|Year : 2013 | Volume
| Issue : 1 | Page : 43-47
Medical tourism in Shiraz
Alireza Jabbari1, Tahereh Shafaghat2, Mohammad Kazem Rahimizarchi3, Zahra Kavosi2, Ali Keshtkaran2
1 Department of Health Services Management, Health Management and Economic Research Center, School of Management and Medical Information, Isfahan University of Medical Sciences, Isfahan, Iran
2 Department of Health Services Management, Shiraz University of Medical Sciences, Shiraz, Iran
3 Department of Management, School of Management and Medical Information, Shiraz University of Medical Sciences, Shiraz, Iran
|Date of Web Publication||30-Nov-2013|
Department of Health Services Management, School of Management and Medical Information, Shiraz University of Medical Sciences, Shiraz
Source of Support: None, Conflict of Interest: None
Background: One of the efficient uses of national resources in countries is the development of medical tourism. The number of patients who are travelling from developed countries to third world countries for medical reasons is increasing. Using the marketing mix elements is one way to attract these patients. Materials and Methods: This study was a descriptive, analytic, and cross-sectional one. The research community included all the public and private hospitals of Shiraz among which, seven public and nine private hospitals were studied. The study data were collected through a researcher-made checklist whose face and content validity was confirmed by the experts. Then, the data were entered into the Statistical Package for Social Sciences (SPSS) software and the statistical tests such as t-test, Mann-Whitney, Kruskal-Wallis, and Pearson were used for data analysis. Results: The study findings showed there was a significant difference between public and private hospitals in price and promotion mix (P < 0.05). These hospitals in the other mixes, had no significant difference
(P > 0.05). Conclusion: Identifying the strength and weakness points of hospitals can help health service managers to succeed in attracting medical tourists by use of hospital strengths and decrease the weaknesses.
Keywords: Iran, marketing mix elements, medical tourism, medical tourists
|How to cite this article:|
Jabbari A, Shafaghat T, Rahimizarchi MK, Kavosi Z, Keshtkaran A. Medical tourism in Shiraz. Int J Health Syst Disaster Manage 2013;1:43-7
|How to cite this URL:|
Jabbari A, Shafaghat T, Rahimizarchi MK, Kavosi Z, Keshtkaran A. Medical tourism in Shiraz. Int J Health Syst Disaster Manage [serial online] 2013 [cited 2019 May 26];1:43-7. Available from: http://www.ijhsdm.org/text.asp?2013/1/1/43/122457
| Introduction|| |
In the era of globalization, the patients purchase the appropriate health services around the world, which would lead to the development of health tourism.  Health tourism is a choice for those with more attention to their health as well as well-being and intent to stay away from the stressful everyday life. These people usually travel to promote their health or cure their diseases.  Medical tourism, as a branch of health tourism, represents a growing industry which involves the patients travelling beyond the national boundaries in order to receive medical services. 
In order to attract these medical tourists, investors have established five-star hospitals in developing countries in which most doctors are licensed from advanced countries. These hospitals try to attract tourists by their high quality of products (services) and reasonable prices. ,
The factors which increase medical tourism include high cost of health services in the industrial countries, increasing ease of international travels, favorable exchange rate of currency in the world economy, rapid advances in the medical technology as well as the standards of care in most countries, and access to the internet. 
Nowadays, the number of the patients who travel from developed countries to the third world ones due to medical reasons is rising. These patients are not prosperous, but look for medical care of high quality and reasonable price. Up to now, various estimations have been made regarding this issue. For instance, McKinsey has reported the income from medical tourism in the global market to reach around 100 billion dollars by 2012. 
Overall, 10% of the patients of European Union countries seek treatment outside their countries and it is estimated that they will have to pay about 12 billion Euros for this purpose.  On the basis of the annual statistics of the World Health Organization, about 50 billion dollars are annually spent for treating the patients in European and American countries and attracting a percentage of this amount can have a significant impact on the economy of the Asian countries. On the other hand, Iran admitted almost 11,000 foreign patients in 2004 and this amount reached 17,500 patients in 2005. 
Considering Iran's advantages in medical tourism, including low cost as well as high quality of health services, qualified physicians, and having abundant natural attractions; the country can use these advantages in order to attract medical tourists.  In the fourth development program which was planned in Iran in 2005, the main approach of health tourism was the active participation in the global markets because of the increasing growth of the concept of globalization.  Iran is expected to be one of the main poles of health tourism in the area by 2020. This not only prevents the exit of foreign currency, but it also yields considerable foreign exchange revenue for the country. This policy can also provide the ground for job creation and attracting investment. 
