Health, Wellness and Tourism: healthy tourists, healthy business ...

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Customer perceived value of medical tourism: an exploratory study The case of cosmetic surgery in Tunisia Yousra Hallem Doctoral student Ecole de Management de Strasbourg/Institut Supérieur de Gestion de Tunis Yousra_hallem@yahoo.fr Isabelle Barth Professor Ecole de Management de Strasbourg Isabelle.barth@free.fr Abdelfattah Triki Professor Institut Supérieur de Gestion de Tunis Abdel.triki@yahoo.fr Abstract The present study is an attempt to investigate the dimensions of customer-perceived value in the context of a medical tourism experience. The value dimensions of the use of the Internet will also be explored owing to the role of the Internet in the worldwide growth of medical tourism. On the basis of the theory of consumption value developed by Sheth, Newman and Gross (1991), the netnographic study shows that the functional dimension has a great influence on the value perception of the medical tourism experience. The use of the Internet essentially has functional, social and epistemic values. Keywords: medical tourism, perceived value, netnography, Internet Customer perceived value of medical tourism: an exploratory study The case of cosmetic surgery in Tunisia Medical tourism is not a modern trend. “Health tourism is a concept as ancient as prehistory and as up-to-date as tomorrow” (Ross, 2005). What is different in the 21 st century is that tourists are travelling farther away, to poorer countries, and for medical care that is invasive and high-tech. (Bookman and Bookman, 2007). In recent years, medical tourism has experienced an explosive growth; it thus seems obvious that patients moving from developed to developing countries for care perceive value. Researchers believe that the growth of medical tourism has been facilitated by the rise of the Internet (Connell, 2006). Bookman and Bookman (2007) think that the Internet has opened the doors to medical tourism in developing countries. The Internet is a huge source of information for medical tourists, enabling them to know more about destinations, facilities, service suppliers and procedures. It is also a primary medium for suppliers to promote their service offers and an increasing number of informative medical tourism websites can be observed. We can then suppose that medical tourism is a profitable activity for developing and developed countries. On one hand, developed countries can resolve the problem of long waiting lists and patients can take advantage of attractive costs. On the other hand, medical
tourism is a lucrative activity for developing countries, and several of them are now tapping into this niche. Countries are thus searching for new ways to promote their infrastructures and skills, attract medical tourists, increase their numbers and, most importantly, improve their satisfaction. Therefore, customer value is now a strategic weapon in attracting and retaining customers (Woodruff, 1997; Zeithaml, 1988). As perceived value is considered as a key component of consumers’ decision-making and behaviour (Zeithaml, 1988), countries receiving medical tourists and practitioners should understand what is the value sought by the customers and where they should focus their attention to achieve the market positioning required and to best satisfy the customer. From a marketing perspective, it thus appears interesting to look at medical tourism experiences through the concept of customer-perceived value. Our research deals with medical tourism in Tunisia and more specifically with cosmetic surgery in Tunisia. Through a qualitative study, we will investigate some research questions: What are the dimensions of customer-perceived value in the context of medical tourism? Is customer-perceived value only limited to cost consideration? What are the dimensions of customer-perceived value related to the use of the Internet in the context of medical tourism? Conceptual background Medical tourism: a booming business Medical tourism is a growing market catering to patients who travel to foreign countries to obtain medical care (Deloitte report, 2008). The Tourism Research and Marketing Report (2006) indicates that the market included approximately 19 million trips in 2005 with a business volume of around $ 20 billion. This report estimates that the number of trips will have reached 40 million by 2010, with a growth of 4% for the overall market volume. Other statistics report that, in 2005, countries like Singapore (www.udel.edu) and Thailand respectively received between 250,000 and 1 million foreign patients. Similarly, the number of foreign patients who took a medical tourism journey in Tunisia has more than doubled between 2003 and 2007. Their number reached 102,000 (Tourismag, 2008) in 2007, as opposed to 42,000 in 2003 (Lautier, 2005). Connel (2006) states that “the biggest hurdle that medical tourism has had to face and continues to face, is the challenge of convincing distant potential visitors that medical care in relatively poor countries is comparable to what is available at home in terms of results and safety”. Despite this, we can observe that a growing number of patients from developed countries are travelling for medical treatment to regions once characterized as ‘third world’ (Herrick, 2007). Therefore, with the increasing number of medical travellers, we can suppose that elements of value other than financial ones may motivate their decision. The concept of customer-perceived value Day (1990) stated that the perceived customer value represents the difference between “customers’ perceived benefits” and “customers’ perceived costs”. The first conceptualizations of customer-perceived value begin with the works of Zeithaml (1988), who defined customer-perceived value as “the consumer’s overall assessment of the utility of a product based on the perception of what is received and what is given”. The pioneering ideas about perceived value were based on economic theory and the concept of utility. Despite the relevance of this one-dimensional conceptualization of customerperceived value, it remains too simplistic and does not make it possible to grasp all of the explanatory attributes of a purchase. In a marketing context, it has been acknowledged that
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Health, Wellness and Tourism: healt
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Acknowledgements TTRA Europe would
Page 5 and 6: Kai Illing, Professor, Joanneum, Au
Page 7 and 8: ELISABETH IXMEIER Elisabeth Ixmeier
Page 9 and 10: Health and Spa Tourism Business: To
Page 11 and 12: Literature Review Health and Spa To
Page 13 and 14: Yoon & Uysal (2005) stated that pus
Page 15 and 16: Push factors Internal motives - phy
Page 17 and 18: Respondents were the international
Page 19 and 20: Perceptions, learning and attitudes
Page 21 and 22: Table 2 Themes of Motivation Factor
Page 23 and 24: elaxation as this is generally the
Page 25 and 26: Oh, H. C., Uysal, M. and Weaver, P.
