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

commodities the consumer is more aware than the seller of what these products’
characteristics mean to him/her. They know their own needs.
The situation in healthcare, on the other hand, is quite different. The acquisition of information
is costly in terms of time and resources. There is little opportunity for consumers to learn by
experience as they will be infrequent users of the market. Doctors, on the other hand, use the
market regularly. In many instances consumers will be unaware that they actually need
healthcare, e.g. women in the early stages of breast cancer, therefore the consumer may no
longer be deemed to be the best judge of his/her own interests. Because of the complex
relationship between healthcare (which consumers do not value per se, i.e. individuals derive
no direct utility from consuming healthcare, rather healthcare is consumed in the expectation
that health status will be improved as a result) and health status, the consumer becomes very
reliant upon the much better informed provider to make the link between the consumption of
healthcare and the resultant effects on health status. Hence, there is a special relevance of the
agency (doctor-patient) relationship in healthcare.
Patients want to be treated as consumers of healthcare in the sense that they want better
information about treatment options and to be more involved in making the decision as to
which option to follow. How far patients behave as consumers depends on the severity of their
illness, the nature of the procedure involved and their individual circumstances. Most severely
ill patients face complex treatment options and many prefer decisions to be made on their
behalf by a well-informed and trusted health professional. On the other hand, they may not
want to be treated as consumers as the nature of healthcare product and service, which is
unpredictable, does not support the role of being a consumer.
However, as suggested by Appleby, Harrison and Devlin (2003), choice is not always
advantageous as it should be counterbalanced by the costs of creating it. Choice for some may
limit and impact on the choice of others. Tritter et al (2010) agree with this as greater choice
may, in fact, even add to a further health inquality burden. In summing up, choice seems
structurally associated with enhanced marketisation of healthcare provision and the arena of
the consumer tends to be based on the economic rationality of maximising personal benefits
within market-based systems. However, evidence about what is driving patients’ choices in
reality is currently limited.
In conclusion, the conceptual frameworks of push-pull, consumer behaviour, consumer choice
and consumerism in healthcare are proposed due to several important factors. According to
Snepenger et al. (2006), the push-pull theory has prevailed over other paradigms in examining
motivations underlying tourist and visitation behaviour (Dann, 1977, 1981; Crompton, 1979),
attracting most attention from several scholars (e.g. Dann, 1977, 1981; Crompton, 1979;
Klenosky, 2002; Kim et al., 2003; Kao, Patterson, Scott and Li, 2008). Due to its theory
having been used much in travel motivation research, this provides a better opportunity to
compare and contrast findings with previous studies. Consumer behaviour literature identifies
the interrelationship between needs and motivations (Goodall, 1988; Witt and Wright, 1992)
as the presence of the former constructs the latter. In other words, people’s needs for
healthcare create their motivations in searching for it. The examination of differences of
motivations between sample populations representing different cultures is important in
understanding tourists’ behaviour (Kim, 1999, as cited in Kozak, 2002). Different cultural
conditionings and different healthcare and insurance system of healthcare consumers will
influence their expectations and perception. As a result, the investigation of health seeking
behaviours and motivations of medical tourists having different cultural and social