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FFAARRHHEEEENNBBAANNUU
BBA Travel & Tourism
Preston University
Ajman, United Arab Emirates
Submitted to:Dr. Reji Johnson
Submitted by:
Farheen Banu
Registration Number5012-108059
Impact of Medical Tourism on
Countrys Economic Growth
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iii
Acknowledgements
A number of people have contributed with comments, suggestions, and input at
different stages of writing this thesis.
First and foremost, I would like to thank my professor Dr. Reji Johnson for his
challenging supervision, extensive guidance, cooperation and valuable support.
His patience, knowledge and understanding were much appreciated.
I would also like to express my grateful appreciation to all those who kindly took
part in and supported this thesis by participating in the survey questionnaire.
Also; a big note of thanks to all my teachers, faculty members and fellow
students and friends at Preston University; whose comments and suggestions
were helpful in revising this paper.
Finally, I wish to express my gratitude to my family for their unconditional support
and to all those who have in one way or other helped me in the successful
completion of my project.
Farheen Banu
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Abstract
iv
This research paper discusses some of the forces driving Medical Tourism. The
study attempts to systematically evaluate the phenomenon of medical tourism
from an economic standpoint.
The primary objective of the study is to examine and highlight the significance
and impact of the medical tourism industry on countrys economic growth.
The study is exploratory in nature and data is gained through a combination of
qualitative (case study) and quantitative (questionnaire survey) methods. The
study focuses on the medical tourism trend that will have an increasing impact on
the healthcare landscape in industrialized and developing countries and their
economic growth.
This study utilizes both quantitative and qualitative data collection tools. The
main data collection techniques used in this research study were documentation
analysis and questionnaire surveys. Data collection sources also include articlesin academic journals, blogs, online report publications, magazine articles,
research papers and book references.
Research results conclude that the combination of three key factors quality,
availability and cost have been key in fuelling the phenomenal growth witnessed
in the medical tourism industry. Furthermore, medical tourism presents important
concerns and challenges as well as potential opportunities. Both positive and
negative impacts of medical tourism on healthcare, economic, social and
environmental sectors create opportunities and challenges for this growing
industry.
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v
Table of Contents
Contents Page No.
Acknowledgements . iii
Abstract .... iv
Chapter 1: Introduction ... 1
1.1. Overview ..... 1
1.2. Statement of the Problem ..... 3
1.3. Objectives of the Study ..... 4
1.4. Scope and Limitations of the Study .... 5
1.5. Significance of the Study ... 6
1.6. Definition of Terms .... 7
Chapter 2: Review of Related Literature ...... 8
2.1. Theoretical/Conceptual Literature ... 8
2.2. Related Studies ..... 11
2.3. Synthesis 15
Chapter 3: Research Methodology ... 22
3.1. Research Design 22
3.2. Respondents of the Study .... 22
3.3. Research Instrument .... 23
3.4. Validity of the Research Instrument ... 24
3.5. Data Collection Procedure .. 24
3.6. Statistical Tool Analysis ... 25
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Table of Contents
Contents Page No.
Chapter 4: Presentation, Analysis and Interpretation of Data ..... 26
4.1. Demographic information ..... 26
4.1.1. Breakdown by Gender . 26
4.1.2. Breakdown by Age Group .. 27
4.1.3. Breakdown by Nationality .. 28
4.2. Medical Tourism Questionnaire Survey Result ... 29
Chapter 5: Summary of Findings, Conclusions and Recommendations.... 44
5.1. Summary of Findings .... 44
5.2. Conclusion ...... 46
5.3. Recommendations . 50
Bibliography .. 53
Appendix A
List of Tables
Table No. and Name Page No.
2.1 Cost comparison for selected surgeries..... 175.1 Economic impact of medical tourism on a nation...... 49
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List of Figures
Figure No. and Name Page No.
