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The purpose of this paper is to explore the supply-side factors that determines the quality of global healthcare services from medical tourism healthcare providers’ (MTHP) perspective, which provide value-in-medical-travel to foreign patients/medical tourists, who travel to India for medical treatment/surgery.

The thematic content analysis of in-depth interviews with 15 senior MTHP, from 15 private hospitals in India was undertaken, to generate the themes, and identify the supply-side factors necessary for sustainable medical tourism management.

The findings conclude that MTHP ranked in ascending order, less waiting-time for surgery, healthcare quality and accreditation, staff/surgeon’s expertise, healthcare information, hospital facilities and services, patient-safety, travel-risk, surgical costs and holiday opportunity as essential factors for providing sustainable quality and value-in-medical-travel to patients.

Many private hospital spokespersons declined to be interviewed due to confidentiality and privacy policy

The findings are generalised in case of global private hospitals treating foreign patients. Policy implications suggest that private hospitals in developing countries need to focus on providing value-in-medical-travel, such as accreditation quality of healthcare, no waiting-time, patient-safety, qualified and experienced medical and non-medical staff, hospital facilities and post-surgery care with positive healthcare outcomes.

Medical-tour facilitators, hotels and tourism sites need to collaborate with agencies to provide inclusive built environment, first-aid and wheelchair access, to medical tourists, having financial and legal implications for business.

There is little qualitative empirical research on the views of MTHP, regarding management of essential supply-side factors that provide value-in-medical-travel to attract medical tourists to India.

医疗保健提供者对印度医疗旅行价值的看法

本文的目的是从医疗旅游医疗保健提供者的角度探讨决定全球医疗服务质量的供应方因素, 这些因素可为前往印度求医的外国患者/医疗游客提供医疗旅行的价值治疗/手术.

对印度15家私立医院的15家高级医疗旅游保健提供者（MTHP）进行了深度访谈, 对主题内容进行了分析, 以生成主题并确定可持续医疗旅游管理所必需的供应方因素。

研究结果得出结论, MTHP以升序排列的顺序是：手术等待时间, 医疗质量和认证, 工作人员/外科医生的专业知识, 医疗保健信息, 医院设施和服务, 患者安全, 旅行风险, 手术费用和度假时间机会是为患者提供医疗旅行可持续质量和价值的重要因素。

由于医院的机密性和隐私权政策, 许多私立医院发言人拒绝接受采访。

如果全球私立医院为外国医疗游客提供治疗, 那么研究结果将得到概括。政策含义表明, 发展中国家的私立医院需要集中精力提供医疗旅行价值, 例如无需等待时间的医疗保健认证质量和患者安全, 合格和经验丰富的医务人员和非医务人员, 医院设施和后期医疗服务。具有积极医疗效果的手术护理。

旅馆, 医疗旅行促进者和旅游景点需要与机构合作, 为医疗游客提供紧急急救和轮椅通道, 这对企业有财务和法律影响。

关于MTHP观点的定性实证研究很少, 涉及对提供医疗旅行价值以吸引医疗游客前往印度的基本供应方因素的管理。

印度, 医疗旅游, 全球化 等待时间, 患者安全, 认证质量

研究论文

Perspectiva del valor de los proveedores del cuidado de la salud en viajes con propositos medicos a la India

El propósito de esta investigación es explorar los factores que del lado de la oferta determinan la calidad de los servicios globales de salud desde el punto de vista del proveedor, el cual agrega valor al viaje con propósitos médicos a pacientes/turistas médicos quienes viajan a la India para tratamientos médicos ó cirugía.

El análisis de contenido temático de las detalladas entrevistas, con-15 proveedores experimentados de asistencia sanitaria de turismo medico, en-15 hospitales de la India, fué realizado para generar los temas é identificar los factores que del lado de la oferta son necesarios para la gestión sostenible del turismo médico.

Los hallazgos concluyen que proveedores experimentados de turismo ranquearon en orden ascendente la reducción en tiempos de espera para cirugías, acreditación de la calidad del cuidado de la salud, experticia del personal no médico y de cirugía, información del cuidado de la salud, servicios é instalaciones de los hospitales, seguridad del paciente, riesgos de viaje, costos de cirugías, y oportunidades vacacionales, como factores esenciales para proveer calidad sostenible y valor en los viajes con propósitos médicos a los pacientes.

