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

particular, thus requires the exploration of how shared cultural constructs, known as cultural
consonance in behaviour, meet social structure. As Comelles (2002) contends, it is impossible
to study health seeking behaviours without taking account of the long development of
healthcare providers which have delivered care services from the late Middle Ages to the end
of the 20 th century and cultural context.
Due to the different pattern of previous and new healthcare consumers, a consumer influence
has reflected into different levels (Hjertqvist, 2002). Previously, the healthcare provider was
not designed to serve a real consumer influence. Similarly later, in the welfare state, the
patients’ specific demands could not be fully responded as need, not demand consideration,
was the key to the healthcare provision. Western healthcare consumers today, however, seek
to influence the organisation of the healthcare system and the services provided. Apart from
being used to making complex decisions, Western healthcare consumers are also provided
with greater access to various means of information sources which they require to create
satisfying information in order to compare the providers’ quality and choices among those
offered (Borgenhammar, 1997, as cited in Hjertqvist, 2002). Freedom of choice and the use of
healthcare facilities in many countries are predominant in the current healthcare consumer’s
framework when they can benefit from shorter waiting times and better quality services.
Hence, this kind of framework promotes the development of healthcare provision both
regionally and globally. As commented by Hjertqvist (2002), the more consumers supported
by public or insurance funding cross borders, the more pressure that is exerted on providers to
offer competitive price information. Herzlinger (1997, as cited in Belien, 2000) agrees that, in
order to achieve patient empowerment or consumer-oriented healthcare, competition in
healthcare services as well as an unrestricted supply of these services, both of which create an
expansion and differentiation of services and make prices decrease, are required (Herzlinger,
1997, as cited in Belien, 2000).
Consumer/Patient Choice
Identity: patient, consumer, citizen
Patients, according to Hogg (1999: 6), are ‘people with particular health problems who may be
taking medicines or receiving treatment’. As Edwards and Elwyn (2001) point out, the term
‘patient’ tends to describe associated images of stereotypical patient with passive role seeking
and following physician advice. ‘Consumer’, on the other hand, depicts those who seek
healthcare in active role and perhaps making their own decisions and having the ability of
exercise choice. Contemporary thinking in the healthcare arena leads health professionals to
view patients as consumers.
As the role of market raises the significant issue of identity, in terms of healthcare market, the
identity of health service users is considered whether they are patients receiving services
passively, consumers shaping and controlling the receipt of services, or citizens utilising their
rights to free healthcare (Milewa, 2009). Therefore, it is essential to explore how health
service users have engaged with these identities, i.e. patient, consumer, citizen as these words
can be differently conceptualised due to different healthcare systems and the role of those
receiving healthcare, and how they are considered in terms of individual consumer (individual
identity) and independent collective mobilisations (collective identity).
Generally, the consumer’s decision to purchase a particular service involves many more risk
considerations than purchasing a product. This is because heathcare service provision is
different from other areas of economic activity, products or services due to the prevalence of
irregular, uncertain and unpredictable demand and supply in healthcare (Arrow, 1963). As