4.1 Gender distribution... 26
4.2 Age composition....... 27
4.3 Nationality chart.... 28
4.4 Medical Tourism First knowledge source... 29
4.5 Medical TourismPreferred research source..... 30
4.6 Medical TourismFrequency of travel.. 31
4.7 Medical TourismMotivation factor.. 32
4.8 Medical TourismType of procedure... 33
4.9 Medical TourismDuration of stay... 34
4.10 Medical TourismTotal expenditure budget... 35
4.11 Medical TourismTraveling ..... 36
4.12 Medical Tourism Performed tourist activities.... 37
4.13 Medical Tourism Hospital rating.. 38
4.14 Medical Tourism Facilitator used.... 39
4.15 Medical Tourism Facilitator service rating..... 40
4.16 Medical Tourism Communication problem.... 41
4.17 Medical Tourism Personalized service... 42
4.18 Medical Tourism Malpractice concern.... 43
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Chapter 1Introduction
1.1. Overview
Tourism as an industry has huge economic benefits. At present, tourism
does not limit itself merely to hotels, restaurants and site-seeing; but has
also created a link with the health sector (Medical Tourism) and
environment (Eco-tourism) as well. The significance of tourism as a factor
for economic growth and employment generation is now acknowledged
globally.
The health care industry, or medical industry, is a segment of
the economic system that offers goods and services to treat patients with
therapeutic, preventive and rehabilitative care. Medical tourism is
basically different from the usual form of global medical travel, where
patients normally travel from less-developed countries to major medical
centers in highly-developed nations for medical treatment that is not
available in their own region.
In contrast, medical tourists are normally people who are residents of the
developed countries who travel to nations, which are usually less-
developed. The medical tourism industry is a productive source of
acquiring hard currency for host countries.
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Popular medical tourist destinations include developing countries such as
India, Philippines, South and Central American countries, as well as fairly
developed countries, such as Singapore and South Korea.
A blend of various factors has led to the present increase in recognition
and popularity of the medical tourism phenomenon. These factors include
soaring costs of healthcare in developed countries, ease and affordability
of international travel, favorable currency exchange rates in the global
economy, rapidly improving technology and standards of care in
numerous countries world-wide.
Medical tourism has had large economic impacts on various geographical
regions which particularly include developing nations. The goal of this
industry is to increase jobs, income, and quality of life of the medical
tourism host country.
Medical tourism offers countries, hospitals and clinics, new sources of
business. There are enormous global opportunities for property investors,
travel agents, hotels and other services. When medical tourists travel for
their medical treatment, they also often take the chance and opportunity to
participate and engage in tourist activities in the country they are visiting
and enjoy what the host country has to offer. Thus, medical tourists may
combine their vacation and medical care into one venture.
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Medical tourism consists of three fundamental features: hospital/health
services, hotels and travel/leisure. Therefore, along with attractive policies
and accurate planning and marketing approach, this upcoming industry
may witness extensive opportunity for economic growth and infrastructure
development for participating countries.
This research paper is an attempt to put forth the role and impact of
Medical Tourism on countrys Economic Growth, with particular emphasis
on India.
India is one of the most profitable medical tourism markets in the world
and has seen an incredible growth during the recent past. This is due to
many reasons; such as low cost, less waiting time and government
support through policies and schemes. India also has a huge potential for
future growth and development.
1.2. Statement of the Problem
Beside prospective opportunities, medical tourism also brings forth
significant concerns and challenges as well. Globalization has formed a
basis for various nations to re-examine their economical strengths and
weaknesses, as well as reassess what products or services can deem
beneficial in which countries.
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One such product and service that has surfaced in the recent past is
Medical Tourism. However, this trend has only occurred in certain,
specific geographical regions mainly due to the nature of its practice and
policies. These regions and countries have attractive policies regarding
medical tourism and have applied exclusive marketing strategies that
promote the medical tourism industry. This in turn has resulted in having a
great impact on these nations economic health. In contrast, other nations,
like US and UK, have not been as successful in attracting the medical
tourism business. Hence, the subject matter is to analytically understand,
through the analysis of other countrys practices, policies and marketing
strategies, as to why the United States and other similar nations should
take benefit of the opportunity to further partake in this promising industry.
1.3. Objectives of the Study
This research paper discusses some of the forces driving Medical
Tourism. The study attempts to systematically evaluate the phenomenon
of medical tourism from an economic standpoint.
The primary objective of the study is to examine and highlight the
significance and impact of the medical tourism industry on countrys
economic growth.
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The study is exploratory in nature and data is gained through a
combination of qualitative (case study) and quantitative (questionnaire
survey) methods.
