijsen, 2020), who reported savings on dental treatment and orthodontics (Mathijsen, 2019). The full scope of “value perception” requires further research, to understand how domestic and foreign medical tourists perceive the benefits and burdens of choosing a specific medical tourism offer, including the role of non-medical support services.

The fourth direction of research on medical tourism may be informal communication between consumers (medical tourists) via the Internet (eWOM) (Mason, 2023), which has not attracted the interest of Polish researchers so far. Attention should also be paid to the robotic-WOM to determine the effectiveness of the communication.

The COVID-19 pandemic played a key role in advancing digital health and the adoption of new technologies, especially telemedicine. Notably, these developments have significantly impacted medical tourism (Chhabra et al., 2021). Consequently, a key area for exploration in the field of medical tourism pertains to its potential growth facilitated by the increasing digitization of healthcare services and the use of artificial intelligence (AI) (e.g. Ediansyah et al., 2023). So far, Polish medical tourism researchers have not addressed the ethical and safety issues, and other challenges of using AI in medical tourism. An important question is: How might AI impact healthcare in a specific MTD?

The above-mentioned directions of research on medical tourism do not exhaust the list of research gaps that have not yet been addressed. Most of them relate to marketing and management in medical tourism (Lubowiecki-Vikuk, 2024b), which is a challenge for Polish researchers representing this discipline. Key issues are the supply side of the medical tourism market (Ediansyah et al., 2023), such as implementing resilience strategies (Mohammadipour and Mazroui Nasrabadi, 2024) and improving the efficiency of processes to increase the satisfaction of medical tourists, doctors, staff and owners, while ensuring sustainability.

It is also recommended that researchers use mixed methods more often in research projects or, in the case of quantitative research, validated measurement scales (e.g. Alp and Yılmaz, 2024; Ghosh and Mandal, 2019; Lubowiecki-Vikuk, 2022). Generalizing about medical tourism is essential for the development of medical tourism research.

A limitation of this article is the nature of the analysis conducted, which does not refer to the scientific quality of the articles selected, a consequence of the method used.

This review uses bibliometric analysis to map current knowledge arising from publications of Polish researchers. Medical tourism is an area of interest for people in various scientific disciplines, especially the social sciences. This interdisciplinary approach to research does not lend itself to a single, universally accepted definition of medical tourism. Terminological issues are still the subject of lively academic debate and international research. Nevertheless, Poland is an example of an MTD where research is being conducted into the image of the destination and the characteristics that determine its attractiveness. Issues concerning the Polish diaspora play an important part in the worldwide study of medical tourism. This group of medical tourists constitutes a distinct segment with specific characteristics. However, the research findings related to Poland can be applied to diasporas from other countries, as the distinguishing characteristics of this segment are believed to be universal.

This review of publications from the past 20 years sheds light on how academic efforts have progressed, and the challenges arising and research tasks necessary for the future. There is no doubt that Polish researchers need to delve deeper into the difficult issues surrounding the controversial issue of medical tourism. According to research by de la Hoz-Correa et al. (2018, p. 207), the sphere of “sensitive practices in medical tourism” including assisted reproduction, will be among the most relevant themes in the future. However, this poses a particular challenge in a country such as Poland, where right-wing views and the strong role of the Catholic Church significantly impact women’s reproductive issues.

There are also practical implications practical implications of our review. Firstly, they provide a coherent picture of the medical tourism market in Poland, where the most important groups of medical tourists come from Germany, the United Kingdom, and the Polish diaspora. These groups are the most frequently studied by Polish researchers. Clinics wishing to serve foreign patients should therefore focus on these markets. Secondly, the results of the research can provide valuable information on consumer behavior in the market. In particular, the research work included in the second cluster, “Medical tourist,” has a practical dimension here. Knowing the motivations of patients and the factors that influence the choice of destination means that the product range can be tailored more effectively. Understanding the factors contributing to the development of medical tourism, as described in the work included in the third cluster, “Development of medical tourism,” makes it easier for local and regional governments to support the development of this form of tourism. Another important practical implication stems from the research on destinations (fourth cluster “Poland as a medical tourism destination”). These are useful for those dealing with promotion and building clusters. With knowledge from research on this topic, it is easier to avoid mistakes that prevent effective cooperation. Finally, this article identifies areas of research on medical tourism, which can provide valuable guidance to those dealing with the issue in practice, by pointing out important sources of information of interest.

Research on medical tourism in Poland is aligned with global trends in tourism research. Polish researchers explore the relationship between medical tourism and sustainable development, design medical tourist experiences, and investigate the impact of artificial intelligence on medical tourism. However, compared to global research (de la Hoz-Correa et al., 2018), Polish studies on medical tourism are less frequently connected to healthcare and ethics. This discrepancy may be attributed to broader cultural factors. Polish scholarly research rarely includes case studies on the development of medical tourism in foreign countries.