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Hospitals catering to the unique needs of international patients often make substantial investments in their international program. Research has yet to evaluate the return on investment (ROI) of establishing these programs. The purpose of this paper is to quantify the economic benefits and costs of international patient programs and evaluate the ROI of international patients for US hospitals by program maturity and size.

Operational information about 29 health systems with international patient programs in the USA was obtained from the US Cooperative for International Patient Programs (USCIPP) Annual Benchmarking Survey. A Spearman correlation coefficient was used to test the association between international program investments and revenue. Mann–Whitney U tests were used to test whether ROI differs significantly by program maturity and size.

It was found that 14 (48.3 per cent) international programs were established and 10 (34.5 per cent) programs were large in size. The median estimated organizational total gross revenue less operating expense for all programs was positive ($15.6m). Total gross revenue less operating expense was higher for large programs ($105.6m) than for small programs ($9.2m) (p < 0.001) and higher for established programs ($40.2m) than for new programs ($8.5m) (p < 0.001).

The results suggest that hospital investment in international programs yields substantial returns for the health systems studied. New programs rely on staff from other areas of the organization while developing operational processes and relationships with providers and payers abroad. Examining the ROI can help hospitals develop a business case for an international program and understand any economies of scale from increased investment.

The purpose of this paper is to propose a general model that examines the contextual factors underlying the decision‐making process of international hospital outshopping.

Patients who chose medical treatment abroad were selected to analyze the drivers of internationalization in medical services. A total number of 27 international patients who traveled from developed countries to receive medical treatment at the largest hospital in Thailand were interviewed and their responses assessed through narrative analysis.

The narrative analysis reveals that while high costs and the deteriorating conditions of health care in developed countries are initially driving consumers to leave their local service area and choose foreign service providers, pull factors such as innovation, organizational efficiency, emotional service quality and patient‐doctor relationships in service encounters are nurturing a real preference for choosing foreign health care providers.

This exploratory study is limited to the largest hospital in South East Asia. Future research could expand upon its findings and comparisons be made with other different foreign health care providers.

In order to attract foreign customers a personal service, such as medical treatment, must be based on and sustained by continuous innovation in service quality.

The paper is the first empirical in‐depth study that examines the factors underlying the decision‐making process of international hospital outshopping.

Health-care tourism has become a major industry in the past decade. Following the increasing activity in health-care tourism, the decision-making process of consumers in choosing an international health-care facility has become increasingly important to the related parties. The present study aims to offer a holistic model of international health-care facility choice that incorporates the important dimensions by assessing the growth drivers and the alternative factors proposed in the literature and by validating them via a survey study.

The factors deemed important in the existing literature were used as the basis of a study in Turkey. In total, 65 structured interviews were conducted with health-care professionals and international health tourists to understand the perspective of the two important parties that affect policymaking.

The findings of the study support the significance of the majority of the variables proposed as important factors affecting international health-care facility choice.

The study was carried out in four large hospital chains in Turkey; however, this creates a limitation in scope and may have limited representativeness of the overall market. The model has yet to be tested on a larger scale.

There are significant differences in the opinions of professionals and international health-care tourists in terms of choice criteria. This indicates problems with health professionals’ understanding of the consumer decision process.

The study provides a model that can be used to gain insights on the consumer decision process and also provides the policymakers and stakeholders of the international health-care industry with a sound theoretical foundation to build further studies upon. Only a limited number of studies was carried out in Turkey that focus on international health-care tourism, and the present study will fill a substantial research gap.

The recruitment of international nurses has been used for a long time to address the global nurse shortage. In 2012, the employment of international nurses was released in Turkey. Cultural differences can hinder interpersonal relationships, and fostering strong interpersonal relationships among nurses in the workplace is known to have a positive impact on productivity, job satisfaction and the quality of care provided. This study aims to explore the lived experiences and perceptions of international nurses working in Turkey regarding their professional integration and interpersonal relationships in the workplace.

It is a qualitative descriptive study. Face-to-face interviews were conducted with 19 international nurses using a semi-structured form. Data were analyzed using thematic analysis.

Data were presented into two themes: (1) Interpersonal relationships in the workplace and (2) Professional integration. Participants reported positive and negative experiences regarding interpersonal relationships in the work environment, such as warm and supportive approaches, or exclusionary and discriminatory behaviors. The existence of different nursing practices, positive and negative factors concerning orientation programs and the gain of experience and professional satisfaction were mentioned by the participants.