Employing the techniques of marketing mix helps organizations to make optimal decisions about product features, pricing, place, and promotion, and processes promotion and successfully apply the selected marketing strategies based on the environmental conditions and the determination and definition units of the market. In fact, whether the number of the determination factors of marketing mix is considered 4, 6, 7, 10, etc., is not important; the important thing is that there shall be a framework for the marketing to organize its activities and strategies upon. 
In the Jones and Keith research (2006), the researchers concluded that medical tourism is a term which can be used to describe medical outsourcing and traveling outside one's area for both mandatory and optional medical measures. 
Lagiewsky and Rick (2008) have stated that the ability to attract tourists in the health sector and the international market is completely dependent on guaranteeing the service quality. 
Also, Ramanda (2006) stated that the patients who were in long-term lists or did not benefit from health insurance usually sought their required services in the developing countries.  Nagarajan (2004) expressed the competitive advantages of India regarding medical tourism, including low cost, optimum healthcare sector history, and the abundance of tourist attractions in the country. From the researcher's perspective, the main barrier of the development of this industry is having little government's initiative, shortcomings in coordinating the components of this industry, lack of credit mechanisms, and lack of price, and standard consistent policies in the country's hospitals. 
With regard to the benefits mentioned (earning foreign currency revenues, job creating, enhancing the quality of healthcare, etc.) and considering the capacity and capabilities of Shiraz city, including a significant number of medical centers and hospital beds, variety of its clinical and paraclinical services, existence of experienced and famous physicians and paramedical staff in the country, advanced medical equipment, proximity to the countries of the Persian Gulf, tourist attractions, and good weather; reveal the necessity of conducting this research in order for Iran, and particularly Shiraz, to be known as the world's largest tourism industry, especially in medical tourism. Moreover, the researchers hope to determine the strengths, weak points, opportunities, and threats of the hospitals under study based on the marketing mix elements, and using the results of this research to develop the Shiraz medical tourism industry as well as the whole country.
| Materials and Methods|| |
The present descriptive, analytical, and cross sectional study was conducted in order to evaluate the status of public and private hospitals of Shiraz in attracting medical tourists based on the marketing mix elements in 2011. The research community included all public and private hospitals in Shiraz. According to the previous studies, most medical tourists travel due to the cosmetic surgery, infertility treatments, and eye surgery.  Also, due to the fact that Shiraz is the pole of transplant in the Middle East, this item was added to the desired specialties, as well. Therefore, the hospitals which contained at least one of the four above specialty were chosen as the study samples. General characteristics of the study hospitals are showed in [Table 1].
The study data were collected through a researcher-made checklist whose face and content validity was confirmed by the experts. This checklist includes eight dimension (marketing mix elements) and 78 indicators: Product mix (11 indicators), place mix (three indicators), promotion mix (13 indicators), price mix (nine indicators), people mix (11 indicators), process mix (six indicators), physical attractiveness mix (19 indicators), and physician mix (six indicators). The scoring scale in this checklist was: No (0), somehow (1), and yes (2). If each of the study hospitals obtained the score less than 50%, between 50 and 70%, and above 70% of the total score of that dimension, the status of the hospitals was considered nonacceptable, average, and acceptable, respectively [Table 2].
The researcher referred to the study hospitals in order to complete the check-lists based on designed indicators and did so through observation and interview. After completing the checklists, the data were entered into the Statistical Package for Social Sciences (SPSS) software version 15 and the statistical tests such as t-test, Mann-Whitney, Kruskal-Wallis, and Pearson were used for data analysis.
| Results|| |
The study findings showed that there was a significant difference between public and private hospitals in price and promotion mix (P < 0.05). These hospitals in the other mixes, had no significant difference (P > 0.05). Mean scores of public hospitals in the product, place, price, people, process, and physician mix were in the acceptable range, and in the promotion and physical attractiveness mix were in moderate status. However, mean scores of private hospitals in the place, people, process, and physician mix were at an acceptable level, in the product, price, and physical attractiveness mix were in the moderate range, and in the promotion mix was in unacceptable status. In general, based on the obtained scores of marketing mix elements, the public hospitals status was acceptable and the private hospitals status was at a moderate level [Table 3].
|Table 3: Mean scores and status of public and private hospitals based on healthcare marketing mix elements|
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According to total score of marketing mix elements, there was a significant difference between hospitals having transplant specialty and medical tourism committee with those not (P < 0.05). Also, a positive correlation was found between the number of medical tourists target specialties and total score of marketing mix elements (P < 0.05). Although, no significant difference was found between total score of marketing mix elements which had infertility treatment, cosmetic and eye surgery specialties, and also the hospital evaluation degree (P > 0.05) [Table 4].
|Table 4: Relationship or correlation between the hospital's general characteristics and total score of healthcare marketing mix elements|
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| Discussion|| |
There was a significant difference between public and private hospitals in price mix; so that the public hospitals in this mix were in an acceptable status, but the private hospitals were in moderate status. This might be due to differences between these two types of hospitals in the tariff of the services and amount of discount and also doing some free services in public hospitals. Price is the initial motivating factor for most patients. The cost of medical care in most developed countries has led the people to seek cheaper care elsewhere, particularly in less developed countries.  Herrick (2007) in a study showed that the patients were looking for medical care of high quality and reasonable price. 