Muchos representates de los hospitales privados se rehusaron a ser entrevistados debido las políticas de privacidad y confidencialidad del hospitales.

Los hallazgos son generalizables en el caso de hospitales privados globales que tratan a turistas médicos extranjeros. Las implicaciones políticas sugieren que los hospitales privados en los países en vía de desarrollo necesitan enfocarse en agregar valor al viaje médico, por medios como la calidad de acreditación de la atención médica, reduccion de tiempos de espera y la seguridad del paciente, personal médico y no médico calificado y experimentado, instalaciones hospitalarias y servicios posoperatorios con resultados sanitarios positivos.

Los hoteles, los facilitadores de toures médicos y los sitios de turismo necesitan colaborar con las agencias para proveer primeros auxilios de emergencia y acceso en silla de ruedas a los turistas médicos, teniendo esto implicaciones financieras y legales para los negocios.

Existe poca investigación empírica cualitativa sobre los puntos-de vista-de (MTHP) proveedores de asistencia sanitaria de turismo médico con respecto a la gestión de los factores esenciales del lado de la oferta que agregan valor al turismo con fiines médicos para atraer turistas médicos a la India.

India, globalización, turismo médico, tiempo-de-espera, calidad, seguridad-del- paciente

Trabajo de investigación

The purpose of this paper is to explore the demand-side factors that influence the inbound medical tourists’ (MTs) decision to travel abroad for medical treatment/surgery.

The researchers conducted thematic analysis of in-depth interviews in India with 24 foreign MTs’ to generate the themes, identify factors and propose a model with hypothesis for future quantitative survey.

The findings conclude that patients ranked in ascending order less waiting time for surgery, healthcare quality and accreditation, staff/surgeons expertise, healthcare information, hospital facilities and services, patient safety, travel risk, surgical costs and holiday opportunity as important factors that influence the decision to travel abroad for medical treatment/surgery.

Foreign patients from six private hospitals were willing to be interviewed with the permission of the hospital. Due to confidentiality and privacy policy, many hospitals declined interviews with foreign patients.

The findings are generalised in case of foreign patients as MTs and all private hospitals treating foreign patients in India and other global healthcare destinations. Policy implications suggest that private hospitals in developing countries need to provide first-class quality of healthcare as foreign patients look for internationally accredited quality, no waiting time, patient safety, qualified and experienced surgeons, healthcare workers education and experience hospital facilities and post-surgery care with positive healthcare outcomes.

There is little empirical research on the views of inbound MTs, about factors influencing their decision to travel abroad for surgery to India.

Increasing globalisation of the healthcare sector suggests that there may be new competitive opportunities for emerging economies in this price‐sensitive sector. The purpose of this paper is to examine the extent to which emerging economies, and in particular the four major Asian competitors – Thailand, India, Malaysia and Singapore – can compete successfully in the medical tourism (MT) sector.

The authors evaluate this sector in terms of Porter's Diamond of National Competitiveness, as well as considering the challenges that competitors must address. The primary challenges relate to attracting consumers, proving assurances of quality for a credence good, increasing scale while maintaining quality, addressing ethical issues and moving beyond simple price‐based competition.

The authors conclude that the major Asian competitors in MT benefit from strong government support, rely heavily on overseas linkages and accreditation, and are competing in very similar ways. In the future, further differentiation is both likely and desirable.

The paper offers a theoretically based analysis of the future competitiveness of the rapidly evolving MT industry in four key Asian economies. This industry appears to relate well to the comparative advantage of emerging economies and offers future opportunities for upgrading and value adding.

The purpose of this paper is to identify the dimensions of service quality as well as of service loyalty in the context of medical tourism. It seeks to demonstrate the conceptualization of medical tourism service loyalty (MTSL) construct. This research also attempts to examine the effect of service quality dimensions on service loyalty dimensions of medical tourism.

The dimensions of service quality as well as of service loyalty are identified using an exploratory factor analysis. Next, the reliability and validity of the quality factors and loyalty factors are established through confirmatory factor analysis using AMOS 18.0 version. The related hypotheses are tested using structural equation modeling (SEM).

