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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 past decade has witnessed a tremendous and progressive growth in the number of Nigerians who engage in medical tourism from Nigeria to India. Various commentators have advanced diverse reasons for this trend. However, there is a dearth of research that has sought to provide empirical insights. This paper aims to investigate the decision-making process of Nigerian medical tourists and why they prefer medical tourism to India to medical care locally.

Eight Nigerian medical tourists are interviewed on a one-on-one basis with open-ended questions using purposive criterion sampling technique from an interpretivist mind-set.

The paper identifies two major motivators, namely, inadequate medical infrastructure and poor medical, and customer service from health workers in Nigeria, which spurred medical tourism from Nigeria to India. Further, it finds that first timers premise their decisions on advice from reference groups, while previous personal experiences guide decisions on subsequent medical travels. Findings are explained using the template provided by the theory of planned behaviour.

This exploratory nature of this research provides a useful basis to elucidate the course of decision-making of Nigerian patients so that appropriate marketing communication channels can be applied. It improves the process of recruiting and engaging Nigerian patients and nurturing wholesome relationships between Nigerian patients and hospitals.

The purpose of the paper is to describe and analyze differences in patients' quality perceptions of private and public primary care centers in Sweden.

The article explores the differences in quality perceptions between patients of public and private primary care centers based on data from a large patient survey in Sweden. The survey covers seven dimensions, and in this paper the measure Overall impression was used for the comparison. With more than 80,000 valid responses, the survey covers all primary care centers in Sweden which allowed for a detailed analysis of differences in quality perceptions among patients from the different categories of owners.

The article contributes with a detailed description of different types of private owners: not-for-profit and for profit, as well as corporate groups and independent care centers. The results show a higher quality perception for independent centers compared to both public and corporate groups.

The small number of not-for-profit centers (21 out of 1,117 centers) does not allow for clear conclusions for this group. The results, however, indicate an even higher patient quality perception for not-for-profit centers. The study focus on describing differences in quality perceptions between the owner categories. Future research can contribute with explanations to why independent care centers receive higher patient satisfaction.

The results from the study have policy implications both in a Swedish as well as international perspective. The differentiation between different types of private owners made in this paper opens up for interesting discussions on privatization of healthcare and how it affects patient satisfaction.

The main contribution of the paper is the detailed comparison of different categories of private owners and the public owners.

This paper explores the effect of perceived service quality, trust, perceived value and perceived cost on patient satisfaction and loyalty as well as exploring the moderating role of the sociodemographic factors.

The data were gathered from 462 patients via a structured questionnaire, while structural equation modeling was utilized for the analysis.

Results indicated that trust, perceived value and patient satisfaction have important roles in shaping the patient loyalty, while patient satisfaction was found to fully mediate the patient’s perceived service quality. Loyalty relationship was also found to partially mediate the trust–loyalty relationship. Nonetheless, the patient’s satisfaction–loyalty relationship was found to be only moderated by the age factor.

Implications are provided to the Egyptian private hospitals in order for them to formulate improvement plans as well as set higher standards of conduct.

This original research is the first one, up to the researcher knowledge, that explores the drivers of patient satisfaction in the private hospitals in Egypt.

Promoting health literacy, i.e. the ability to access, collect, understand and use health-related information, is high on the health policy agenda across the world. The digitization of health-care calls for a reframing of health literacy in the cyber-physical environment. The article systematizes current scientific knowledge about digital health literacy and investigates the role of health-care organizations in delivering health literate health-care services in a digital environment.

A literature review was accomplished. A targeted query to collect relevant scientific contributions was run on PubMed, Scopus and Web of Science. A narrative approach was undertaken to summarize the study findings and to envision avenues for further development in the field of digital health literacy.

Digital health literacy has peculiar attributes as compared with health literacy. Patients may suffer from a lack of human touch when they access health services in the digital environment. This may impair their ability to collect health information and to appropriately use it to co-create value and to co-produce health promotion and risk prevention services. Health-care organizations should strive for increasing the patients’ ability to navigate the digital health-care environment and boosting the latter’s value co-creation capability.

Tailored solutions should be designed to promote digital health literacy at the individual and organizational level. On the one hand, attention should be paid to the patients’ special digital information needs and to avoid flaws in their ability to contribute to health services’ co-production. On the other hand, health-care organizations should be involved in the design of user-friendly e-health solutions, which aim at engaging patients in value co-creation.

This contribution is a first attempt to systematize extant scientific knowledge in the field of digital health literacy specifically focused on the strategies and initiatives that health-care organizations may take to address the limited digital health literacy pandemic.

This study aims to deal with the paucity of studies in the stages of the development of loyalty behaviour of customers in the healthcare context by incorporating three crucial service quality dimensions (physical environment, personnel quality and technical quality) and also investigating trust and commitment as mediating factors.

Survey data were obtained from 420 respondents admitted to government hospitals in Kerala employing a convenience sampling method. The formulated hypotheses were tested using partial least square structural equation modelling.

Results indicate that patient satisfaction, trust and commitment can create favourable behavioural intentions amongst patients. When patients reveal higher trust, they are more inclined to value healthcare services and willing to commit to a long-term relationship, resulting in increased patient loyalty.

Organisational efforts should improve trust and commitment and build a good relationship between service providers and patients. Efforts should be taken to raise the standard of technical and personnel aspects, and a focus on physical infrastructure should also be considered to build a favourable behavioural intention to revisit and positive referrals.

This is the first empirical study to analyse technical quality, personnel quality and physical environment along with the mediating effect of trust, and commitment in a four-stage loyalty development model in the healthcare context of Kerala, India.

The purpose of this study is to investigate the inbound and outbound medical tourism in the UK to determine if the UK can be considered as a net exporter of health services as well as the impact of the 2007 global economic crisis, diaspora populations and the number of UK expats on medical tourism figures.

