TREATMENT TYPE AS A FACTOR IN MEDICAL TOURISM DESTINATION PREFERENCES: THE CASE OF TURKEY

Year 2017, Volume: 2 Issue: 2, 58 - 72, 11.12.2017

Aydan Özdemir Feride Bahar Işın , Bülent Eşiyok

Abstract

Medical
tourism has grown rapidly with its increased availability in destination
countries, which has resulted in intense competition to attract medical
tourists. At the same time, the preferred destinations of medical tourists have
shifted from developed to developing countries. This is a result of high costs,
uneven health services and quality, long waiting lists, and poor access to health-care
services in the tourists’ home countries coupled with greater privacy and
confidentiality available overseas. The choice of location choice is likely to be
affected by the treatment needed. Currently, few empirical studies have taken
into account the heterogeneity in treatment types offered at a subnational
level. The present study aims to address this gap: it analyzes the factors that
affect the location choice of international patients diagnosed with chronic
illnesses in need of treatment at surgical or internal medicine clinics in
Turkey. We use a panel of annual data for Turkish cities that hosted medical
tourists over a 4-year period. We found that patients who underwent treatment
at surgical or internal medicine clinics evidenced different sensitivities to
climate conditions, costs, and the ratio of private to total hospitals in their
destination cities. However, we discovered no considerable differences in the
responses related to travel convenience or the existence of local medical expertise.

Keywords

surgical clinic, internal medicine clinic, chronic illness, medical tourist, health infrastructure, travel convenience, climate

