Compilation and Evaluation of Indexes for the Development of Health Villages by Taking a Medical Tourism Development Approach towards Service Integration in Iran (A Qualitative & Quantitative Study)

Document Type : Research Paper

Authors

1 Postdoctoral researcher, working under the Iran National Science Foundation (INSF) in collaboration with the University of Isfahan; Isfahan, Iran

2 Professor of urban planning, Faculty of Geography Sciences and Planning, University of Isfahan, Isfahan, Iran

Abstract

Introduction
As a subset of health tourism, medical tourism has become one of the most popular and fastest-growing trends in the healthcare and tourism industry, annually has about 20% increase in income. Nowadays, it represents one of the flourishing sectors in the tourism markets. Perceiving its great potential and opportunities, dozens of developing nations have joined this contest and are seriously pursuing the policies effective for increasing their attractiveness for this lucrative/profitable segment of the global tourism industry. During the recent years, there has been a remarkable growth in the development trend of this sector of tourism industry in moving towards service integration of medical and tourism domains. This in turn can act as an effective policy for increasing Iran’s attractiveness as a medical tourism destination and create new competitive advantage.
Methodology
Applied in nature, this study was conducted by using qualitative-quantitative research method. To do so, in the first stage, content analysis was selected as the research strategy. The data were sorted through open and axial coding and finally were put into MAXQDA-18 software to be analyzed. Sorted through questionnaire and interview, the obtained data were submitted to the professors and respective authorities in the field of health tourism. In this way, the indexes/indicators and sub-indexes/sub-indicators were finalized through expert panel. In the second stage, quantitative evaluation of indexes was done by taking a quantitative approach by using FUZZY DEMATEL technique to illustrate the way in which the identified indexes affect and are affected by each other. Finally, the relative weight and rank of each of the indexes and sub-indexes were calculated by using AHP technique.
Results & Discussion
In this research, the indexes and sub-indexes for the development of health villages in moving towards the expansion of medical tourism were coded, sorted and determined in terms of 19 indexes and 105 sub-indexes. Based on the findings of research, from among the indexes in question, the most effective indexes were advertising and marketing, quality and facilities of hospital and medical centers, service quality of physicians, specialists and nursing staff while the most effective indexes were the environmental status and policy making. From expert panel’s perspective, the indexes of medical treatments, service quality of physician, specialists and nurses, quality and facilities of hospital and medical centers, natural treatments, advertising and marketing and access to medical information were of higher significance compared to other involved factors in moving towards the development of medical tourism in Iran. In this study, medical factors included natural, traditional and medical indexes. From among the sub-indexes, infertility treatments, organ transplantation, orthopedic services (rehabilitation and Arthroplasty/joint replacement), cosmetic surgeries, alimentary and cardiovascular services, dentistry, Ophthalmology, different types of hydrotherapy and plant therapy ranked higher in order of priority. From type of treatment perspective, the most important theories supporting the index of natural treatments included heat regulation theory, energy sources recovery theory, body energy conservation theory and Niels Finnsen’s theory (1903). As far as traditional treatments are concerned, holistic approach to patient (Holistic nursing care) (holistic philosophy) and Humorisme (blood, phlegm, black bile and yellow bile), local theories and experiences in different cultures, compliance theory in Chinese culture and Ying-Yang balance theory (Hung, 2009) can be considered as the theories and models supporting this index. Furthermore, biomedical theories (Schaffner, 1993; Thagard, 1996, 1999) can also be of high significance for medical treatments. Regarding the factors related to the quality of medical and tourism services and facilities as one of the most important factors involved in the development of medical tourism, the present research has focused on three major indexes, namely quality and facilities of hospitals, services quality of physicians, specialists and nurses, quality of tourism services and attractions with 17 sub-indexes. From among these sub-indexes, tourism safety, care quality of physicians and nurses, advanced equipment and physician specialty occupied the highest ranks, respectively. Communications and marketing factors included 2 indexes, namely language and communications and advertising and marketing and 9 sub-indexes from which branding, inter-organizational and inter-departmental cooperation and tourism package obtained the highest ranks in terms of priority. The theories and models supporting this index were as follows: marketing mix model, promotion dimension (promotional marketing mix model) (Ricafort, 2011), push-pull theory, supply dimension (Fetscherin & Stephano,2016), Pike’s model of competitive advantages sources (2004), dimensions of communication resources, development resources and implementation resources (Pike, 2004), Crouch & Ritchie’s model, dimension of destination management (Crouch, 2007). Considering the high significance of information and communications technology in expansion of health villages and consequently, the medical tourism, from among the sub-indexes, electronic access to treatment follow-up, access of authorities to health tourists’ statistics for planning in this section of tourism, access to information relating to medical costs were found to be of the highest importance, respectively. In the same vein, the theories supporting this index were Poon’s model, dimension of information technology (Poon, 1993) and World Economic Forum, dimension of electronic infrastructures (Schwab, 2017).
Conclusions
To increase Iran’s attractiveness as a medical tourism destination, this research attempted to identify, sort and prioritize the factors relating to the expansion of medical tourism considering the capabilities, relative advantages and service provision facilities available in Iran. This was done for the purpose of capacity building based on global competition criteria in the medical tourism domain and by taking the approach of service integration to satisfy the tourist's welfare and identify active and successful private centers. Considering all the involved factors as integrated, the respective authorities are required to pay particular attention to the indexes and sub-indexes of high priority so as to compile, design and implement short- and long-term strategies. These strategies should be determined proportionate to the identified indexes in order to realize all the healthcare capacities and meet the main objectives of Iran’s vision plan.