Page 27 and 28: According to Ajzen, “persuasive c
Page 29 and 30: Behavioural Control: Workload Lack
Page 31 and 32: A Case Study of Innovative Wellness
Page 33 and 34: RP Care is an innovative modular ex
Page 35 and 36: The introduction of its modular bus
Page 37 and 38: UNDERSTANDING THE IMPACT OF LEISURE
Page 39 and 40: development but, three years later,
Page 41 and 42: Hamer, D., & Connor, B. (2004).Trav
Page 43 and 44: URBAN ZEN - AND HOW TO EXPLORE THIS
Page 45 and 46: Health Tourism - The SPA Goers in P
Page 47 and 48: Whether we opt for more realistic s
Page 49 and 50: focused on the paradigm of wellness
Page 51 and 52: immediately followed by specific ho
Page 53 and 54: particular reference must be made o
Page 55: Tabbachi, M. (2008), “American an
Page 59 and 60: Functional value Functional value i
Page 61 and 62: “Before my operation, I did exten
Page 63 and 64: The table below recapitulates the m
Page 65 and 66: Herrick, D. M. (2007). Medical tour
Page 67 and 68: Cosmeceuticals in wellness tourism
Page 69 and 70: will replace chemical materials; ad
Page 71 and 72: Issues in Co-branding and Co-creati
Page 73 and 74: producers of the cosmecuticals to a
Page 75 and 76: Lee, C. L. & Decker, R. (2008). A s
Page 77 and 78: scheme, although this theoretically
Page 79 and 80: study identifying the motivation of
Page 81 and 82: highlighted by Folland et al (2001)
Page 83 and 84: ackgrounds is expected to accomplis
Page 85 and 86: Understanding mature traveller’s
Page 87 and 88: attention to the mature travellers
Page 89 and 90: Table 1 Travellers’ demographic p
Page 91 and 92: • To distinguish spring and spa t
Page 93 and 94: Budapest’s thermal spas on screen
Page 95 and 96: Budapest as film location The power
Page 97 and 98: Usually viewers attach an icon to t
Page 99 and 100: In the second part of the questionn
Page 101 and 102: Riley R. & Van Doren C. (1992) Movi
Page 103 and 104: health as “a state of complete ph
Page 105 and 106: how much exercise they get. Two-thi
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arts, comedy clubs and festivals) w
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The use of the internet in wellness
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The main characteristics of Portugu
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29 Termas de Unhais da Serra 30 Ter
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ongoing consumer and industry resea
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Name Table 2. Spa websites analysed
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more than a handful of links were o
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Health Spa and Wellness - Competiti
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The Czech Republic is rich in spas
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Foreign Exchange Receipts and Expen
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the total fertility exceeded the va
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1. Waters - the internal and extern
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• N - Postoperative and posttraum
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Foreign guests at accommodation fac
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Table 6 shows the number of guests
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M. Zuckerman defines wellness as pr
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Today´s health spa hotels are most
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without spa facilities and service
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Ten Spa Domains. Downloaded from: h
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customer is value, which at each gi
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experiences that renew the spirit.