Also in this study, there was a significant difference between public and private hospitals in promotion mix; so that the public hospitals in this mix were in moderate status, but the private hospitals, were in unacceptable status. Its reason seems to be offering advantages and gifts to the poor persons in public hospitals that lead to word of mouth marketing. A research performed in 2011 showed that among the variables of notification mechanism, just the advertising media had a significant correlation with attracting the medical tourists.  This implies that the advertising opportunities in the international media in the field of healthcare, physicians, high quality services, and technology can lead to attracting the medical tourists.  A researcher (2009) expressed that advertising the country's capabilities and health facilities in the international media and providing brochures and pamphlets for the tourists, can be a great help in attracting the medical tourists.  In the same line, Afshani (2009) and his colleagues suggested that one of the major weaknesses of the country's medical tourism industry is the lack of awareness of internal and foreign medical tourists regarding the actual capabilities of the international health services, lack of professional and appropriate information, and the existing disturbance in electronic public relations at the hospitals of the country. 
In this study, mean scores of public and private hospitals in the place, people, process, and physician mix were in the acceptable status. Perhaps this results' reasons includes position of the two types of hospitals in low-traffic areas and have respectful and sympathetic staff and professional physicians with high academic qualifications and famous at the international level. Lfebvre and Flora (1988) expressed difficult access to the hospitals and their large distances may also result in increasing the costs and also reducing the customers' motivation for selecting them.  Khodayari (2010) suggested that appropriate training of the staff and their acquisition of desired qualifications could support medical centers in providing the medical tourism services.  It seems one of the indicators of process mix is informing both the patients and their families about the details of service delivery. Several studies have also emphasized that the patients and their companions have the right to be informed about care and treatment, and their consequences and be actively involved in the treatment processes. ,,
In this study, both types of hospitals in physical attractiveness mix were in the acceptable status. Its reasons seem to be the rusty hospitals building, officials' insufficient attention to the physical space, and governmental troublesome rules for the playing smooth music according to each patient culture. Ghadamgahi (2011) reported the reasons for the low standard of physical attractiveness had to result from the old hospital buildings as well as the lack of awareness of the employees regarding the health conditions in hospitals. 
In this study, according to total score of marketing mix elements, there was a significant difference between hospitals having medical tourism committee with those not. It is obvious that the existence of medical tourism committee in the hospitals can lead to many advantages such as: Understanding medical tourists' new demands, the new methods of attracting them by the hospitals, and also the more capability in medical tourism.
According to total score of marketing mix elements, there was a significant difference between hospitals having transplant specialty with those not. Perhaps this result represents that Shiraz is the pole of transplants, particularly in some special of them, that is, liver transplant not only in the country but in the Middle East.
Also, a positive correlation was found between the numbers of medical tourists target specialties and total score of marketing mix elements. The reason can be noted is the product mix existence between marketing mix elements, since the set of new and varied services is one of this mix indicators. Torabi (2005) in a study explained the customer satisfaction reason depends on product performance in delivering the customer desirable value.  Aqarahimi (2009) mentioned, product development, such as compiling a variety of service packages for the patients as the requirements of promoting the medical tourism industry. 
| Conclusions|| |
The findings of the present research showed that in general, public hospitals were in the acceptable status and private hospitals were in the moderate status; this can be indicative of the relative readiness of the study hospitals in attracting the medical tourists. The status of hospitals regarding the place, people, physician, and process mix were in the acceptable level; however, regarding some other mixes, such as promotion and physical attractiveness mix, they were not in good conditions and need to improve.
According to the strengths and weaknesses of the study hospitals regarding the mixes studied, the hospitals under the study can invest on their strengths and use the existing opportunities, to promote the status of the marketing mix elements which can affect the development of medical tourism and attraction of medical tourists in Shiraz, and design strategic plans for the areas of improvement; for example: 1-Updating the hospitals' websites, 2-using telephone counseling services, 3-giving discount to the patients from other countries based on the international markets as well as the patients' place of living, 4-asking the patients to give feedbacks on the services they were provided within 10 days after discharge, 5-paying attention to the peripheral view of the hospital, and 6-providing all facilities for the patients, such as internet, television, and computer games.
| Acknowledgements|| |
This article was extracted from a research project (No. 90-5812) at student research committee of Shiraz University of Medical Sciences. Also Research Improvement Center of Shiraz University of Medical Sciences is appreciated for improving the use of English in the manuscript.