References

• Alhemoud, A.M., Armstrong, E.G., 1996. Image of tourism attractions in Kuwait. J. Travel Res. 34 (4), 76–80. Alleman, B.W., Luger, T., Reisinger, H.S., Martin, R., Horowitz, M.D., Cram, P., 2011. Medical tourism services available to residents of the United States. J. Gen. Intern. Med. 26 (5), 492–497. Altin, M.M., Singal, M., Kara, D., 2011. Consumer decision components for medical tourism: a stakeholder approach. 16th Graduate Students Research Conference, Houston, Texas, January 6–8, 2011 AMA-OMSS, 2007. Medical Travel outside the U.S. OMSS Governing Council Report B, June, AMA: New York. Alsharif, M.J., Labonté, R., Lu, Z., 2010. Patients beyond borders: A study of medical tourists in four countries. Glob. Soc. Policy. 10 (3), 315–335. Beerli, A., Martin, J.D., 2004. Factors influencing destination image. Ann. Tour. Res. 31 (3), 657-681. Bookman, M.Z., Bookman, K.R., 2007. Medical tourism in developing countries. Palgrave Macmillan, New York. Burkett, L., 2007. Medical tourism: concerns, benefits, and the American legal perspective. J. Leg. Med. 28 (2), 223–245. Carrera, P.M., Bridges, J.F., 2006. Globalization and healthcare: understanding health and medical tourism. Expert Rev. Pharmacoecon. Outcomes Res. 6 (4), 447–454. Chou, S.Y., Kiser, A.I., Rodriguez, E.L., 2012. An expectation confirmation perspective of medical tourism. J. Serv. Sci. Res. 4 (2), 299–318. Cohen, R., 2008. Global Diasporas: An Introduction. Routledge, New York. Connell, J., 2006. Medical tourism: Sea, sun, sand and… surgery. Tour. Manage. 27 (6), 1093–1100. Connell, J., 2011. Medical Tourism. Cabi, London. Connell, J., 2013. Contemporary medical tourism: Conceptualisation, culture and commodification. Tour. Manage. 34, 1–13. Crompton, J., Ankomah, P., 1993. Choice set propositions in destination decision. Ann. Tour. Res. 20, 461–476. Crooks, V.A., Kingsbury, P., Snyder, J., Johnston, R., 2010. What is known about the patient's experience of medical tourism? A scoping review. BMC Health Serv. Res. 10 (1), 1. Demicco, F.J., Cetron, M., 2006. Club medic. Asia Pac. Biotech News. 10 (10), 527–531. Eggertson, L., 2006. Wait-list weary Canadians seek treatment abroad. CMAJ. 174 (9), 1247. Ekinci, Y., Riley, M., 1998. A critique of the issues and theoretical assumptions in service quality measurement in the lodging industry: time to move the goal-posts? Int. J. Hosp. Manage. 17 (4), 349–362. Esiyok, B., Çakar, M., Kurtulmuşoğlu, F.B., 2016. The effect of cultural distance on medical tourism. J. Destination Mark. Manage. Fetscherin, M., Stephano, R.M., 2016. The medical tourism index: Scale development and validation. Tour. Manage. 52, 539–556. Florida, R., Mellanderi C., Stolarick, K., 2008. Inside the black box of regional development human capital, the creative class and tolerance. J. Econ. Geogr. 8, 615–649. Forgione, D.A., Smith, P.C., 2006. Medical tourism and its impact on the US health care system. J. Health Care Finance. 34 (1), 27–35. Fried, B.J., Harris, D.M., 2006. Managing healthcare services in the global marketplace. Front. Health Serv. Manage. 24 (2), 3–18. Glinos, I.A., Baeten, R., Helble, M., Maarse, H., 2010. A typology of cross-border patient mobility. Health Place. 16 (6), 1145–1155. Goodman, D. C., Grumbach, K., 2008. Does having more physicians lead to better health system performance? JAMA. 299 (3), 335–337. Gray, H.H., Poland, S.C., 2008. Medical tourism: crossing borders to access health care. Kennedy Inst. Ethics J. 18 (2), 193–201. Hall, C.M., 2011. Health and medical tourism: a kill or cure for global public health? Tour. Rev. 66 (1/2), 4–15. Han, H., 2013. The healthcare hotel: Distinctive attributes for international medical travelers. Tour. Manage. 36, 257–268. Han, H., Hwang, J., 2013. Multi-dimensions of the perceived benefits in a medical hotel and their roles in international travelers’ decision-making process. Int. J. Hosp. Manage. 35, 100–108. Han, H., Hyun, S.S., 2015. Customer retention in the medical tourism industry: Impact of quality, satisfaction, trust, and price reasonableness. Tour. Manage. 46, 20–29. Hausman, J.A., 1978. Specification tests in econometrics. Econometrica. 6: 1251–1271. Henderson, J.C. (2004). Paradigm shifts: National tourism organisations and education and healthcare tourism. The case of Singapore. Tour. Hosp. Res. 5 (2), 170–180. Herrick, D.M., 2007. Medical tourism: Global competition in health care. National Center for Policy Analysis (NCPA), Policy Report, 304, 19–20. Heung, V.C., Kucukusta, D., Song, H., 2011. Medical tourism development in Hong Kong: An assessment of the barriers. Tour. Manage. 32 (5), 995–1005. Holman, H., Lorig, K., 2004. Patient self-management: a key to effectiveness and efficiency in care of chronic disease. Public Health Rep. May-Jun; 119 (3), 239–243. Hopkins, L., Labonté, R., Runnels, V., Packer, C., 2010. Medical tourism today: what is the state of existing knowledge? J. Public Health Policy. 31 (2), 185–198. Horowitz, M.D., Rosensweig, J.A., 2008. Medical tourism vs. traditional international medical travel: a tale of two models. Int. Med. Travel J. 3 (3), 21–24. Hunter, M., Cannon W., 2007. Medical tourism: A new global niche. Int. J. Tour. Sci. 7 (1), 129–140. Issac, G., Rajendran, C., Anantharaman, R.N., 2003. Determinants of software quality: customer's perspective. Total Qual Manage Bus. Excellence. 