The paper identifies eight-factor construct for medical tourism service quality and three-factor construct for MTSL. It is found that the treatment satisfaction dimension of service quality has positive and significant impact on MTSL. It is also observed that, overall, medical tourism service quality has positive impact on MTSL.

These dimensions of service quality should be viewed as the levers of improving perceived service quality with respect to medical tourism. Examining the service quality dimensions’ impact on customer loyalty for medical tourism sector can offer the industry valuable insights regarding which aspects of the service to focus on in order to improve medical tourist’s satisfaction and loyalty toward the firms.

This paper introduces the concept of service quality and service loyalty in medical tourism sector. In conceptualizing MTSL, the authors propose an integration of behavioral measures, attitudinal measures and cognitive measures. The interrelationship between the service quality construct and medical loyalty construct was established using SEM. This is useful for the healthcare manager to measure the medical tourist’s perceptions of service quality on these dimensions as related to medical tourism performance.

The purpose of this paper is to develop a comprehensive framework to identify and classify key medical tourism enablers (MTEs) and to study the direct and indirect effects of each enabler on the growth of medical tourism in India.

In this paper, an integrated approach using interpretive structural modeling (ISM) and Fuzzy Matrice d'Impacts Croisés Multiplication Appliquée á un Classement (FMICMAC) analysis has been developed to identify and classify the key MTEs, typically identified by a comprehensive review of literature and expert opinion. The key enablers are also modeled to find their role and mutual influence.

The key finding of this modeling helps to identify and classify the enablers which may be useful for medical tourism decision makers to employ this model for formulating strategies in order to overcome challenges and to become a preferred medical tourism destination. Integrated model reveals enablers such as medicine insurance coverage, international healthcare collaboration, and efficient information system as dependent enablers. No enabler is found to be autonomous enablers. The important enablers like healthcare infrastructure facilities and global competition are found as the linkage enablers. Research in medicine and pharmaceutical science, medical tourism market, transplantation law, top management commitment, national healthcare policy, competent medical and para-medical staffs are found as the independent enablers. Integrated model also establishes the direct and indirect relationship among various enablers.

The research provides an integrated model using ISM and FMICMAC to identify and classify various key enablers of medical tourism in India. In conventional cross-impact matrix multiplication applied to classification analysis, binary relationship of various enablers is considered. FMICMAC analysis helps to establish possibility of relationship among various enablers so that low-key hidden factors can be identified. The low-key hidden factors may initially exhibit marginal influence but they may show significant influence later on during analysis. The uncertainty and fuzziness of relationship among various enablers can be conveniently handled by FMICMAC and expert opinions can easily be captured. This research will help medical tourism decision makers to select right enablers for the growth of medical tourism in India.

The present paper aims to analyse who actually benefits from the policies to promote international trade in healthcare services through medical tourism in India. It also assesses the implications of unfettered and unchecked medical tourism for public health policy-making.

The research methodology adopted in this paper is inter-disciplinary (socioeconomic and legal) and includes a mix of doctrinal and empirical qualitative research.

The present paper argues that in the absence of any baseline data in the public domain on inbound traffic of tourists visiting India on medical tourism, it is difficult to assess and evaluate the private sector claims and that the absence of any format for data collection, management and analysis results in questionable accountability and institutional fragmentation and non-coordination. Furthermore, it results in asymmetrical policy-making in areas like international trade, which may have unintended negative effects for public health.

The research findings of the present paper will also assist other developing countries considering to promote medical tourism to learn lessons from India’s experiences.

The present paper uses the qualitative empirical research conducted by the author to analyse the state of affair of medical tourism in India.

This study contends that customers’ perceived value can drive medical tourism. To demonstrate this, the purpose of this paper is to propose and test a research model capturing elements of perceived benefits and sacrifice that, by affecting the perceived value of medical tourism products, influence the buying intention of potential customers.

Potential medical tourists from China are tapped due to their cultural similarity to Taiwan, and the absence of a language barrier. Data from 301 usable questionnaires were tested against the research model using the structural equation modeling approach.

The results indicated that perceived value was a key predictor of customer intentions. As for benefits, perceived medical quality, service quality and enjoyment were critical components that significantly influenced the perception of value. Regarding sacrifice, the effects of perceived risk on perceived value were significant.

This study targeted potential medical tourists. Therefore, a validation using another large sample gathered elsewhere is required to generalize the findings.

