13 15 It is similar to structure, in that it is social, cultural, historical or institutional. Context allows or, conversely, constrains agency.22 Outcomes refer to expected or unexpected intermediate (mediating) and final outcomes.15 They are the inhibitor Bosutinib result of the interaction of mechanisms and context. The C-M-O configurations help ensure external validity, as they allow the research to extend to a level of abstraction for the theory/theories to be useful in other contexts.1 13 17 22 The iterative approach to theory building and C-M-O configuring will enable us to confirm

or refute our novice theories. Research aim and objectives The primary aim of this synthesis is to explain why patients from LMICs cross international borders for healthcare by finding underlying theories that explain this movement. Our objectives are to Document why patients from LMICs cross international borders for healthcare;

Identify the mechanisms generating patient decisions to cross borders; Investigate the contextual characteristics of domestic health markets (demand-side and supply-side factors) that influence this choice; Develop an explanatory framework that synthesises review findings of why patients cross borders. We will address these objectives by searching for studies of cross-border patient movement to identify C-M-O configurations across studies, to produce a middle-range theory explaining why, how, for what purpose and in what circumstances patients choose to seek healthcare outside of their domestic health system. For the purpose of this review, we conceptualise health systems as market systems. Market systems refer to the multiplayer, multifunction social arrangement consisting of three main sets of functions: demand and supply; rules or regulation; and supporting functions (eg, product development, skills improvement, research and development, coordination and advocacy) that are undertaken by different players, for example, private sector, government, representative organisations,

civil society and so forth. Within this forum, system exchange takes place, develops, adapts and grows.10 11 Anacetrapib 23 Our primary focus is healthcare services or healthcare markets. Healthcare markets are a set of socioeconomic arrangements by which users and providers of health services are in contact to exchange goods or services, usually through some kind of formal or informal financial exchange through the process of demand and supply.24 While basic services, such as health (which may be considered a public good) may seem to be different institutions from markets, with one being seen as primarily a public service and the other being prominently private, in reality they share many of the same characteristics.