1.4. Scope and Limitations of the Study
The scope of this thesis is to offer an enhanced perception and
understanding of the current situation of the Medical Tourism Industry.
This study focuses on the phenomenon of medical tourism which will
consequentially have a growing impact on the healthcare sector in
industrialized and developing nations and on their economic growth.
Additionally, study limitations also exist. The lack of literature covering the
aspects of the study posed some difficulties in gaining better background
information. This led to the collection of large amounts of external
secondary data obtained from different sources of information, which were
combined in order to gain an insight into the topic.
Medical tourism is an emerging industry, extensive research for any
particular country or on any individual branch of medical tourism, its
policies and marketing strategies was not available.
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Reliable and solid medical tourism statistics are hard to find since the
emergence of medical tourism phenomenon is recent; it is a topic that
remains fairly un-researched. Optimistically, further academic research is
being performed in this area, and with proven infrastructure, the medical
tourism industry can look forward to updated, accurate, and transparent
data within the near future.
1.5. Significance of the Study
Medical Tourism is an immense revenue generating sector. On the
economic front, medical tourism is quickly emerging into an important and
vital revenue generator for countries such as Thailand, Singapore, India
and Malaysia.
This study may be viewed of substance by various groups having interest
in the field of medical tourism. It can also deem to be highly significant for
companies operating in the tourism industry. Moreover, this research
study can ultimately help in understanding the patients experience. So far,
the subject of medical tourism has been left fairly ignored by academic
researchers. Amongst the outbreak of business consultations, industry
reports and news media coverage that have addressed the quick growth
of the industry, only a limited number of articles from an academic
perspective exist.
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1.6. Definition of Terms
Technical terms used within this research are mentioned below. These
terms are operationally defined.
1. Medical Tourism: the act of people travelling to another country to
obtain treatment for a disease, ailment, or condition, and who are
seeking higher quality of care at lower costs than they could receive at
home; while at the same time touring, vacationing and experiencing
the attractions of the countries that they are visiting.
It can be broadly defined as travel undertaken for the purpose of
availing cost effective healthcare that meets international standards of
care and comfort.
2. Economic Growth: An increase in the capacity of an economy to
produce goods and services, compared from one period of time to
another. Economic growth can be measured in nominal terms, which
include inflation, or in real terms, which are adjusted for inflation. The
growth of an economy is thought of not only as an increase in
productive capacity but also as an improvement in the quality of life to
the people of that economy.
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Chapter 2Review of Related Literature
This chapter presents a review of literature and research which is related
to the study.
2.1. Theoretical/Conceptual Literature
Connell (2006) defines medical tourism as a popular mass culture where
people travel often-long distances to overseas destinations (India,
Thailand, Malaysia) to obtain medical, dental and surgical care while
simultaneously being holidaymakers, in a more conventional sense.
Medical tourism has become a US$60 billion dollar-a-year business and is
growing by 20% each year (Jones & Keith, 2006; MacReady, 2007).
The booming industry is expected to maintain its growth in future as well,
since more people are accessing the Internet to gain information related to
care and health services being offered abroad at affordable rates.
According to Connell (2011), there is a more prosaic and less
glamorous explanation for the growth of medical tourism including: rising
cost of health care, weakened status of the public health sector, long
waiting lists for some procedures and the inability of many to pay for
necessary medical treatment.
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The fundamental premise of medical tourism is that the same care, or
even better quality of care, may be available in other countries, and
obtained at a more affordable cost than in the home country (Medical
Tourism Association, 2008). This lower cost is especially important for a
patient who does not have health insurance and for whom a procedure
may be financially crippling in the home country, but affordable in another
one. One such example is coronary artery bypass surgery. The estimated
cost of this surgery in the United States (US), one of the countries for
which such statistics are available, is US$150,000, while the total cost of
surgery and a 20 day stay in India, is cited as US$10,000 (Herrick, 2007).
Experts pinpoint that another advantage of medical tourism is that it is
non-seasonal therefore it is unlikely that medical procedures will have
different prices depending on the time of the year summer or winter prices
(Nautiyal & Dogra, 2005).
Connell (2006) states that another feature of medical tourism, namely -
distance from home, may offer desired anonymity. Some medical
procedures, such as gender changes, have become small but significant
parts of medical tourism, especially in Thailand, where recuperation and
the consolidation of a new identity may be better experienced at a
distance from standard daily life.
