“HEXAL Model” How It Can Collaborate With Health Service Providers and Travel Medicine

International medical travel (IMT), which is also known as medical tourism, has had many definitions throughout the past few years such as: “movements by persons from one country to another to obtain healthcare services.”1,2 The factors showing why people undertake IMT are often divided into push and pull factors. The push factors include the structural attributes between the “sending” and “receiving” countries,2 which include the costs of healthcare in their own country,3 avoiding waiting lists,4,5 escaping regulations and access to experimental or non-standard treatments.6 In contrast, the pull factors include the complicated motivations of individuals conditioned by cultural, linguistic and religious factors.7,8 Nowadays, the trend to travel internationally and abroad has increasingly grown. The development of air transportation has ensured that more than 700 million people currently travel internationally each year to every part of the world.9 Travel medicine which is also known as medical tourism, plays a tremendous role in the future of global medical care.10 Travel medicine tries to prevent illnesses and injuries occurring to travelers going abroad and manages problems arising in travelers coming back or coming from abroad.11 This is all due to the growth of technology, economy and other global relations.11 Globally speaking, medical tourism has become one of the fastest growing tourism sectors throughout the world with many countries strategically planning for their economic expansion.12 This significant growth in medical tourism has been facilitated by the rise of http://ijtmgh.com Int J Travel Med Glob Health. 2017 June;5(2):38-40 doi 10.15171/ijtmgh.2017.08


Introduction
International medical travel (IMT), which is also known as medical tourism, has had many definitions throughout the past few years such as: "movements by persons from one country to another to obtain healthcare services." 1,2 The factors showing why people undertake IMT are often divided into push and pull factors.The push factors include the structural attributes between the "sending" and "receiving" countries, 2 which include the costs of healthcare in their own country, 3 avoiding waiting lists, 4,5 escaping regulations and access to experimental or non-standard treatments. 6In contrast, the pull factors include the complicated motivations of individuals conditioned by cultural, linguistic and religious factors. 7,8Nowadays, the trend to travel internationally and abroad has increasingly grown.The development of air transportation has ensured that more than 700 million people currently travel internationally each year to every part of the world. 9Travel medicine which is also known as medical tourism, plays a tremendous role in the future of global medical care. 10Travel medicine tries to prevent illnesses and injuries occurring to travelers going abroad and manages problems arising in travelers coming back or coming from abroad. 11This is all due to the growth of technology, economy and other global relations. 11Globally speaking, medical tourism has become one of the fastest growing tourism sectors throughout the world with many countries strategically planning for their economic expansion. 12This significant growth in medical tourism has been facilitated by the rise of

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International air travel has increased during the recent century, and the number of pregnant women who travel internationally by air is on the rise.Most pregnant women are able to fly safely, but general considerations must be taken into account.Prior to traveling, pregnant women should be assessed for gestational age, fetus and placenta status, blood group and Rh status by laboratory evaluation or with diagnostic ultrasound imaging.The Center for Disease Control and Prevention (CDC) recommends that pregnant women travelers carry a copy of their medical records with them on their trip. 1 The latest recommendation of the ACOG indicates that occasional travel by air during pregnancy is safe.Specifically, occasional air travel by women with a singleton pregnancy can be done until 36 weeks gestation.Women with an uncomplicated multiple pregnancy are allowed to fly up to the end of the 32nd week.As emergencies usually happen in the first and third trimesters, the safest time to travel is probably the middle of the pregnancy, between 14-18 weeks. 2,3lmost all women with a normal pregnancy can travel without limitation up to 28 weeks, but there are few contraindications for air travel, including obstetric complications, severe anemia (Hb<7.5 g/dL), recent hemorrhage, sickle cell anemia, acute otitis media and sinusitis, uncontrolled cardiac or respiratory disease, and a post-operative condition as with recent gastrointestinal surgery. 3lthough air travel is safe, there are specific risks during pregnancy.The incidences of miscarriage and preterm birth are greater among flight attendants than the general population.Exposure to cosmic radiation is not hazardous to the fetus for the occasional pregnant air traveler.One other concern is venous thromboembolism for which flight duration is a key factor.Air travel of more than 4 hours at a time may increase the risk of venous thromboembolism, but this is a weak risk factor.Immobility during long flights can lead to such a condition. 4,5here are some general suggestions for the pregnant traveler to minimize the risk of an adverse outcome related to air travel during pregnancy.Before planning to travel, women should check the airline's policy about air travel during pregnancy.The traveler's seat belt should be closed during a flight, and unnecessary traffic should be avoided.Because of the necessity of take occasional walks, pregnant women should have an aisle seat to facilitate movement.Women should drink plenty of fluids to avoid dehydration.][3] the internet and the emergence of healthcare intermediaries or medical tourism facilitators between international patients and hospital networks. 13Incredible advances in technology along with affordable travelling offers have significantly brought advantages to the global tourism industry. 14As seen in many parts of the world, medical tourism is resulting from the globalization of healthcare and tourism itself constituting extreme economic potential for the global economy. 15,16It is obvious that one of the most important sectors which are playing a tremendous role in medical tourism are the health care providers. 17he biggest and most effecting health care providers all around the world are hospitals."A hospital is a health care institution, providing patient treatment with specialized staff and equipment." It is said that hospitals are one of the most critical organizations in every society. 18