This is the first study to explore the lived experiences and perceptions of international nurses working in Turkey. The study highlights the unique needs and challenges faced by international nurses during workplace adaptation and provides practical recommendations to facilitate interpersonal relationships in the workplace and other aspects related to professional integration from hiring to the end of the adaptation period.

The purpose of this paper is twofold: First, it analyzes demand and supply-side factors that influence patient flows to and from Austria. Second, building on the empirical research and existing conceptualizations, the study offers a general extended framework to guide future comparative analysis.

The paper draws on multiple data sources including a literature review, secondary data, website analysis and semi-structured interviews with patients and health providers. Content analysis was carried out to identify common motives for seeking care abroad and providers' orientation towards medical travel.

Outbound medical travel is largely determined by factors of access, affordability and vicinity, while inbound medical travel is predominately driven by a lack of adequate medical infrastructure in source countries and quality, both in terms of medical and service quality. Providers distinguish themselves according to the extent they take part in medical travel.

The findings emerging from a single country case study approach cannot be generalized across settings and contexts, albeit contributing to a better understanding of current medical travel patterns in Europe.

Unlike most recent contributions, this study focuses both on inbound and outbound medical travel in Austria and investigates patient flows for distinctive treatments and drivers. While analysis of the supply-side of medical travel is often limited to tourism studies, this study provides a critical insight into developments in Europe from a health policy perspective, acknowledging that diverse medical travel patterns in Europe coexist.

The study aims to facilitate the medical tourists visiting emerging countries for various kinds of ailments by ranking the possible destinations to avail medical treatments.

A Fuzzy Analytical Hierarchical Process (FAHP) with a mixed-method approach is applied to analyze data collected from patients and substantiate it with medical tour operators in India to gain managerial insights on the choice-making patterns of the patients.

India is a preferred emerging market location due to the low cost and high medical staff quality. India offers value for money, whereas Singapore and Thailand are preferred destinations for quality and technology.

The study will facilitate the emerging markets' governments, hospitals and medical tourists to understand the importance of various determinants responsible for availing medical treatment outside their country.

The study recommends that cost and quality care are the patients' prime focus; government policies must provide clear guidelines on what the hospitals and country environment can offer and accordingly align the marketing strategies.

This study is the first attempt to rank various factors affecting medical tourism using the FAHP approach.

This study aims to examine hospital image, perceived medical quality, relationship marketing and word-of-mouth as the determinants of patients’ intent to revisit private hospitals in Penang, based on the theory of planned behaviour.

A quantitative study comprising a self-administered questionnaire was distributed to domestic and international patients at the airport, private hospitals and hotels located in Penang. The partial least squares structural equation modelling (PLS-SEM) approach was used to analyse and test the research hypotheses.

The results show that cognitive components (i.e. hospital image and perceived medical quality) do not have any significant influence on patients’ intent to revisit, while affective components (i.e. relationship marketing) and behavioural components (i.e. word-of-mouth) are important in increasing patients’ intent to revisit private hospitals in Penang, Malaysia. Trust has no significant mediating effect between predictor variables and patients’ intent to revisit, but it has significant association with affective and behavioural components.

The findings provide insights to medical marketing teams in promoting and increasing patients’ intent to revisit their respective hospitals and for the governments to sustain and enhance medical tourism in their countries.

This study is one of the few studies that looks at the relationship between hospital image, perceived medical quality, relationship marketing, word-of-mouth and patients’ intent to revisit private hospitals in Penang, Malaysia. This study also explored the direct and indirect effects of trust on patients’ intent to revisit that was still limited.

This paper aims to address and identify the major stakeholders in the medical tourism industry, based on their participation in medical tourism activities and their support for medical tourism development.

This paper systematically reviews the content of medical tourism studies from literature to identify key stakeholders and address the roles they play in the medical tourism industry.

This study shows that the key stakeholders in the medical tourism industry are eight, namely, medical tourists, health-care providers, government agencies, facilitators, accreditation and credentialing bodies, health-care marketers, insurance providers and infrastructure and facilities. These stakeholders strongly influence medical tourists’ decision-making process in seeking medical treatment abroad. Besides, a successful medical tourism development depends greatly on the excellent partnership between all stakeholders.

This paper sheds light on the crucial role of these stakeholders that can be an important consideration in medical tourists’ decision-making process and industry growth. The study can facilitate policymakers in designing and developing policies to improve medical tourism practices.

