Table 5. External Factors Affecting Shiraz Medical Tourism Industry .

Weighted score	Score	Index	Main Internal Factors	Subthemes	Themes
22.64	3.83	5.91	Adjacency to the Persian Gulf states, with which we share a common religion and a sense of cultural affinity and the more solid ties among people form Shiraz living in these countries	Socio-cultural	Opportunities
17.94	3.17	5.67	Geographical location, mild climate and historical, religious and natural sites in Shiraz
13.13	2.67	5	Foreign students in Shiraz and their familiarity with Shiraz healthcare services	Technology
16.61	3.17	5.24	Relative improvement of the diplomatic relations of Iran, stable inflation in the country over the recent years, and the facilitation of the arrival of tourists to Shiraz	Political
26.46	4	6.61	Iran’s national security, hence Shiraz’s
11.86	2.50	4.74	The lack of legislation prohibiting the advertisement of medical services in foreign countries
14.80	2.83	5.22	The poor quality of service delivery in other countries and aging in countries with weak health systems	Competitive
15.73	3	5.24	Lack of security in rival countries regarding healthcare services
19.27	3.33	5.78	Shiraz fame in the international communities
17.22	2.83	6.08	Expensive medical and tourism services in competitor countries
8.85	2.67	3.32	Immigration of experienced medical professionals to other countries	Socio-cultural
11.22	2.33	4.81	Lack of trust in Iranian planes	Technology
11.05	2.50	4.42	Expensive medical services following the implementation of the Relative Tariffs Services	Economic
15.40	3	5.13	Weaknesses in Iran’s international relations with certain countries, political instability at the Ministry of Foreign Affairs in different governments, uncertainty as to entering the medical tourism industry, economic and banking sanctions against Iran	Political	Threats
11.75	2.17	5.42	Legal, welfare, and religious restrictions and regional unrest for tourists, especially medical ones
12.73	2.67	4.77	Negative publicity in other countries as to Iran’s security	Political	Threats
9.89	2.33	4.24	The existence and activities of non-specialists (intermediaries/dealers)
10	2.50	4	Seasonality of tourism in Shiraz
11.87	2.17	5.48	European and Asian countries advertising their medical services for the Persian Gulf countries, creating a strong marketing competition	Competitive
6.22	1.67	3.73	Progress of the Persian Gulf countries in the field of health
282		100	Sum
2.82			Total score