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eigenvalue 3.668, function 2 explai
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The results of this study support t
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Smith M, & Puczko´ L (2009). Healt
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and Bushell (2009, 11) have defined
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listed reasons in more general leve
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One 54 (13.3) Yes 180 (44.3) 2-4 21
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Discussions and Conclusions The aim
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Kelly, C. & Smith, M. (2009). Holis
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While wellness tourism in Australia
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Cairns, which has been suffering fr
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significantly from there, so if the
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Other factors raised by participant
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Connell, J. (2006b). Medical touris
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The Impact of a Festive Event on Re
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The mission of the World Acadian Co
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Table 1 Positive social impacts of
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The Acadians’ quest for pride and
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Ap, J., & Crompton, J. (1998). Deve
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and other characteristics of the ho
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Figure 1). Many of the hotels take
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Target groups As shown in Figure 2,
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to have an influence on these corre
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Purification 11 Application of alte
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Mueller H. and Lanz-Kaufmann E. (20
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The term multidimensional scaling (
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Figure 3 shows the split of bednigh
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Note: Objects: 32. Proximities: 496
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Group one account for 37% of the va
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Measurement of Tourism-oriented Asp
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Social indicator systems Social ind
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1999/2000, Table 1. presents the me
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However, according to Table 1, it a
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Since the TSTAR database does not h
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the hundred happiest settlements re
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Managing Cost, Revenue and Yield in
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Method: A Case Study Approach The a
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methodologies, and educational trav
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and times the data was collected, F
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SALA RIES AN D W AGES 18.17% PROFES
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Table 11 Treatment and revenue rate
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Measurement of the Economic Impacts
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o The macro and micro environment r
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Employment impacts During our analy
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• The examined wellness hotels we
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Total number of available beds (acc
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• Our analysis showed that new jo
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City of Budapest is seen as a touri
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of the area will also grow by marke
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of the case studies will be present
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The water is radio-active and conta
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Conclusions In our changing environ
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no exception. Already, patients are
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Data regarding levels of training o
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Figure 2 - Graph showing price will
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Table 13 - Typical hospital costs f
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that people willing to pay slightly
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Continue follow-up care in the UK F
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HEALTH TOURISM IN IZMIR: POTENTIAL,
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• Service provided within the ins
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Table 2 - SWOT Analysis of Health T
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16. Increasing interest in alternat
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APPENDIX 1 Interview Questions 1. M
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point of view it means wholeness as
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Men Women International Playboy, Me
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elderly wanted to look like, to act
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Table 4. The number of experienced
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emains an open question when the sh
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Most important criteria when bookin
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The study investigates the performa
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The survey was distributed to 400 u
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Conclusions and Discussion In this
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A Comparative Analysis of Spa Touri
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year-long Ottoman occupation: the T
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although unintentionally, represent
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separated and I don't like being st
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Creighton, M. (1997): Consuming Rur
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Does tourism really contribute to o
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Africa (mainly Cape Verde, Angola a
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The theoretical significance of und
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Veenhoven (2005:61) “quality-of-l
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Brunt and Courtney (1999). Brunt, P
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Expectations of Health Tourists in
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40%). Only those guests were includ
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accommodation, meals and health off
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Exploring The Relationship Between
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proposed at 1975 by Cskiszentmihaly
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Table 1 Participant information ana
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Table 3 Well-being analysis result
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Csikszentmihalyi, M.,(1990), Flow:
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evident in Ancient Greece and Rome.
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Resort spas - Sometimes called ‘a
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analytic model has several methodol
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From this survey, we selected sever
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Gulliver in the land of giants? The
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emergency cases. As the commonly kn
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Figure 1. The main factors of quali
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Surgical medical touristic market T
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• Seamless services: The professi
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of price-advantage segment. Due to
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Appendix 1. The characteristics of
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Appendix 2. The characteristics of
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Introduction Arguments for the need
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The DOSTWELL Wellness Quality Seal
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The statistics obtained from the su
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Table 1 Sample of the Classificatio
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Goebel, G., Kapfensteiner, C., Wenz
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interest activity and health and we
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performance calls for a unity of wi
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Table 2 - Learning Commitment Analy
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higher the tourists satisfaction in
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supporting factors and resources, d
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Sustainable Wellness Tourism Destin
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In tourism marketing Savonlinna has
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The role and actions of Savonlinna
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Haaga-Helia (2010). DP in Experienc
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Hall, M. (2003) Spa and Health Tour
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excellent capabilities. Despite of
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Australian Wellness Tourism Provide
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thrills and excitement which someti
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The actual responses were compared
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therapies such as Feldenkrais, acup
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Table 2: Average Number of Employee
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As expected, Day Spas and Beauty Sp
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Snoj & Mumel, 2002). Furthermore, r
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Cooper, C. P., Fletcher, J., Noble,
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The Exploration of the Perceived Tr
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The key question in market segmenta
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significantly from each other. Ther
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Table 3 Cross-table of Background o
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4. Travel benefit perception reflec
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http://www.oxfordreference.com/view
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summary or as a commonly accepted b
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Third, these proxy prototypes were
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Table 2 Main travel purpose of the
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Table 4 Non-response shares for des
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Figure 1 Image positions of five As
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Figure 2 Image positions of five Eu
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piecemeal hypothesis and an undiffe
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Taasci, A.D.A. and Kozak, M. (2006)
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Among the economic factors determin
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The demographic profile of the dent
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The main part of the tourists’ ex
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Interview II was with the Chief Den
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anchor point of the dental tourism
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The country itself could profit muc
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