This paper expands the knowledge about medical tourism literature by identifying and explaining the significant role of each stakeholder in the industry. The results of this paper are quite revealing to all practitioners in terms of the potential strategies and medical tourism growth. The study establishes a foundation for future medical tourism research in the rapidly growing industry.

本文旨在根据医疗旅游的参与及其对医疗旅游发展的支持, 来确定医疗旅游的主要利益相关者。

本文系统地回顾了文献中的医疗旅游研究内容, 以识别关键的利益相关者并探讨他们在医疗旅游行业中所扮演的角色。

这项研究表明, 医疗旅游的主要利益相关者有八个：医疗游客, 医疗保健提供者, 政府机构, 促进者, 资格认证机构, 医疗保健营销人员, 保险提供者以及基础设施。这些利益相关者强烈影响医疗旅游游客在国外寻求医疗服务的决策过程。此外, 医疗旅游业的成功发展很大程度上取决于所有利益相关者之间的良好伙伴关系。

本文阐明了这些利益相关者的关键作用, 这是医疗游客决策过程和行业增长的重要考虑因素。该研究可以帮助决策者设计和制定改善医疗旅游实践的政策。

本文通过确定和解释每个利益相关者在行业中的重要作用, 扩展了对医疗旅游文献的了解。本文的结果在潜在策略和医疗旅游的增长方面对所有从业者都颇具启发性。该研究为快速发展的医疗旅游行业的未来方向研究奠定了基础。

Este artículo, tiene como objetivo abordar e identificar, los principales actores en la industria del turismo médico, en función de su participación en actividades de turismo médico y su apoyo al desarrollo del turismo médico.

El trabajo revisa sistemáticamente, la literatura y el contenido de los estudios de turismo médico para identificar a las partes interesadas, elementos clave y abordar los roles que desempeñan en la industria del turismo médico.

Este estudio muestra que los actores clave en la industria del turismo médico son ocho: turistas médicos, proveedores de atención médica, agencias gubernamentales, facilitadores, organismos de acreditación y acreditación, comercializadores de atención médica, proveedores de seguros e infraestructura e instalaciones. Estos actores, influyen de forma notable, en el proceso de toma de decisiones de los turistas médicos, al buscar tratamiento en el extranjero. Además, un desarrollo exitoso del turismo médico depende en gran medida de una excelente asociación entre todas las partes interesadas.

Este documento arroja luz sobre el papel crucial de estos actores y puede ser una consideración importante en el proceso de toma de decisiones de los turistas médicos y el crecimiento de la industria. El estudio puede facilitar, en el diseño y desarrollo de políticas para mejorar las prácticas de turismo medico, a los responsables políticos.

Este documento amplía el conocimiento sobre la literatura de turismo medico, identificando y explicando el papel importante de cada actor en la industria. Los resultados de este documento son bastante reveladores para todos los profesionales, en términos de estrategias potenciales y crecimiento del turismo médico. El estudio establece una base para futuras investigaciones sobre turismo médico en la industria de rápido crecimiento.

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

Medical tourism, characterized by patients leaving their home community to seek health-care services elsewhere, is on the rise globally. In New York state, approximately 5% of the 35,661,559 hospital visits in 2018 were non-residents. Although some are visiting New York for other reasons, and unintentionally wind up hospitalized – a percentage of this population come to New York intentionally to seek care. Understanding the make-up, needs and patterns of this population allows hospitals to tailor investments in marketing, technological resources and culturally responsive initiatives to prepare for broadening their patient population and remain competitive globally.

Using a rich all-hospital discharge data set, the authors identify patterns in diagnoses, treatment and hospital choice of patients who intentionally travel across borders for health care. The authors model the characteristics associated with “elective” admit patients with a multivariate logistic regression approach.

The authors find that among non-resident patients in New York, domestic travelers, those using insurance plans for payment and women are positively associated with seeking elective inpatient care across border. There are clear patterns of type of treatment that is more likely to be sought, with care for musculoskeletal concerns accounting for more than one-third of all non-resident elective admissions. Proximity also matters, both in terms of patients being more likely to live in a travel zone adjacent to the state, as well as being more likely to seek care from hospitals in counties closest to the borders.

To the best of the authors’ knowledge, this is the first study, using a large set of claims data, that is able to empirically differentiate between patients who travel to NY for the primary purpose of obtaining health care versus those who emergently must access care while traveling for other reasons. This approach can inform future studies seeking to better understand patient migration patterns and strategic educational and marketing initiatives to motivate consumers to cross borders to seek care.