Impact of economic uncertainty on investment in health tourism and healthcare service capacity building: a multicenter provincial study in Iran

Background: Health tourism is increasingly recognized as a strategic component of health system development, contributing to investment attraction, service capacity enhancement, and financial sustainability. However, economic instability and policy uncertainty may adversely affect investment decisions in this sector. In recent years, Iran has experienced elevated levels of economic uncertainty. This study aimed to examine the impact of economic policy uncertainty on investment in health tourism across selected provinces of Iran. Methods: This applied–analytical study utilized secondary panel data covering the period from 2011 to 2021. The study population included major metropolitan provinces of Iran (Tehran, Karaj, Qom, Isfahan, Mashhad, Shiraz, Tabriz, and Ahvaz). A Panel Smooth Transition Regression (PSTR) model was employed to estimate the nonlinear effects of economic policy uncertainty on health tourism investment. Results: The results indicated a threshold value of −0.428 for the economic policy uncertainty index. Above this threshold, economic uncertainty exerted a positive effect (−0.353), whereas below the threshold it had a negative effect (0.218) on health tourism investment. Inflation, exchange rate fluctuations, and the COVID-19 pandemic demonstrated significant negative effects, while financial development, liquidity, and provincial tourist volume showed positive and significant associations with investment levels. Conclusion: The findings suggest that economic uncertainty plays a complex and nonlinear role in shaping investment behavior in health tourism. Effective economic and health policy coordination may enhance investment stability and promote the sustainable development of health tourism services.