Determining destination competitiveness in medical tourism: A study based on AHP-QFD framework

Yıl 2023, Cilt: 8 Sayı: 2, 141 - 157, 15.12.2023

Vildan Yilmaz , Ebru Güneren

https://doi.org/10.31822/jomat.2023-8-2-141

Cited By: 2

Öz

This study investigates the competitiveness of Alanya, a medical tourism destination in Türkiye, and determines appropriate strategies using the analytical hierarchy process and quality function deployment. Data were collected from medical tourism experts to gain managerial insights into the factors affecting the competitiveness of medical tourism. The findings show that medical tourists primarily focus on medical factors such as competence of doctor and quality of treatment. The main strategies to strengthen competitiveness are to create a healthcare-free zone, to increase the number of accredited health care providers, and to encourage the involvement of doctors in academic research and ongoing training. For researchers interested in assessing competitiveness in medical tourism destinations, the study presents general determinants that should be considered in each destination. In addition, the findings show that each medical tourism destination should focus on its own determinants of medical tourism competitiveness when developing its marketing strategies. Finally, it shows that the analytical hierarchy process and quality function deployment approaches can be successfully applied in achieving destination competitiveness and strategic planning, with content validity and importance performance analysis.

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Anahtar Kelimeler

Destination competitiveness, Medical tourism (MT), Analytic hierarchy process (AHP), Quality function deployment (QFD), House of quality (HOQ), Alanya

Teşekkür

This research paper was produced from the PhD thesis (Id: 687300) at Nevşehir Hacı Bektaş Veli University, Institute of Social Sciences, Department of Tourism Management, prepared by Vildan YILMAZ in July, 2021.

确定医疗旅游的目的地竞争力： 基于AHP-QFD框架的研究

Öz

本研究调查了阿兰雅这个土耳其医疗旅游目的地的竞争力，并利用分析层次过程和质量功能部署确定了适当的战略。从医疗旅游专家那里收集数据，以获得对影响医疗旅游竞争力的因素的管理洞察力。调查结果显示，医疗旅游者主要关注医疗因素，如医生的能力和治疗质量。加强竞争力的主要策略是建立无医疗区，增加经认证的医疗机构的数量，并鼓励医生参与学术研究和持续培训。对于有兴趣评估医疗旅游目的地竞争力的研究人员，该研究提出了每个目的地应考虑的一般决定因素。此外，研究结果表明，每个医疗旅游目的地在制定其营销战略时都应关注其自身的医疗旅游竞争力的决定因素。最后，它表明分析层次过程和质量功能部署方法可以成功地应用于实现目的地竞争力和战略规划，并具有内容有效性和重要性绩效分析。

