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)

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.