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The technological advances in the Industrial Revolution (IR) 4.0 era escalate the advancement of the healthcare industry, including the health tourism phenomenon. Based on the current trend in connected health care (e.g. mobile healthcare technology; digital health, etc.), this paper aims to propose that the distance between healthcare providers around the globe and its potential patients can be vastly reduced to almost on a real time basis.

A secondary literature review is conducted to identify the key development of IR 4.0 technologies in the healthcare industry and its possible trend leading the health tourism sector.

The adoption of IR 4.0 technologies is expected to make seeking treatments overseas more affordable, accessible and health records readily available on a real-time and secured basis. However, it is worth to note that the growth of health tourism raises the eyebrows of society from the security, social and economic perspectives.

This paper contributes to our understanding that the emergence of IR 4.0 technologies changes the landscape of the health care and health tourism industry. Continuous technology advancement is expected to further shape the future trend and escalate the commercialization aspect of the health tourism industry.

The purpose of this study is to systematically analyze the evolution of health tourism development, identify relevant themes and segments of health tourism research and offer future research directions and practical implications for academic researchers and tourism practitioners worldwide using China as an example.

Using a bibliometric analysis, the present study comprehensively analyzes the theme, segments and the evolution of health tourism research over the past 40 years in China.

Major findings show that health tourism research in China could be divided into four stages with different characteristics, and three segments, including wellness tourism, health and wellness tourism and medical tourism. Findings also reveal the trend of health tourism development tends to be industrialized, diversified and systematic under the guidance of recent policies. Theoretically, based on the theoretical framework developed by Hall (2011), the present study contributes to the establishment and extension of the framework for health tourism within the context of China. Practically, findings can provide health tourism-related policy implications for the future development of health or health sector-integrated tourism.

The study proposes possible collaboration between government and academia in terms of health tourism-related policy formulation.

Through 40-year bibliometric analysis of health tourism evolution in China, the present study explores the main themes of health tourism development, identifies the segments of health tourism and analyzes the development stages of health tourism. Findings should be of use to international readers to better understand the uniqueness of health tourism development and find out possible future health tourism development research directions. As a result, major contributions of this paper are the comprehensive analysis of the evolution of health tourism research and the implications on other countries and regions to adopt a pragmatic approach to explore the trend and unique characteristics of health tourism for future development.

本研究旨在系统地分析中国健康旅游的演变过程, 探索健康旅游研究的相关主题及细分领域, 并为全球学术研究人员及旅游从业者提供未来的研究方向。

此研究通过文献计量学的研究方法, 全面分析了中国近40年健康旅游研究的主题、细分以及演变。

中国健康旅游研究根据其发展特点可以分为四个阶段及三个细分主题：分别是养生旅游, 康养旅游及医疗旅游。调查结果还表明, 在近期政策的引导下, 健康旅游发展趋于产业化、多元化和系统化。从理论意义来说, 本研究基于Hall (2011) 提出的理论框架, 构建了中国背景下的健康旅游框架。从实践意义来说, 研究结果可以为健康和旅游业相关部门提供政策建议。

此研究还有助于促进政府和学术界在健康旅游政策制定方面的合作。

此研究通过对中国近40年健康旅游的研究进行文献计量分析, 探索了健康旅游发展的主题, 分析了健康旅游的细分市场以及发展阶段。研究结果有助于学术界及旅游业更好地了解健康旅游发展的独特性及未来健康旅游的研究方向。因此, 本研究的主要贡献是全面地分析了健康旅游研究的演变, 并有助于其他国家/地区探索未来健康旅游的发展趋势和其独特特征。

El propósito del presente estudio es analizar sistemáticamente la evolución del desarrollo del turismo de salud, identificar temas y segmentos relevantes de la investigación en turismo de salud y ofrecer direcciones de investigación futuras e implicaciones prácticas para investigadores académicos y profesionales del turismo en todo el mundo utilizando a China como ejemplo.

Mediante un análisis bibliométrico, el presente estudio analiza exhaustivamente la temática, los segmentos y la evolución de la investigación sobre turismo de salud en los últimos 40 años.

Los principales hallazgos muestran que la investigación del turismo de salud en China podría dividirse en cuatro etapas con diferentes características y tres segmentos, incluido el turismo de bienestar, el turismo de salud y bienestar y el turismo médico. Los hallazgos también revelan que la tendencia del desarrollo del turismo de salud tiende a ser industrializado, diversificado y sistemático bajo la guía de políticas recientes. El presente estudio hace aportes tanto teóricos como prácticos. Teóricamente, basado en el marco teórico desarrollado por Hall (2011), el presente estudio contribuye al establecimiento y extensión del marco para el turismo de salud en el contexto de China. En la práctica, los hallazgos pueden proporcionar implicaciones políticas relacionadas con el turismo de salud para el desarrollo futuro de la salud o el turismo integrado en el sector de la salud.

El estudio también propone una posible colaboración entre el gobierno y la academia en términos de formulación de políticas relacionadas con el turismo de salud.

A través del análisis bibliométrico de 40 años de la evolución del turismo de salud, el presente estudio explora los temas principales del desarrollo del turismo de salud, identifica los segmentos del turismo de salud y analiza las etapas de desarrollo del turismo de salud. Los hallazgos deberían ser de utilidad para los lectores internacionales para comprender mejor la singularidad del desarrollo del turismo de salud y descubrir posibles direcciones futuras de investigación sobre el desarrollo del turismo de salud. Como resultado, las principales contribuciones de este documento son el análisis exhaustivo de la evolución de la investigación en turismo de salud y las implicaciones en otros países y regiones para adoptar un enfoque pragmático para explorar la tendencia y las características únicas del turismo de salud para el desarrollo futuro.