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Kaynakça

• Albayrak, T., & Caber, M. (2011). Önem-performans analizi: Destinasyon yönetimine dair bir örnek. Ege Akademik Bakış, 11(4), 625-636.
• Al-Talabani, H., Kilic, H., Ozturen, A., & Qasim, S. (2019). Advancing MT in the United Arab Emirates: toward a sustainable health care system. Sustainability, 11(1), 1-15.
• Arueyingho, O., Ghasemi, M., & Bodamyalı, T. (2022). Medical Tourism in the Turkish Republic of Northern Cyprus: Strategies for Improvement. Journal of Multidisciplinary Academic Tourism, 7 (1), 1-18. DOI: 10.31822/jomat.2022-7-1-1
• Awang, Z., Afthanorhan, A., Mohamad, M., & Asri, M. A. M. (2015). An evaluation of measurement model for medical tourism research: the confirmatory factor analysis approach. International Journal of Tourism Policy, 6(1), 29-45.
• Aydın, G., & Karamehmet, B. (2017). Factors affecting health tourism and international health-care facility choice. International Journal of Pharmaceutical and Healthcare Marketing, 11(1), 16–36.
• Ayre, C., & Scally, A. J. (2014). Critical values for Lawshe’s content validity ratio: revisiting the original methods of calculation. Measurement and Evaluation in Counseling and Development, 47(1), 79-86.
• Bookman, M. Z., & Bookman, K. R. (2007). MT in developing countries. New York: Palgrave McMillan.
• Carlsson, C., & Fullér, R. (1996). Fuzzy multiple criteria decision making: Recent developments. Fuzzy Sets and Systems, 78(2), 139-153.
• Carrera, P. M., & Bridges, J. F. (2006). Globalization and healthcare: understanding health and MT. Expert Review of Pharmacoeconomics & Outcomes Research, 6(4), 447-454.
• Chan, L. K., & Wu, M. L. (2005). A systematic approach to quality function deployment with a full illustrative example. Omega, 33(2), 119-139.
• Chien, T. K., & Su, C. T. (2003). Using the QFD concept to resolve customer satisfaction strategy decisions. International Journal of Quality and Reliability Management, 20 (3), 345-359.
• Cohen, I. G. (2015). Patients with Passports: MT, Law and Ethics. New York: Oxford University Press.
• Connell, J. (2006). MT: Sea, sun, sand and … surgery. Tourism Management, 27(6), 1093-1100.
• Connell, J. (2011). Medical Tourism (CABI, Wallingford).
• Cormany, D. (2010). Hospitality and destination marketing's role in MT: a call for research. International Journal of Behavioural and Healthcare Research, 2(1), 38-58.
• Crooks, V. A., Kingsbury, P., Snyder, J., & Johnston, R. (2010). What is known about the patient's experience of MT? A scoping review. BMC Health Services Research, 10(1), 1-12.
• Crouch, G. I. (2011). Destination competitiveness: An analysis of determinant attributes. Journal of Travel Research, 50(1), 27-45.
• Crouch, G. I., & Ritchie, J. B. (1999). Tourism, competitiveness, and societal prosperity. Journal of Business Research, 44(3), 137-152.
• Crouch, G. I., & Ritchie, J. B. (2005). Application of the analytic hierarchy process to tourism choice and decision making: A review and illustration applied to destination competitiveness. Tourism Analysis, 10(1), 17-25.
• Das, D., & Mukherjee, K. (2008). Development of an AHP-QFD framework for designing a tourism product. International Journal of Services and Operations Management, 4(3), 321-344.
• Das, G., & Mukherjee, S. A. (2016). Measure of MT destination brand equity. International Journal of Pharmaceutical and Healthcare Marketing, 10(1), 104-128.
• De Arellano, A. B. R. (2007). Patients without borders: the emergence of medical tourism. International Journal of Health Services, 37(1), 193-198.
• Debata, B. R., Patnaik, B., Mahapatra, S. S., & Sree, K. (2015). Interrelations of service quality and service loyalty dimensions in MT. Benchmarking: An International Journal, 22 (1),18-55.
• Dinler, Z. (2015). İktisada giriş. Bursa: Ekin Basım Yayın.