Keywords

Main Subjects


  1. داداش‏پور، امیر؛ محمدی، رسول و داداش‏پور، علی، ۱۳۹۲، بررسی تأثیر یک دوره تمرین در آب بر کیفیت خواب مردان سالمند، مجلة علمی- پژوهشی دانشگاه علوم پزشکی شهید صدوقی یزد، دورة ۲۱، ش ۳، صص ۳۰۰-۳۱۰.
  2. سالاروند، شهین، 1391، مروری کامل بر امور طبیعیه در مبانی نظری طب سنتی ایران، مجلة طب سنّتی اسلام و ایران، س 3، ش 3، صص ۲۵۱-262.
  3. سلیمی، اعظم و احمدیان، علیرضا، 1392، اثربخشی فوتوتوریسم در کنترل علائم اختلال افسردگی فصلی، فصل‏نامة تحقیقات کاربردی علوم جغرافیایی، س 13، ش 28،صص ۱۹۱–۲۱۵.
  4. طباطبایی، سیدمحمد؛ نوری، ابوالفضل؛ محمد نوری، زهره و حشمتی، فرزانه، 1393، گونه‏شناسی مشتریان در گردشگری پزشکی، فصل‏نامة علمی- پژوهشی مطالعات مدیریت گردشگری، س 8، ش 26، صص ۵۳–
  5. قاسمی یالقوز آغاج، اکبر؛ اسدزاده، احمد؛ ایمانی خوشخو، محمدحسین و جبارزاده، یونس، 1396، ارزیابی عوامل جذب گردشگران درمانی با رویکرد تصمیم‏گیری چندمعیارة ترکیبی فازی (مطالعة موردی: استان آذربایجان شرقی)، فصل‏نامة علمی‏- پژوهشی گردشگری و توسعه، س 6، ش 3، صص ۳۹-57.
  6. قلی‏پور سوته، رحمت‏الله؛ امیری، مجتبی؛ ضرغام بروجنی، حمید و کیانی فیض‏آبادی، زهره، 1397، بررسی راهکارها و ابزارهای سیاستی توسعة گردشگری پزشکی در ایران، فصل‏نامة سیاست‏گذاری عمومی، دورة 4، ش 4، صص 29-53.
  7. گودرزی، مجید؛ تقوایی، مسعود و زنگی‏آبادی، علی، 1393، توسعة گردشگری پزشکی داخلی در شهر شیراز، مدیریت اطلاعات سلامت، دورة 11، ش 4، صص ۴۸۵-496.
  8. لوح موسوی، سیدعلیرضا؛ تقوایی، مسعود؛ وسیلی، محمدرضا و زارع، محمدحسین، 1396، شناسایی و رتبه‏بندی عوامل مرتبط با مکان‏یابی دهکده‏های سلامت: مطالعة موردی استان اصفهان، مدیریت اطلاعات سلامت، دورة 14، ش 3، صص ۹۶-102.
  9. ناصرپور، مهرداد؛ موسوی، سیدنجم‏الدین و سبهوند، رضا، 1397، بررسی تأثیر عوامل غیردرمانی بر توسعة گردشگری سلامت، فصل‏نامة علمی‏- پژوهشی گردشگری و توسعه، س 7، ش 3، صص ۱۹۵-212.
  10. وزارت بهداشت، درمان، و آموزش پزشکی، ادارة گردشگری سلامت، 1398.
  11. یاوری گهر، فاطمه و منصوری مؤید، فرشته، 1396، مدیریت بحران در صنعت گردشگری، مطالعات مدیریت گردشگری، دورة 12، ش 40، صص ۲۱-40.
  12. Bahar, O. and Kozak, M., 2007, Advancing Destination Competitiveness Research, Journal of Travel & Tourism Marketing, 22(2), 61-71.
  13. Bookman, M. Z. and Bookman, K. R., 2007, Medical tourism in developing countries. New York: Palgrave Macmillan.
  14. Carrera, P. M. and Bridges, F. P., 2006, Globalization and healthcare: Understanding health care and medical tourism. Expert Review of Pharmacoeconomics and Outcomes Research, 6(4), 447-454.
  15. Connell, J., 2006, Medical tourism: Sea, sun, sand and … surgery. Tourism Management, 27(6), 1093 -1100. http://doi.org/10.1016/j.tourman.2005.11.005.
  16. Connell, J., 2011, Medical Tourism, Oxfordshire: CAB International.
  17. Cook, P. S., 2010, Constructions and experiences of authenticity in medical tourism: The performances of places, spaces, practices, objects and bodies. Tourist Studies, 10(2), 135-153
  18. Crouch, G., 2007, Modelling Destination Competitiveness, A survey and Analysis of the Impact of competitiveness Attributes, Sustainable Tourism Pty Ltd, Australia.
  19. Dadashpoor, A.; Mohammadi, R. and Dadashpoor, A., 2013, Investigating Effect of a Period of Water Exercise on Sleep Quality in Male Elders. JSSU, 21(3), 300-310. [Persian]