Under the Directive 2011/24/EU, medical tourism and cross-border health are interrelated terms regarding the freedom to move to get the most accessible medical treatment into EU Member State within the defined procedures for reimbursement. Little known empirically regarding the efficiency of the cross-border health/medical tourism industry. This study aims to measure its efficiency in Europe for the years 2010-2014, by using Data Envelopment Analysis (DEA).

Data obtained from OECD and the European Core Health Indicators (ECHI), which is collecting the data through Eurostat. Eurostat collects data on health-care activities and provides data on hospital discharges, including the hospital discharges of non-residents and these include hospital discharges of in-patients and day care patients. The analysis uses “DEA.P, 2.1 for windows” by Coelli (1996).

The results show that the Members States health systems were very efficient in handling non-residents in-patients; however, when managing day cases/outpatients, the efficiency scores dropped.

The findings would have significant associations affecting intentions to revisit clinics and the destination country. In addition, will be useful to those seeking a better understanding of the cross-border health and medical tourism industry efficiency.

Extending the findings of the European Commission report (2015c) by examining how well medical tourists are informed about the decision they are making, would be of perceived value. These are important indicators at European level by helping each Member State to measure its medical tourism services.

This paper's purpose is to give an overview of current research regarding the concept of “health tourism” with a focus on Switzerland, and to determine whether a consensus on this concept and its embedding in existing/future markets can be found.

The paper is an explorative study combining literature review, questionnaires and qualitative interviews. Grounded theory was employed.

A service from the field of health care must have been provided prior to health tourism, allowing it to be classified under the health care system. Thus, health tourism is classified under the market for the sick and not under tourism which targets the healthy. Furthermore a new market for the healthy is emerging, which needs to be defined. As an example health(i)ness could help to clarify the terminology, to be seen as a gatekeeper of health and as a cultural paradigm change from cure to prevention.

Further research is needed, regarding the positioning and development of health tourism and its synergies, as the cost pressures in health care increase and will continue to have a sustainable impact on health tourism.

The paper provides better knowledge of the term health tourism, its general classification, and particular reference to Switzerland, and information about upcoming changes in health care.

The findings add to the knowledge of how health tourism is embedded into health care and tourism, and show potential within the market for the healthy. It provides information to members of the tourism and health care market.

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.

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 major purpose of this introduction to the special issue of Tourism Review on health and medical tourism is to outline some of main issues that exist in the academic literature in this rapidly developing field.

The paper reviews relevant health and medical tourism and cognate literature.

The paper identifies some of the interrelationships between different areas of health and medical tourism, including wellness and wellbeing tourism, dental tourism, stem‐cell tourism, transplant tourism, abortion tourism, and xeno‐tourism. Key to defining these areas are the relationships to concepts of wellness and illness and the extent to which regulation encourages individuals to engage in cross‐border purchase of health services and products. Key themes that emerge in the literature include regulation, ethics, the potential individual and public health risks associated with medical tourism, and the relative lack of information on the extent of medical tourism.

The development of international medical tourism is demonstrated to have potentially significant implications for global public health.

The paper covers an extensive range of academic literature on international medical tourism which indicates the different approaches and emphases of research in different disciplines as well as the ideological and philosophical differences that exist with respect to health medical tourism. The paper also notes that some of the individual and public health risks of medical tourism are not usually incorporated into assessments of its potential economic benefits.

This paper aims to explore the public’s attitude toward medical tourism activities by developing a measurement instrument in Turkey, an emerging medical tourism destination.

During the development phase of the scale, 24 question pools were created. After the pilot study, data from a 20-question survey were collected from a study group consisting of Turkish citizens who received services from hospitals in the city of Ankara. Data were collected through convenience sampling of 221 study participants as they were walking in the Square of Kızılay, one of the most important centers and junction points in Turkey, between November 25, 2017, and December 27, 2017.

The content validity of the scale was assessed by expert opinion. The scale reliability is high with Cronbach’s α (0.908). A factor analysis was performed to assess the factor structure of the scale. The Kaiser–Meyer–Olkin measure of sampling adequacy (0.895) and Bartlett’s test (χ² = 2,020.967; p = 0.001) were applied to determine the conformity of the scale of factor analysis. Exploratory factor analysis with Varimax rotation was performed to determine the factor structure of the scale. The 20 questions loaded under three factors: “contribution to the country,” “anxiety in getting services” and “service justice”. These factors explained approximately 55% of the total variance. Confirmatory factor analysis was performed with goodness-of-fit index (0.877), Bentler comparative fit index (0.909) and root mean square error of approximation index (0.069) to determine the validity of the factor structure, and the results indicated that the three-factor model is an acceptable level. All the results show that this new scale is valid and reliable in measuring the public’s attitude toward the development of medical tourism in Turkey.

The public’s attitudes on the medical tourism scale show that, as a measurement tool, it can be used validly and reliably in determining the public’s attitudes toward medical tourism.

The purpose of this paper is to delineate a clear definition of health tourism, and to explain it in two sub-categories, namely, medical tourism, and wellness tourism.

Grounded theory approach through an in-depth literature review and practical data from three different cities were researched to support the study.

Determinants of travelers’ decision making for the destination of health tourism, such as distance, cost, language, economy, competency of medical technology, and culture, in each classification of health tourism, were identified.

This study suggests an inductive research model to synthesize and structure a logical relationship of determinants that affect health tourists’ decision to visit specific health tourism destinations. The results of this study are quite revealing to governments, industrial practitioners, and potential customers of health tourism in terms of the context of health tourism and the behavior of health tourists.