31 Demand-side factors are those factors that influence demand and operate at the individual, household EPZ-5676 leukemia or community

level.32 One demand-side barrier is the affordability, or cost, of healthcare services and products.33–36 Costs include formal and informal charges, as well as opportunity costs.35 36 Other demand-side barriers relate to accessibility, including distance and access to transport, and adequacy and acceptability, in terms of perceptions of quality of care.36 Another demand-side determinant relates to consumer satisfaction. This refers to consumer attitudes towards healthcare services, based on past contact with healthcare services.33 34 It includes perceived convenience of care, coordination and cost, courtesy of health staff, information given

to the patient about dealing with illness, and subjective assessment of the quality of the care received.33 Demand is also influenced by perceptions of illness and need, and willingness to seek services.32 Availability can also act as a demand-side barrier, particularly in LMICs, where a patient’s choice concerning the range of healthcare goods and services is limited by supply creating demand, rather than vice versa. Availability, however, may also be a supply-side determinant.10 36 Supply-side determinants of healthcare services are those that arise from the healthcare production function, and that interact to produce effective healthcare services.10 32 Supply-side factors relate to (1) the quality

of staff, and include whether they speak the same language as the target population, their availability to provide services, and their ability to treat certain conditions; (2) the quality and availability of buildings, technology and equipment; (3) the price, availability and quality of consumables and (4) the quality of management.32 Together, demand-side and supply-side factors result in a demand for healthcare of a given quality that is determined by individual and community factors, and the cost of healthcare and related goods.10 23 32 Based on the above, we propose that, in some LMIC markets, the interaction between demand-side and supply-side determinants results in market imperfections that, in turn, lead to patient movement across borders. This working theory is illustrated in figure 1. Figure 1 Preliminary theory. The theory will then be examined Entinostat using a realist mode of analysis involving the concepts of C-M-O configuration. The outcome of interest is utilisation of healthcare services across geopolitical state borders. Based on this preliminary scoping of the literature, we aim to further elucidate: (1) a theory of domestic health system failure and its relationship to patient movement across borders; (2) the identification of the contextual factors that influence patients to cross international borders and (3) the effects of patient movement across borders. This will be done in an exploratory, non-exhaustive and inductive manner.