  20. Debra, S. Sandberg, 2017, Medical tourism: An emerging global healthcare industry, International Journal of Healthcare Management.
  21. Dilber, U. and Anadol, Y., 2016, A case study for medical tourism: investigating a private hospital venture in Turkey, Anatolia, (An International Journal of Tourism and Hospitality Research), 27(3), 327-338.
  22. Dwyer, L. and Kim, C., 2003, Destination competitiveness: Determinants and indicators. Current Issues in Tourism, 6(5), 369-414.
  23. Eugenia, Panfiluk, 2016, Aesthetic medicine tourism – nature and scope of the services Engineering Management in Production and Services, 8(1), 71-79.
  24. Fetscherin, M. and Stephano, R.M., 2016, The medical tourism index: Scale development and validation, Tourism Management, 52, 539-556.
  25. Ghasemi Yalghouzaghaj, A.; Asadzadeh, A.; Imani Khoshkhoo, M.H.  and Jabarzadeh, Y., 2017, Evaluation of Medical Tourism Attraction Factors with Fuzzy Combined Multi-criteria Decision Making Approach (Case Study: East Azarbaijan Province)  Tourism and Development, 6(3), 39-57. [Persian]
  26. Gholipour, R.; Amiri, M.; Zargham Boroujeni, H. and Kiani Feizabadi, Z., 2019, Investigating the Solutions and Policy Instruments of Medical Tourism Development in Iran, Public Policy,4(4), 29-53. [Persian]
  27. Gilbert, D., 1984, The need for countries to differentiate their tourist product and how to do so. Seminar papers: Tourism managing for results. University of Surrey, Guildford.
  28. Goodarzi, M.; Taghvaei, M. and Zangiabadi, A., 2014, Developing of Domestic Medical Tourism in Shiraz ,Health Information Managment, 11(4), (serial No 38), 485-496. [Persian]
  29. Hall, M., 2011, Publish and perish? Bibliometric analysis, journal ranking and the assessment of research quality in tourism. Tourism Management, 32(1), 16-27.
  30. Henderson, J. C., 2004, Healthcare tourism in Southeast Asia. Tourism review International, 7(3-4), 111-121.
  31. Heung, VC.; Kucukusta, D. and Song, H., 2011, Medical tourism development in Hong Kong: An assessment of the barriers. Tourism Manage, 32, 995-1005.
  32. Horowitz, M.; Rosensweig, J. and Jones, C.A., 2007, Medical tourism: globalization of the healthcare marketplace, Meds cape General Medicine, 9(4), 33-42.
  33. Huang, W.; Kutner, N. and Bliwise, D. L., 2009. A systematic review of the effects of acupuncture in treating insomnia, Sleep Medicine Reviews, 13, 73-104.
  34. IMTJ, 2018, Medical Travel and Tourism, Global Market Report, First Edition. International medical travel journal. Available from: https://imtj.com
  35. Japanese Institute of Tourism Research, 2010, Handbook of Health Tourism; Japanese Institute of Tourism Research: Tokay, Japanese.
  36. Joohyun Lee Hong-bumm Kim, 2015, Success factors of health tourism: cases of Asian tourism cities, International Journal of Tourism Cities, 1(3), 216-233.
  37. Junio, M.M.V.; Kim, J. H. and Lee, T.J., 2016, Competitiveness attributes of a medical tourism destination: The case of South Korea with importance-performance analysis, Journal of Travel & Tourism Marketing, 34, 444 - 460.