• Doğan, N. O., & Karakuş, Y. (2014). KFG-AHP bütünleşik yöntemi kullanılarak turizm sektöründe hizmet kalitesinin değerlendirilmesi: Göreme Açık Hava Müzesi üzerine bir uygulama. Süleyman Demirel University Journal of Faculty of Economics & Administrative Sciences, 19(3), 169-194.
• Dwyer, L., & Kim, C. (2003). Destination competitiveness: determinants and indicators. Current Issues in Tourism, 6(5), 369-414.
• Dwyer, L., Forsyth, P., & Rao, P. (2000). The price competitiveness of travel and tourism: a comparison of 19 destinations. Tourism Management, 21(1), 9-22.
• Dyer, J. S., Fishburn, P. C., Steuer, R. E., Wallenius, J., & Zionts, S. (1992). Multiple criteria decision making, multiattribute utility theory: The next ten years. Management Science, 38(5), 645–654.
• Enright, M. J., & Newton, J. (2004). Tourism destination competitiveness: a quantitative approach. Tourism Management, 25(6), 777-788.
• Enright, M. J., & Newton, J. (2005). Determinants of tourism destination competitiveness in Asia Pacific: Comprehensiveness and universality. Journal of Travel Research, 43(4), 339-350.
• Erbaş, E. (2016). Competitive determinance–performance analysis: an illustration on Turkish winter tourism destinations. Tourism Analysis, 21(1), 93-106.
• Erbaş, E., & Perçin, N. S. (2016). Destinasyon rekabetçiliginin stratejik planlanmasında hibrit bir yaklaşım: KFG-ÖBA-AHS. Pamukkale Üniversitesi Sosyal Bilimler Enstitüsü Dergisi, 25, 74-97.
• Fetscherin, M., & Stephano, R. M. (2016). The MT index: Scale development and validation. Tourism Management, 52, 539-556.
• Ganguli, S., & Ebrahim, A. H. (2017). A qualitative analysis of Singapore's MT competitiveness. Tourism Management Perspectives, 21, 74-84.
• Gill, H., & Singh, N. (2011). Exploring the factors that affect the choice of destination for MT. Journal of Service Science and Management, 4(03), 315-324.
• Goepel, K. D. (2013). Implementing the analytic hierarchy process as a standard method for multi-criteria decision making in corporate enterprises–a new AHP excel template with multiple inputs. In Proceedings Of The İnternational Symposium On The Analytic Hierarchy Process, 2(10), 1-10.
• Gomezelj, D. O., & Mihalič, T. (2008). Destination competitiveness-Applying different models, the case of Slovenia. Tourism Management, 29(2), 294-307.
• Govers, C. P. (1996). What and how about quality function deployment (QFD). International Journal of Production Economics, 46, 575-585.
• Hanefeld, J., Lunt, N., Smith, R., & Horsfall, D. (2015). Why do medical tourists travel to where they do? The role of networks in determining medical travel. Social Science & Medicine, 124, 356-363.
• Henson, J. N., Guy, B. S., & Dotson, M. J. (2015). Should I stay or should I go?: Motivators, decision factors, and information sources influencing those predisposed to MT. International Journal of Healthcare Management, 8(1), 4-14.
• Heung, V. C., Kucukusta, D., & Song, H. (2010). A conceptual model of MT: Implications for future research. Journal of Travel & Tourism Marketing, 27(3), 236-251.
• Heung, V. C., Kucukusta, D., & Song, H. (2011). MT development in Hong Kong: An assessment of the barriers. Tourism Management, 32(5), 995-1005.
• Hopkins, L., Labonté, R., Runnels, V., & Packer, C. (2010). MT today: what is the state of existing knowledge?. Journal of Public Health Policy, 31(2), 185-198.
• Horowitz, M. D., Rosensweig, J. A., & Jones, C. A. (2007). MT: globalization of the healthcare marketplace. Medscape General Medicine, 9(4), 33.
• Hoz-Correa, A., Muñoz-Leiva, F., & Bakucz, M. (2018). Past themes and future trends in MT research: A co-word analysis. Tourism Management 65, 200-211.
• Hsu, T. K., Tsai, Y. F., & Wu, H. H. (2009). The preference analysis for tourist choice of destination: A case study of Taiwan. Tourism Management, 30(2), 288-297.