| References|| |
|1.||Ramanda JD, Candidate LL. Medical tourism and the demand for hospital accreditation overseas. Available from: http://www.law.ul.edu/healthlaw/perspectives/2006%5(MR)Medical Tourism final. [Last accessed on 2009]. |
|2.||Vajirakachorn T. Implementation of an effective health tourism development plan for Thailand. A research paper requirements for the MS degree, the Graduate school, University of Wisconsin Stout, Thailand; 2004. |
|3.||Jonson Y, Sim S, Nelson N. Medical tourism: The Asian chapter. Available from: http://www.healthtourisminasia.com [Last accessed on 2008 Jun 27]. |
|4.||Connell J. Medical tourism: Sea, sun, sand and y surgery. School of Geosciences, University of Sydney, NSW 2006, Australia. J Med Tourism 2005. |
|5.||Karen H. International accreditation and medical tourism: The value equation. Medical Tourism in Turkey Conference. Chicago, Illinois;2006. |
|6.||Jabbari AR. The design of Iran medical tourism′s pattern. Ph. D Dissertation of Management of Health Care. Tehran: Faculty of Management and Medical Informatics, Iran University of Medical Sciences; 2008. |
|7.||Herrick MD. Medical Tourism: Global Competition in health care. National center for Policy Analysis, Dallas, US. NCPA 2007; Policy Report No. 304. |
|8.||Practicing Medical Tourism: A Resounding success [web page]. Available from: http://www.expresshealthcaremgmt.com/200603/medicaltourismconf01.shtml [Last accessed on 2006 Apr 23]. |
|9.||Available from: www.chn.ir/news.htm [Last accessed on 2013 Jun 26]. |
|10.||Shalbafiyan AA. The health tourism development Solutions with the medical tourism approach. Master′s thesis. University of Allamehtabatabaei; 2005. |
|11.||Tebyan tourism group, 2010. Available from: http://www.tebyan.net/Social/SevenContinents/2010/4/14/120591.html [Last accessed on 2010]. |
|12.||The world and Iran therapeutic tourism. Trade promotion organization of Iran. Vice President Marketing and market investigation. The Office of review the goods and services market. 1 st ed. 2007. |
|13.||Sham Abadi MA, Khodadhoseini H. Marketing export handmade carpets, Iran: Effective factors and pathology. Q J Commer 2007;43:1-34. |
|14.||Jones CA, Keith LG. Medical tourism and reproductive outsourcing: The dawning of a new paradigm for healthcare. Int J Fertil Womens Med 2006;51:251-5. |
|15.||Lagiewsky M, Rick R. Medical tourism: Perspective and applications for destination development. American collage of Management and Technology. Dubrovnik, Croatia; 2008. |
|16.||Nagarajan GS. Medical tourism in India: Strategy for the development. Banglare: Crisil young leader series; 2004. |
|17.||Ayoobiyan A. Relation between mechanism of informing and attracting medical tourists in private hospitals of Isfahan. Master′s Thesis. Tehran: University of Research Sciences; 2012. |
|18.||Aqarahimi Z. Study of the medical tourism industry in selected countries and provide suggestions for Iran. Bachelor thesis, Faculty of medicine, University of medical sciences, Tehran, Iran; 2009. |
|19.||Ghalami S. Review of strategies to upgrade the position of Iran in the for the issuance of health services and attracting traputic tourism market. Tehran: Tarbiatmodares University, School of management; 2009. |
|20.||Afshani A. Public relations role in the development of health tourism, Uremia. Proceedings of the 3rd International Conference on Regional Health Services in Iran; 2009, Nov 13-14. |
|21.||Lefebvre RC, Flora JA. Social marketing and public health intervention. Health Educ Q 1988;15:299-315. |
|22.||Khodayari ZR. The level of readiness of Iran University of medical sciences hospitals in attracting medical tourists, based on the international standards of the Joint Commission. Master′s thesis, Tehran: The Faculty of administration and Informatics, Iran University of Medical Sciences; 2010. |
|23.||Goswami CR. Are we ready for medical tourism? The Hindu; 2005. |
|24.||Manalo F. Presentation on the Philippines as the Hub of cosmetic surgery in Asia: Plastic Surgeons viewpoint. Medical tourism Asia conference, Singapore; 2008. |
|25.||Ghadmgahi F, Zighaimat F, Ebadi A, Houshmand A. Knowledge, attitude and self-efficacy of nursing staffs in hospital infections control. Iran J Mil Med 2011;13:167-72. |
|26.||Torabi A. Social marketing in the health services. J Soc Secur 2007;8:127-43. |
[Table 1], [Table 2], [Table 3], [Table 4]