Further, the research that is available provides limited guidance for decision-makers on how to adapt health policies to their objectives, target populations and local selleckchem Y-27632 contexts, and promote equitable access. In this research, we propose to begin to address this gap through a rapid realist synthesis of the literature. The questions we seek to answer are: Why do patients from LMICs cross international borders for healthcare? What are the contextual factors that influence this choice? Such questions are very pertinent for health systems in developing countries, and underscore the

need to better understand how people behave within market systems.10–12 In this rapid review, our outcome of interest is the decision by patients to cross borders. Although important, it is beyond the scope of this review to examine the impact of these decisions on patients themselves, health services, health financing

and health equity outcomes. A number of insights relating to provision of healthcare may, however, be gleaned from the current review to be further built on in future research. A realist synthesis has been selected because it is specifically designed for use in complex systems, such as health markets, and is ideal for investigating questions requiring depth of understanding.13–15 The study is planned to be undertaken from November 2014 to March 2015. Realist synthesis Realist synthesis is a theoretically driven, qualitative approach to synthesising qualitative, quantitative and mixed-methods research evidence.14 16–21 A realist review is theory driven. In this review, the key theories relate to the interaction between the demand and supply-side functions in a market and health systems performance.11 While most of the realist reviews to date have focused

on specific interventions or cases of interventions, in contrast, our research seeks to generate, test and refine a theory on why patients cross international borders for healthcare. This approach is appropriate, as it provides a framework to (1) examine the circumstances in which patients cross international borders and (2) provide policy makers with information on which they can act. While systematic reviews provide evidence on outcomes and a typology of patient movements, a realist review provides a method to understand which patients decide to cross Cilengitide borders, how those decisions are made, and what contextual factors affect those decisions. In realist terms, these are referred to as context, mechanisms and outcomes (C-M-O configuration). Mechanisms refer to the variables in the decision-making process and, more specifically, to the resources offered by the health market and the reasoning of patients who choose to seek healthcare outside the domestic market.15 They include the beliefs, values, desires and cognitive processes that influence behavioural choices.14 16 These mechanisms are influenced by the context.