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Various countries engage in medical tourism in order to strengthen their
Gross Domestic Product (GDP) as foreign patients bring in needed cash
to pay for procedures and other activities. GDP is defined as the primary
indicator used to measure the health of a country's economy.
Most countries that engage in delivering care to medical tourists do so to
increase the level of direct foreign exchange earnings coming into their
country; to improve their balance-of-payments position (Timmermans,
2004, Ramrez de Arellano, 2007, Turner, 2007). To some extent this
might be income thought of as accruing directly to the health system. For
instance, foreign patients purchase health care services, and hence
provide an income that can be used within hospitals to cross-subsidize
care for domestic patients, or could be used to help fund capital
investment, such as MRI scanners, that are then used by all patients in
the hospital.
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2.2. Related Studies
The Medical Tourism Association (MTA) provides the following statistics
for a June 2009 MTA Patient Survey:
Almost 83% of patients traveled with a companion.
Almost 70% of patients rated their medical care as excellent.
Almost 90% of patients or their companions engaged in tourism
activities.
Almost 85% of US patients found they received more personalized
medical care in comparison to their home country.
Almost 86% of US patients said they would travel again overseas for
medical care.
According to the National Coalition on Health Care (NCHC), long waiting
lists serve as a catalyst for many citizens to seek care overseas. For that
reason approximately 500,000 Americans alone traveled overseas in 2007
for medical treatment (NCHC, 2007). Moreover, this phenomenon is not
exclusive to the US alone. Large numbers of Britons also seek care
overseas (Terry, 2006). Donnelly and Sawer (2007) reported that, in 2007,
70,000 Britons traveled overseas for treatment for diverse surgical
procedures including cataracts, hip operations, and cardiac surgery.
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As a consequence of the development of medical tourism, a number of
countries actively advertise their services and have companies that
specialize in arranging overseas medical care (Cortez, 2008). These
countries market various procedures as an attractive package that
combines both hospital care and also tourist activities. They are aware of
the fact that medical tourists and/or their accompanying family members
may spend extra money on recreation and tourist activities both while
during the treatment period and even after the care has been concluded.
Additionally, according to Gopal (2008) many governments have started
an aggressive promotion to boost the sector in the respective countries:
Malaysia plans to develop itself as a medical tourism center. The country
has outstanding infrastructure and also English is widely spoken. Malaysia
has its own national accreditation scheme (MSQH). The Association of
Private Hospitals in Malaysia is working to develop medical tourism.
New Zealand is a comparatively new participant in the medical tourism
industry focusing mainly on non-acute surgical procedures and fertility
treatment. The cost of treatment in New Zealand (inclusive of Air travel,
accommodation etc) is estimated to be around 40% of the cost of the US
and the UK.
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Philippines is another country that is increasingly leaping forward in the
area of medical tourism. The medical centers in Metro Manila are
complied with ISO standards and have received accreditations from the
Philippines Department of Health, Joint Commission International (JCI) of
USA etc.
Singapore Medicine is a multi agency government initiative that aims to
develop Singapore into a top destination for health care services. In 2005,
approx. 374,000 medical tourists visited the country.
According to experts, medical tourism is considered to have a positive
impact on the economies of destination countries and will also promote
skilled and unskilled trades. The medical tourism trend may also deem
beneficial for foreign investors who hold an interest in those countries.
India varies greatly from other destinations in terms of cost, infrastructure,
human resources, patient perceptions, competencies, and the level of
government support. India has allotted excellent budgetary amounts for
diverse policies and initiatives. The Indian medical tourism sector is
experiencing swift growth, with approximately 500,000 foreign patients
travelling to India for medical care in 2005, compared to an estimated
150,000 patients in 2002, according to experts quoted in the University of
DelawaresUDailynews.
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In financial terms, experts estimate that medical tourism could fetch India
as much as $2.2 billion per year by 2012.
India has a reputation for high quality care in a number of major hospitals.
Medical tourism is growing and diversifying in India. Estimates vary, but
McKinsey & Company and the Confederation of Indian Industry put gross
medical tourism revenues at more than $40 billion worldwide in 2004. 1
Others estimate the worldwide revenue at about $60 billion in 2006.
