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

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