14 (9), 1053–1070. Johnson, T.J., Youngquist, J.S., Garman, A.N., Hohmann, S., Cieslak, P.R., 2015. Factors influencing medical travel into the United States. Int. J. Pharm. Healthcare Marketing, 9 (2), 118–135. Johnston, R., Crooks, V.A., Snyder, J., Kingsbury, P., 2010. What is known about the effects of medical tourism in destination and departure countries? A scoping review. Int. J. Equity Health. 9 (1), 1. Jones, C.A., Keith, L.G., 2005. Medical tourism and reproductive outsourcing: the dawning of a new paradigm for healthcare. Int. J. Fertil. Womens Med. 51 (6), 251–255. Kozak, M., Rimmington, M., 2000. Tourist satisfaction with Mallorca, Spain, as an off-season holiday destination. J. Travel Res. 38 (3), 260–269. Lee, M., Han, H., Lockyer, T., 2012. Medical tourism—attracting Japanese tourists for medical tourism experience. J. Travel Tour. Marketing. 29 (1), 69–86. Lunt, N., Carrera, P., 2010. Medical tourism: assessing the evidence on treatment abroad. Maturitas, 66 (1), 27–32. Lunt, N., Horsfall, D., Hanefeld, J., 2016. Medical tourism: A snapshot of evidence on treatment abroad. Maturitas, 88, 37–44. Makrai, S., Almsafir, M.K., 2014. The challenges of medical tourism in Kuala Lumpur, Malaysia. J. Adv. Soc. Res. 4 (1), 8–25. Mattoo, A., Rathindran, R., 2006. How health insurance inhibits trade in health care. Health Affairs, 25 (2), 358–368. Medical Tourism Association 2013. Healthcare Clusters, Medical Clusters and Healthcare Association MTA. Milman, A., Pizam, A., 1995. The role of awareness and familiarity with a destination: The central Florida case. J. Travel Res. 33 (3), 21–27. Murrow, E.J., Oglesby, F.M., 1996. Acute and chronic illness: similarities, differences and challenges. Orthop. Nurs. 15 (5), 47–51. Musa, G., Thirumoorthi, T., Doshi, D., 2012. Travel behaviour among inbound medical tourists in Kuala Lumpur. Curr. Issues Tour. 15 (6), 525–543. Nadiri, H., Hussain, K., 2005. Perceptions of service quality in North Cyprus hotels. Int. J. Contemp. Hosp. Manage. 17 (6), 469–480. OECD, 2011 Medical Tourism: Treatments, Markets and Health System Implications Report, OECD. Ormond, M., 2011. Shifting subjects of health‐care: Placing ‘medical tourism’in the context of Malaysian domestic health‐care reform. Asia Pac. Viewpoint, 52 (3), 247–259. Ormond, M., 2015. En route: Transport and embodiment in international medical travel journeys between Indonesia and Malaysia. Mobilities, 10 (2), 285–303. Padma, P., 2013. Antecedents of Customer Loyalty in Medical Tourism. Working Paper 13/03 Lisbon. Padma, P., Rajendran, C., Sai, L.P., 2009. A conceptual framework of service quality in healthcare: perspectives of Indian patients and their attendants. Benchmarking. 16 (2), 157–191. Penninx, B.W.J.H., van Tilburg, T., Boeke, A. Joan P., Deeg, D.J.H., Kriegsman, D.M.W., van Eijk, J.T.M., 1998. Effects of social support and personal coping resources on depressive symptoms: Different for various chronic diseases? Health Psychol. 17 (6), 551–558. Peters, C.R., Sauer, K.M., 2011. A survey of medical tourism service providers. J. Mark. Dev. Competitiveness. 5 (3), 117. Schneider, I.S., Sönmez, M., 1999. Exploring the touristic image of Jordan. Tour. Manage. 20 (4), 539–542 Smith, R., Álvarez, M.M., Chanda, R., 2011. Medical tourism: a review of the literature and analysis of a role for bi-lateral trade. Health Policy. 103 (2), 276–282. Snyder, J., Crooks, V.A., Adams, K., Kingsbury, P., Johnston, R., 2011. The ‘patient's physician one-step removed’: the evolving roles of medical tourism facilitators. J. Med. Ethics. 37 (9), 530–534. Taylor, S.E., Aspinwall, L.G., 1996. Psychological aspects of serious illness: Chronic conditions, fatal diseases, and clinical care, in Costa, P.T., Jr., VandenBos, G.R. (Eds.), American Psychological Association, Washington, DC, pp. 3–60. Turner, L., 2007. ‘First world health care at third world prices’: globalization, bioethics and medical tourism. Biosocieties, 2 (3), 303–325. UNESCAP, 2007. Patients without borders: An overview of the medical travel industry in Asia, its challenges and opportunities. Paper presented at the UNESCAP EGM, Bangkok. Wongkit, M., McKercher, B., 2013. Toward a typology of medical tourists: A case study of Thailand. Tour. Manage. 38, 4–12. Wongkit, M., McKercher, B., 2016. Desired attributes of medical treatment and medical service providers: A case study of medical tourism in Thailand. J Travel Tour Mark, 33 (1), 14–27. Woo, E., Schwartz, Z., 2014. Towards assessing the knowledge gap in medical tourism. J. Qual. Assurance Hosp. Tour. 15 (2), 213–226. Wooldridge, J.M. (2006). Econometrics, Modern Approach.Thomson, South-Western. Ye, B. H., Qiu, H. Z., Yuen, P. P. (2011). Motivations and experiences of Mainland Chinese medical tourists in Hong Kong. Tour. Manage. 32 (5), 1125–1127. Yu, J.Y., Ko, T.G., 2012. A cross-cultural study of perceptions of medical tourism among Chinese, Japanese and Korean tourists in Korea. Tour. Manage. 33 (1), 80–88. Zagreb Decleration of Healthy Cities, WHO, 2008. International Healthy Cities Conference, Zagreb October 18, 2008.