2
McKinsey & Company projects the total will rise to $100 billion by 2012.3
1. McKinsey & Company and the Confederation of Indian Industry, cited
in Laura Moser, The Medical Tourist, Slate, December 6, 2005, and
Bruce Stokes, Bedside India, National Journal, May 5, 2007.
2. See Dudley Althaus, More Americans Seeking Foreign Health Care
Services, Houston Chronicle, September 4, 2007.
3. McKinsey & Company and the Confederation of Indian Industry, cited
in Laura Moser, The Medical Tourist, and Bruce Stokes, Bedside
India.
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2.3. Synthesis
Research affirms the fact that the economic revenue that the medical
tourism industry adds to the nations gross domestic product (GDP) is
considered as a determinant of success. This monetary revenue can be
calculated by healthcare incomes, as well as earnings gained from tourism
related pursuits and activities. Besides the financial value that is
calculated, countries can evaluate the affects of this industry by the boost
in number of tourists, as well as creation in the number of new jobs and
career openings. Countries are also able to establish numerous influences
and impact that the medical tourism industry has on its economic growth.
Medical tourism normally provides various types of services. Basically,
medical tourism offers a medical tourist with the healthcare service that
they need or desire. Additionally, it also provides the consumer with
relevant accommodation services that they need. Often consumers also
participate and engage in some leisure, recreational or tourist activities
during their visit. Therefore, it can be stated that the tourism industry also
indirectly provides services to these consumers as well.
Medical tourism benefits everyone involved: patients of all ages benefit by
receiving immediate treatment at very affordable prices from the best
medical attention available in the world; doctors in foreign countries
receive more patients; local governments benefit from lower health costs;
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insurance companies can offer their clients the opportunity of quality
treatment at great savings for both; service providers benefit from added
business: airlines, transportation, hotels, tourist destinations, etc.
Patients who do not have much knowledge regarding medical tourism and
those who are not familiar with specific medical facilities being offered
abroad can organize their treatment through medical travel mediators or
facilitators. These service providers work similar to specialized travel
agents. Their job is to investigate health care providers to ensure quality
treatments and screen customers in order to assess those who are
physically capable to travel. They often also have doctors and nurses on
staff to assess the medical efficiency of procedures and assist medical
tourist in selecting appropriate physicians and medical centers.
Due to the increasingly high cost of health care in developed countries like
the United States, some individuals have no other choice but to go abroad
for surgery because the surgery or procedure they will undergo is
considered cosmetic or elective (and thus not covered by insurance), or
is only partially covered by medical insurance or is considered
experimental. In some cases, even if medical insurance does provide
coverage, the cost of paying the deductible and non-covered portion of a
surgery performed in the U.S. is more expensive than paying for the entire
procedure in a foreign country.
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The following table gives a very brief comparative picture of the price of
the treatment.
Table 2.1 Cost comparison for selected surgeries
Regardless of the economic recession, the medical tourism sector
in India is the most rapidly emerging and growing segment of the tourism
industry. Factors such as low cost, range and quality of treatments
provided in the country add to its appeal as a medical tourism destination.
In spite of the lengthy travel time, India is a trendy spot for medical
tourists. It possibly, has the lowest cost and highest quality of all medical
tourism destinations, according to a report on medical tourism published
by the National Center for Policy Analysis (NCPA) in 2007.
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Rates for medical treatments can be acquired in advance and numerous
hospitals bundle services and offer package deals that include the cost of
medical procedure and the cost of treating any complications. Moreover,
hospitals also often have lodge rooms or can offer discounts for hotel
accommodation in close proximity.
Indias medical tourism industry is a significant and an increasing source
of foreign exchange in addition to positive reputation and goodwill outside
the country. Moreover, India government has also effectively introduced a
new category of Medical Visa (M-Visa), which is issued for a specific time
period to foreign tourists coming to India for medical care and treatment.
Thus, healthcare industry has shown significant growth in recent years in
India. The development of outstanding hospitals and constant efforts for
enhancement of quality of care has placed Indian healthcare in a top
position globally.
The immense growth of the medical tourism trend has had a huge impact
not just for the patient alone but it has also influenced economic, social,
environmental, business and medical sectors.