• Hunter, W. C. (2007). MT: A New Global Niche. International Journal of Tourism Sciences, 7(1), 129-140.
• Kahveci, A., & Okutmuş, E. (2017). A qualitative research on medical tourism potential of Alanya/Turkey in the concept of international service trade. Economic Themes, 55(3), 437-450.
• Karakuş, Y. (2019). Identifying the Best Alternative Tourism Product for a Destination: the case of Cappadocia. Revista Anais Brasileiros de Estudos Turísticos - ABET, 9(1, 2 e 3). doi:10.34019/2238-2925.2019.V9.16929
• Karakuş, Y., & Çoban, S. (2018). Evaluation Of Stakeholders’ Expectations Towards Congress Tourism By Kano Model: Case Of Nevşehir. Anais Brasileiros de Estudos Turísticos - ABET, 8(2), 8–20. doi:10.34019/2238-2925.2018.v8.3207
• Kotler, P., Shalowitz, J. I., & Stevens, R. J. (2008). Strategic marketing for health care organizations: building a customer-driven health system. United States of America: John Wiley & Sons.
• Lawshe, C. H. (1975). A quantitative approach to content validity. Personnel Psychology, 28(4), 563-575.
• Lunt, N., & Carrera, P. (2010). MT: assessing the evidence on treatment abroad. Maturitas, 66(1), 27-32.
• Lunt, N., Horsfall, D., & Hanefeld, J. (Eds.). (2015). Handbook on MT and Patient Mobility. Cheltenham: Edward Elgar Publishing.
• Martilla, J. A., & James, J. C. (1977). Importance-performance analysis. Journal of Marketing, 41(1), 77-79.
• Matzler, K., & Hinterhuber, H. H. (1998). How to make product development projects more successful by integrating Kano's model of customer satisfaction into quality function deployment. Technovation, 18(1), 25-38.
• Murali, S., Pugazhendhi, S., & Muralidharan, C. (2016). Integration of IPA and QFD to assess the service quality and to identify after sales service strategies to improve customer satisfaction–a case study. Production Planning & Control, 27(5), 394-407.
• Oh, H. (2001). Revisiting importance–performance analysis. Tourism Management, 22(6), 617-627.
• Ömürbek, N., & Tunca, M. Z. (2013). Analitik hiyerarşi süreci ve analitik ağ süreci yöntemlerinde grup kararı verilmesi aşamasına ilişkin bir örnek uygulama. Süleyman Demirel Üniversitesi İ.İ.B.F.Dergisi, 18(3), 47-70.
• Otamış, P. A., & Yüzbaşıoğlu, N. (2015). Medikal turizm kümesinin gelişimi: Antalya örneği. Journal of Management and Economics Research, 13(1), 165-185.
• Pekerşen, Y., Gunes, E., & Canöz, F. (2021). Importance-performance analysis of private health facilities serving within the scope of medical tourism: Istanbul example. PASOS Revista de Turismo y Patrimonio Cultural, 19(3), 589-603.
• Perna, F., Custódio, M. J., & Oliveira, V. (2018). Tourism destination competitiveness: an application model for the south of Portugal versus the Mediterranean region of Spain: COMPETITIVTOUR. Tourism & Management Studies, 14(1), 19-29.
• Porter, M. E. (1990). The competitive advantage of nations. Harvard Business Review, 90(2), 73-93.
• Ritchie, J. B., & Crouch, G. I. (2003). The competitive destination: a sustainable tourism perspective. Cabi.
• Roy, D. G., Bhattacharya, S., & Mukherjee, S. (2022). MT brand equity in emerging markets: scale development and empirical validation. International Journal of Emerging Markets. Vol. ahead-of-print No. ahead-of-print. https://doi.org/10.1108/IJOEM-05-2021-0805
• Roy, J., Chatterjee, K., Bandyopadhyay, A., & Kar, S. (2018). Evaluation and selection of MT sites: A rough analytic hierarchy process based multi‐attributive border approximation area comparison approach. Expert Systems, 35(1), 1-19.
• Saaty, R. W. (1987). The analytic hierarchy process-what it is and how it is used. Mathematical Modelling, 9(3-5), 161-176.
• Saaty, T. L. (1977). A scaling method for priorities in hierarchical structures. Journal of Mathematical Psychology, 15(3), 234–281.