Using microdata drawn from the International Passenger Survey (2000-2016), the authors estimate the flows, number of nights and expenditure of tourists looking for medical treatment who complete international visits of less than 12 months’ duration to and from the UK. The authors also analyse the main destinations of UK residents, the country of origin of overseas residents and the particular case of British expats.

The results show the upward trend of inbound and outbound patients, the strong seasonality in outbound patients, and the significant increase in the levels of expenditure of overseas residents since 2005. Poland, France, Hungary and India are the chosen countries by UK residents to be treated, whereas Irish Republic, Spain, France, Gibraltar and the United Arab Emirates are the main countries providing inbound health patients. However, the processes of migration explain full or partly the inbound and outbound flows found for some countries.

This study offers a critical insight into inbound and outbound medical flows, demonstrating both the scope for and limitations to market development in this area.

User experience is key for measuring and improving the quality of services, especially in high personal and relation-intensive sectors, such as healthcare. However, evidence on whether and how the organizational model of healthcare service delivery can affect the patient experience is at an early stage. This study investigates the relationship between healthcare service provision models and patient experience by focusing on the nursing care delivery.

65 nurses' coordinators were involved to map the nursing models adopted in the healthcare organizations of in an Italian region, Tuscany. This dataset was merged with patient experience measures reported by 9,393 individuals discharged by the same organizations and collected through a Patient-Reported Experience Measures Observatory. The authors run a series of logistic regression models to test the relationships among variables.

Patients appreciate those characteristics of care delivery related to a specific professional nurse. Having someone who is in charge of the patient, both the reference nurse and the supervisor, makes a real difference. Purely organizational features, for instance those referring to the team working, do not significantly predict an excellent experience with healthcare services.

Different features referring to different nursing models make the difference in producing an excellent user experience with the service.

These findings can support managers and practitioners in taking decisions on the service delivery models to adopt. Instead of applying monolithic pure models, mixing features of different models into a hybrid one seems more effective in meeting users' expectations.

This is one of the first studies on the relationship between provision models of high-contact and relational-intensive services (the healthcare services) and users' experience. This research contributes to the literature on healthcare service management suggesting to acknowledge the importance of hybridization of features from different, purely theoretical service delivery models, in order to fit with providers' practice and users' expectations.

• This is one of the first studies on the relationship between provision models of nursing care and patient experience.

• Healthcare services' users appreciate service delivery characteristics identified with “be cared by,” or in other words with having a reference nurse.

• Nursing models' features that relate to the organizations and that providers tend to judge as professionalizing and evolutive, such as team working, appear not key in relation to patient experience.

• Pure models of service delivery are theoretically useful, but hybrid models can better meet users' expectations.

This is one of the first studies on the relationship between provision models of nursing care and patient experience.

Healthcare services' users appreciate service delivery characteristics identified with “be cared by,” or in other words with having a reference nurse.

Nursing models' features that relate to the organizations and that providers tend to judge as professionalizing and evolutive, such as team working, appear not key in relation to patient experience.

Pure models of service delivery are theoretically useful, but hybrid models can better meet users' expectations.

Emergency care delivery is a process requiring input from various healthcare professionals within the hospital. To deliver efficient and effective emergency care, professionals must integrate rapidly at multiple interfaces, working across functional, spatial and professional boundaries. Yet, the interdisciplinary nature of emergency care presents a challenge to the optimization of patient flow, as specialization and functional differentiation restrict integration efforts. This study aims to question what boundaries exist at the level of professionals and explores how these boundaries may come to influence integration and operational performance.

To provide a more holistic understanding of the inherent challenges to integration at the level of professionals and in contexts where professionals play a key role in determining operational performance, the authors carried out an in-depth case study at a busy, Level 1 trauma center in The Netherlands. In total, 28 interviews were conducted over an 18-month period.

The authors reveal the existence of structural, relational and cultural barriers between (medical) professionals from different disciplines. The study findings demonstrate how relational and cultural boundaries between professionals interrupt flows and delay service processes.

This study highlights the importance of interpersonal and cultural dynamics for internal integration and operational performance in emergency care processes. The authors unveil how the presence of professional boundaries creates opportunity for conflict and delays at important interfaces within the emergency care process, and can ultimately accumulate, disrupting patient flow and increasing lead times.

The present article aims at rising stream of literature about intellectual capital in healthcare organizations, by exploring how knowledge-based activities are designed to promote innovation and create value. This process concerns not only buyers and sellers of industrial products/services but, more widely, larger networks of healthcare actors which include patients, payers and health institutions.

To answer the research question, we adopted a conceptual approach aimed at reaching overall comprehension of healthcare innovation mechanisms. We have tracked the pivotal extant studies for catching the roots and dynamics at the base of diffusion of healthcare innovation. This article demonstrates, based on previous literature and theoretical speculations, the contribution that innovative knowledge-based activities (e.g. market access approach) make to intellectual capital in healthcare organizations to promote innovation and create value.

The results show that three knowledge-based activities of the healthcare ecosystem shape the basis of the proposed conceptual framework. First, a value co-creation strategy to develop capabilities for each health stakeholder is intended as human capital. Second, the market access approach to promote innovation is reported to the relational capital. Third, a digital servitization strategy is referred to the structural capital.

This paper provides implications for the stream of literature about intellectual capital in healthcare organizations. It aims at exploring three knowledge-based activities as value co-creation, market access and digital servitization that respond to different intellectual capital levels components (human, relational, structural).

This article provides a conceptual framework based on the linkage of two fundamental streams of management studies, which correspond to innovation diffusion and intellectual capital management. This offers a more solid conceptualization for managing intellectual capital in healthcare organizations with respect to previous studies and creates value in the ecosystem.