Methods
Regarding the above mentioned facts, a theory has been presented to help these organizations coordinate and direct much more effectively in compared to the past.It is noticeable to mention that this theory can help health care providers to gain a more sustainable position in order to develop medical tourism in their centers.
The dimensions of this theory include the mother, father, sister, brother, step sister and other relationship dimensions which are described as follows.
Mother: In this category, a bigger hospital exists which provides methods to other centers.The other centers are much smaller but provide similar services.It is actually said that the bigger hospital supports the other centers both for their human and financial resources.
Father: In this type of categorization, all the hospitals are the same.All of them have a main center which enables them at the same time.This center is a hyper or huge hospital which enables the others.This is while these centers do no support the other hospital as regards to their needed human resources and also their financial resources.
Sister: These centers do not have a role in each other's creation, but they play a role in enabling and especially in supporting.
Brother: These centers do not have a role in creation but do play a role in enabling each other.For example they help in education fields, exchanging lecturers and students.In the meanwhile, in case of the occurrence of bankruptcies in any center, the other centers are not responsible for supporting the specific center.
Step Sister: These centers help each other in limited areas.This collaboration is usually due to some similarities in these centers.For example, like when specific physicians are present in two hospitals at the same time.The concentration in these kind of collaborations is basically support and it is said that this is due to the common sides that exist in organizations.These type of collaborations are made for further alliance and correlations.
In order for 2 cities to become step sisters, similarities are needed to be provided between them.For example, 2 historical cities, 2 scientific cities, 2 port cities and so on.The development of tourism in between 2 step sister cities and also naming the streets and roads of those cities from the other city is the result of naming 2 cities as step sisters.After the revolution, Tehran became the step sister of Bishkek, the capital of Kyrgyzstan for the first time.
Other relationships: Another type of relation is when organizations are neither involved in creation nor in support.These organizations have an extremely weak role of empowerment along with a much weaker role in supporting each other.For example, a medical team travel once a year from Germany to Iran for about a one-month period for different intentions and goals.Some of these intentions and goals have a financial base and the others have a charitable base.

Results
The major aspects of this model have been designed according to the relationships which exist in families.These relationships include parents, children and others.Each of these aspects have been divided into 2 segments which are female and male.These aspects play their roles in 3 different dimensions.As shown in the HEXAL model, these dimensions are: support, enabling and creation (Table 1).In this model, a parent is an organization which has main roles of creation and support in both the male and female gender, whereas the enabling dimension is only considered in the female segment.

Discussion
The Apollo Hospitals model is an Indian Healthcare Center Chain (HCC).It was first established in 1983 between India, Kuwait, Qatar, and Bangladesh.Hospital networks are the networks or groupware relations between the hospitals that work together in order to coordinate and deliver a broad spectrum of services to their community.These health care systems which are more than two hospitals owned, sponsored, or contract managed by a central organization. 19he Hannover-Tehran Hospitals is one of the samples of the Hexal Model definition which was established in the field of neuroscience by Professor Majid Samii. 20he Avicenna clinics are another example of the HCC models which has been introduced in the medical tourism field.These clinics could also be defined according to the Hexal Model. 5Actually, it could be mentioned that the Hexal Model can help promote some aspects of HCC, especially in ethical values. 20y analyzing some health service center websites and their constructions, the HEXAL model can help develop and practice between them. 21Hence, the hospitals should design their websites according to a hierarchical construction because in order to avoid the confusion of patients.It also discusses the criteria of constructing outstanding hospital websites by hospital research bases according to knowledge

Table 1 .
HEXAL ModelConclusionWhile travelling, tourists may face several difficulties either physical or spiritual.It can be concluded that by using this model, health service providers can collaborate much more effectively.As a result, medical tourists and even other tourists can experience much more satisfying trips throughout their lives.