13 selleck kinase inhibitor To ensure a transparent process, we will develop a summary table specifying the authors, objectives, type of study, different methodological aspects and study country.13 Data extraction The documents included in the review will be compiled in Excel. The variables extracted will be (1) author and year of publication; (2) patient sending and receiving countries; (3) the socioeconomic and political contextual variables influencing decisions to seek healthcare abroad (at country, health system and individual level); (4) beliefs, values, desires and cognitive processes influencing behaviour (mechanisms) and (5) outcomes.

Data synthesis The analytical framework developed in the first step will be used to analyse the data, and will be further specified in an iterative manner, in order to integrate new explanatory elements categories. Each primary

study will be examined for evidence based on how it supports, refutes, reinterprets or refocuses the novice theories developed in the first step, looking at how each study contributes to refining the initial theory. In this way, using an abductive approach, that is combining methods of inductive and deductive analytical processes to developing theory, it will be possible to specify C-M-O configurations, with each study helping to clarify or reformulate the C-M-O configurations, in order to take into account potential contradictory elements. Following the RAMESES guidelines, the intent will not be to provide a quantifiable summary of the abstracted variables but rather to interrogate the interaction between context, mechanism and outcomes. Validity The construction of explanations to make ‘sense’ of patient mobility, through an iterative process between empirical data and construction of C-M-O configurations, enhances internal validity, as does the use of an appraisal tool for quality assessment. The inclusion of context in our analysis increases the generalisation potential of the study. Further, the theories generated by the review will be examined Brefeldin_A by the review group, and will help to fill any gaps in the published

literature.26 An audit trail will be maintained to help ensure transparency. Ethics As the study does not involve primary research, it does not require formal ethical approval. The study will, however, follow the relevant standards of utility, usefulness, feasibility, propriety, accuracy and accountability.40 Discussion Significance of the proposed research Cross-border healthcare has implications for health equity. While there have been several studies looking at medical tourism, few studies have considered how market failure contributes to patient cross-border movement in LMICs. The results of the proposed research will be useful to health policy makers in increasing utilisation of domestic health services.