The findings can assist governments in developing policies that promote medical destination and provide insights into research on how destination countries can make medical tourism a win/win option for themselves and international patients.

The proposed model is original; unlike most prior papers which take a conceptual approach to medical tourism, this study contributes to an understanding of the factors that influence the travel intentions of medical tourists through its empirical investigation, and especially in its targeting of customers’ value perception.

The purpose of this paper is to determine the dimensions of service quality in Indian hospitals, from the perspectives of patients and their family members/friends (referred to as “attendants”).

Based on the existing models and the literature on healthcare services, a framework is proposed to conceptualize and measure hospital service quality.

Two instruments for measuring the dimensions of hospital service quality, one each from the perspective of patients and attendants, are proposed.

This framework enables hospital managers to understand how patients and their attendants evaluate the quality of healthcare provided in respect of every dimension. A comparison of perceptions between patients and attendants would aid them to allocate resources to various aspects of healthcare, with respect to these two customer groups. Hospital administrators can use the instruments proposed to obtain feedback on their performance on service quality parameters so that they can benchmark themselves with their competitors.

This paper contributes to research on healthcare services by the development of a comprehensive framework for customer (both patient and attendant)‐perceived healthcare quality.

Medical tourism encourages the traveling of patients, expert healthcare professionals and promotes cross-border trade in healthcare services. The Indian medical tourism sector is facing new challenges as well as certain ethical and legal issues because of continuous market changes and patient’s requirements while at the same time advancements in current health services have also been observed. It is therefore very important to understand and address the issues of the medical tourists. The purpose of this paper is to evaluate the important factors which can make India an affordable medical tourism destination.

In this paper, the factors influencing Indian medical tourism sector have been explored by conducting literature review, they are ranked according to the results of a questionnaire-based survey and further analyzed by using the interpretive structural modeling (ISM) approach. The mutual relationships between these factors were identified to develop an ISM model so as to find out the important factors which can make India an affordable place for medical tourism.

The results of the survey and the model show that cost of medical procedures, facilitation, and care, the infrastructure of Indian hospitals, clinical excellence and the competence of doctors and staff are the top level factors.

It is very important to address the concerns of the patients coming to a developing country like India for availing medical services. This research has evaluated the important factors which can make India an affordable medical tourism destination.

This research assesses the effects of globalization on delivery of healthcare services in India by conducting critical analysis of the medical tourism industry by collecting original data from the international patients coming to India for different types of medical procedures so that a comprehensive model can be prepared which will help the hospitals and policymakers to improve the processes related to medical tourism.

Indian healthcare system, especially in rural regions, faces several problems that prevent it from achieving universal and sustainable healthcare coverage. The purpose of this paper is to capture such problems through expert opinions and provide solution concepts that are derived from other similar scenarios.

Delphi study has been conducted with 38 experts from diverse areas related to the Indian healthcare sector. Nineteen theses were formulated based on the discussion with experts and were reconfirmed through intensive desktop research. Finally, theses were subjected to expert panel member’s evaluation.

The pool of arguments provided by the participating experts included 415 written statements explaining the (dis-)agreement with the theses. The experts achieved consensus in six theses with interquartile ranges smaller or equal to 20. The written arguments provided by experts were summarized into five different categories, namely interrelations/dependencies in healthcare, inequalities in healthcare, lack of proactive measures, importance of healthcare personnel and role of government in healthcare. Finally, a framework is proposed mapping the issues identified at different stages of the healthcare value chain. Problem-based cost allocation and hub-and-spoke model are discussed as potential solutions for the issues identified.

Lack of empirical and statistical data on the effective cost arising from the present issues suggests future research to determine these expenses and therefore examine the feasibility of applying the problem-based cost allocation framework discussed in this study.

Results show that merely targeting the supply side of healthcare falls short of the mark, especially in a country, such as India, with large socio-economic differentials. Healthcare system, hence, should be viewed from a market perspective, taking both forces of supply and demand into consideration.

This study intends to allow for a comprehensive approach to identify the issues in Indian healthcare system by reviewing the existing key studies in literature and validating it through empirical inputs from experts in the domain. Based on the validation, a framework is proposed mapping the issues identified at different stages of the healthcare value chain.