• Saaty, T. L. (1990). How to make a decision: the analytic hierarchy process. European Journal of Operational Research, 48(1), 9-26.
• Saaty, T. L. (2008). Decision making with the analytic hierarchy process. International Journal of Services Sciences, 1(1), 83-98.
• Saaty, T. L., & Özdemir, M. S. (2003). Why the magic number seven plus or minus two. Mathematical and Computer Modelling, 38(3-4), 233–244.
• Sayın, K. Ş., Yeğinboy, E. Y., & Yüksel, İ. (2017). Türkiye’de medikal turizm uygulamaları: bir üniversite ve İzmir sağlık serbest bölgesi değerlendirmesi. Dokuz Eylül Üniversitesi İktisadi İdari Bilimler Fakültesi Dergisi, 32(2), 289-313.
• Smith, P. C., & Forgione, D. A. (2007). Global outsourcing of healthcare: a MT decision model. Journal of Information Technology Case and Application Research, 9(3), 19-30.
• Smith, R., Álvarez, M. M., & Chanda, R. (2011). MT: a review of the literature and analysis of a role for bi-lateral trade. Health Policy, 103(2-3), 276-282.
• Sultana, S., Haque, A., Momen, A., & Yasmin, F. (2014). Factors affecting the attractiveness of MT destination: an empirical study on India-review article. Iranian Journal of Public Health, 43(7), 867-876.
• Tan, K. C., & Shen, X. X. (2000). Integrating Kano's model in the planning matrix of quality function deployment. Total Quality Management, 11(8), 1141-1151.
• Temizkan, S. P., Çiçek, D., & Özdemir, C. (2015). Bibliometric profile of articles published on health tourism. International Journal of Human Sciences, 12(2), 394-415.
• Tontuş, H. Ö. (2018). Promotion of health tourism and evaluation of the principles of marketing of health services. Journal of Multidisciplinary Academic Tourism, 3(1), 67-88.
• Ulaş, D., & Anadol, Y. (2016). A case study for MT: Investigating a private hospital venture in Turkey. Anatolia, 27(3), 327-338.
• Üstün, U., & Uslu, Y. D. (2022). Türkiye’nin sağlık turizminde tercih edilme nedenleri üzerine bir çalışma: Medikal turizm endeksi. Avrupa Bilim ve Teknoloji Dergisi, (33), 344-353.
• Wang, J. (1999). Fuzzy outranking approach to prioritize design requirements in quality function deployment. International Journal of Production Research, 37(4), 899-916.
• Wang, X., Li, X. R., Zhen, F., & Zhang, J. (2016). How smart is your tourist attraction?: Measuring tourist preferences of smart tourism attractions via a FCEM-AHP and IPA approach. Tourism Management, 54, 309-320.
• Wilson, F. R., Pan, W., & Schumsky, D. A. (2012). Recalculation of the critical values for Lawshe’s content validity ratio. Measurement And Evaluation İn Counseling And Development, 45(3), 197-210.
• Wongkit, M., & Mckercher, B. (2016). Desired attributes of medical treatment and medical service providers: A case study of MT in Thailand. Journal of Travel & Tourism Marketing, 33(1), 14-27.
• Yazan, T., Şengül, S., & Girgin, A. (2018). Sağlık hizmetleri ve hasta memnuniyeti. Acta Medica Alanya, 2(1), 24-29.
• Yeşilyurt, S., & Çapraz, C. (2018). A road map for the content validity used in scale development studies. Erzincan Universitesi Egitim Fakultesi Dergisi, 20(1), 251-264.
• Zehrer, A., Smeral, E., & Hallmann, K. (2017). Destination competitiveness-A comparison of subjective and objective indicators for winter sports areas. Journal of Travel Research, 56(1), 55-66.
• Zhang, W., Qin, Z., & Tang, J. (2022). Economic benefit analysis of MT industry based on Markov model. Journal of Mathematics, 2022, 1-9.
• Zhou, Y., Maumbe, K., Deng, J., & Selin, S. W. (2015). Resource-based destination competitiveness evaluation using a hybrid analytic hierarchy process (AHP): The case study of West Virginia. Tourism Management Perspectives, 15, 72-80.
• Zolfagharian, M., Rajamma, R. K., Naderi, I., & Torkzadeh, S. (2018). Determinants of MT destination selection process. Journal of Hospitality Marketing & Management, 27 (7), 775-794.