  38. Lee, C. W. and Li, C., 2019, The Process of Constructing a Health Tourism Destination Index. International journal of environmental research and public health, 16(22), 45-79.
  39. Lepp, A. and Gibson, H. 2003, Tourist roles, perceived risk and international tourism. Annals of Tourism Research, 30, 606–624. Liang, ZX; Hui, TK and Sea, PZ., 2017, Is price most important? Healthcare tourism in Southeast Asia. Tourism Geographies, 19(5), 823-847.
  40. Loh-Mousavi, S.A.R.; Taghvaei, M.; Vasili, M.R. and Zare, M.H., 2017, Identification and Ranking of Criteria Related to Location Decisions of Health Villages; A Case Study for Isfahan Province, Iran, Health Information Management, 14(3), (SERIAL NO 55), 96-102. [Persian]
  41. Lunt, N. and Carrera, P., 2010, Medical tourism: Assessing the evidence on treatment abroad. Maturities, 66(1), 27-32.doi:10.1016/maturitas.2010.01.017.
  42. Mahdavi Y. et al., 2013, The Factors in Development of Health Tourism in Iran, International Journal of Travel Medicine and Global Health, 1(3), 113-118.
  43. Ministry of Health, Treatment and Medical Education, Health Tourism Office, 2019. [Persian]
  44. Mueller, H. and Kaufmann, E.L., 2001, Wellness Tourism: Market Analysis of a Special Health Tourism Segment and Implications for the Hotel Industry. Vacat. Mark, 7, 5-17.
  45. Naserpour, ;  Muosavi, S.N. and Sepahvand,  R., 2019, Effect of non-medical Factors on Health, Tourism Development, 7(3), Serial Number 16,  195-212. [Persian]
  46. Nutworadee, K., 2015, Motivation and Decision on Medical Tourism Service in Thailand, Rev. Integr. Econ. Res. 4(3), 173-182.Panfiluk, E., 2016, Aesthetic medicine tourism – nature and scope of the services Engineering Management in Production and ServicesVolume 8: Issue 1 p.p. 71-79
  47. Pike, S., 2004, Destination Marketing Organizations, Oxford: Elsevier.
  48. Poon, A., 1993, Tourism, Technology, and Competitive Strategy, Wallingford: CAB International.
  49. Porter, M.E., 1990, The Competitive Advantage of Nations, New York, NY: Free Press.
  50. Ricafort, K.M.F., 2011, A Study of Influencing Factors That Lead Medical Tourists to Choose Thailand Hospitals as Medical Tourism Destination (Master Disertation), Webster University, Cha-am, Thailand.
  51. Salarvand, S., 2012, Comprehensive Theoretical overview of Natural things (Tbyyh Affairs) in Iranian traditional medicine. Jiitm, 3(3), 251-262. [Persian]
  52. Salimi, A. and Ahmadian, A.R, 2013, Effectiveness of Phototourism in control of seasonal affective disorder symptom, Journal of Geographical, 13(28), 191-215. [Persian]
  53. Sarwar, A., Manaf, N. A., & Omar, A., 2012, Medical Tourist’s Perception in Selecting their Destination: A Global Perspective, Iranian J Publ Health, 41(8), 1-7.
  54. Schaffner, K.F., 1993, Discovery and explanation in biology and medicine. Chicago: University of Chicago Press.
  55. Schwab, K., 2017, The Global Competitiveness Report 2017-2018, World Economic Forum, Geneva, Switzerland.
  56. Smith, P.C. and Forgione, D.A., 2007, Global outsourcing of healthcare: a medical tourism
    decision model. J Inform Technol Case Appl Res, 9, 19-30.
  57. Smith, M. and Puczko, L., 2009, Health and wellness tourism. Oxford: Jordan Hill.
  58. Strübing, J., 2014, Was IST grounded theory? Grounded theory (pp. 9-35). Springer. Available at: https://www.springer.com/gp/book/9783531198965.
  59. Tabatabaeinasab, S.; Nouri, A.; Mohammadnabi, Z. and Heshmati, F., 2015, Customers' typology in medical tourism. Tourism Management Studies, 9(26), 60-82. [Persian]
  60. Thagard, P., 1999, Howscientists explain disease. Princeton, NJ: PrincetonUniversity Press.
  61. Thagard, P., 1996, The concept of disease: Structure and change. Communication and Cognition, 29, 445-478.
  62. Thilagavathi, K. and Shankar, C., 2013, Medical Tourism Research: A Conceptual Framework of Emerging Business Strategies In Healthcare Industry, Proceedings of International Conference on Tourism Development.
  63. TRAM (tourism research and marketing), 2006, Medical Tourism: a global analysis. a report by tourism research and marketing. Netherlands: Atlas publication.
  64. Turner, L., 2011, Medical tourism and the global marketplace in health services: U.S. patients. International hospitals and the search for affordable health care. 40(3), 443-467.
  65. Ulaş, D., and Anadol, Y., 2016, A case study for medical tourism: Investigating a private hospital venture in Turkey. Anatolia, 27(3), 327-338.
  66. Upadhyaya, M., and Swoni, S., 2008, The growth and development of Indian global healthcare destinations. Journal of Marketing & Communication, 4(2), 81-88.
  67. Veerasoontorn, R. and Beise-Zee, R., 2010, International hospital outshopping: A staged model of push and pull factors. International Journal of Pharmaceutical and Healthcare Marketing, 4(3), 247-264.
  68. Yang, Yung-Sheng, 2013, Key Success Factors in Medical Tourism Marketing, International Journal of Academic Research in Business and Social Sciences, 3(3).
  69. Yavari Gohar, F. and Mansouri Moayed, F., 2017, Tourism Crisis Management. Tourism Management Studies, 2017; 12(40): 21-40. doi: 10.22054/2018.15614.1439[Persian]
  70. Ye, B. H.; Qiu, H. Z. and Yuen, P. P., 2011, Motivations and experiences of Mainland Chinese medical tourists in Hong Kong. Tourism Management, 32, 1125-1127. doi:10.1016/ tourman.2010.09.018.
  71. Ye, B. H.; Yuen, P. P.; Qiu, H. Z. and Zhang, V. H., 2008, Motivation of medical tourists: An exploratory case study of Hong Kong medical tourists. Paper presented at the Asia Pacific Tourism Association (APTA) Annual Conference, Bangkok, Thailand.
  72. Yeoh, E.; Othman, K. and Ahmad, H., 2013, Understandingmedical tourists: Word-of-mouth and viral marketing asbpotent marketing tools. Tourism Management, 34, 196-201. doi:10.1016/tourman.2012.04.010.
  73. Yu, J. Y. and KO, T. G., 2012, A cross-cultural study of perceptions of medical tourism among Chinese, Japanese and Korean tourists in Korea. Tourism Management, 33, 80-88.