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Positive impacts of Medical Tourism on a country
It adds not just in terms of improved, quicker or affordable healthcare,
but also contributes to infrastructural enhancements.
It creates more employment opportunities with an increased tendency
towards overall wealth creation.
Numerous industries that are closely associated with the global health
tourism sector are extensively impacted by its growth and
development.
It acts as a major source of revenue for the tourism industry and
outlines a segment of total earnings of the industry. Numerous medical
tourists do not visit a country with the sole intention of only receiving
treatment or surgery. They also plan to engage in other attractions the
host country has to offer. This trend is growing as tourists have a
tendency to spend the amount they saved in healthcare on tourist
activities.
The pharmaceutical industry is highly associated with the field of
medical science. When medical tourists undergo treatment or surgery,
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they are also bound to take over-the-counter drugs sold in the same
area. As a result, this increases the sale of medicines in a directly
proportional manner such that, the number of surgeries or treatment
carried out directly adds to the earnings of the pharmaceutical
company of the host country.
Negative impacts of Medical Tourism on a country
In the midst of high rate of patient travels, there is a considerable
amount of risk of corresponding bacterial travel. The recent superbug
research has also produced a significant alert regarding this issue. It is
essential that all the related industry professionals should recognize
and comprehend the negative impact of communicable diseases.
The natural environment and habitat is compromised in order to
accommodate more buildings, hospital facilities, roads, treatment or
diagnostic centers etc. Moreover, there is a constant expulsion of
impure air, solid toxic medical waste, liters of contaminated sewage.
Architectural, noise and visual pollution also has a direct negative
impact on the environment.
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Health tourism may also produce a shortage of local resources like
power, food stock, fuel and other non-renewable natural resources,
which could already be in short supply within the host country. Water is
usually misused in hotels, spas and swimming pools because of
careless personal use by tourists. This not only produces large amount
of waste water but also leads to water shortages and exhaustion of
natural water sources.
In the midst of growing number of medical tourists, the hospital
implements the strategy and standards of being paid in as per the
international foreign system. Such a structure and policy, even though
economical to a foreigner, appears to be expensive for the local
resident. Consequently, numerous people within a particular country
are not able to benefit from the advance treatment opportunities
available within their own country. This in turn creates a negative
impact on the health care system of a country.
Legal issues and problems are also expected to arise as this industry
tenders to unique problems and challenges for both consumers as well
as providers.
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Chapter 3Research Methodology
3.1. Research Design
Descriptive research design (also known as statistical research) and a
combined methodology have been adopted for this study. A preliminary
qualitative study is combined with a main quantitative study in order to
yield a project that will help to describe the subject matter of this thesis
efficiently. Furthermore, a case study approach is used to recognize,
understand and present the context in an enhanced form. The in-depth
case approach was adopted based on extensive secondary research,
which include literature review, research of online articles and reports.
The questions contained within the survey were developed to provide
valuable information that could be used to benefit the individual consumer
as well as the industry as a whole.
3.2. Respondents of the Study
Respondents were chosen based on the Convenience Samplingmethod
(also referred to as availability sampling method). Moreover, the
respondents were selected on the basis of their closeness to the topic of
the study and their level of experience in Medical Tourism.
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A questionnaire survey was conducted over the Internet on a sample size
of 100 respondents. The survey was designed to have an international
reach; hence the questionnaire was posted on various social media
websites and forums and was also electronically sent to parties in
America, Africa, Europe, Asia, the Middle East and Gulf regions.
The questions designed, were clear and transparent in meaning and
vocabulary so that respondents can understand them easily and avoid
response bias. The research was conducted respecting confidentiality of
all collected primary data and strict ethical rules were applied for the entire
time of research and analysis.
3.3. Research Instrument
For this research, two methods were selected to be the most appropriate
instruments with the purpose of collecting authentic and helpful data -
case study approach and questionnaire survey.
Since the aim of this research is to examine the impact of medical tourism
on countrys economic growth; the questionnaire survey was chosen as an
instrument because it allows to measure perceptions and attitudes of the
respondents/patients mindset.
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The questionnaire is divided into two parts. The first part gathers
demographic information and the second part examines and estimates the
usage and effects of medical tourism in terms of revenues from medical
services and value added gained from the activities of patients and the
companions travelling with them before and after medical treatment.
3.4. Validity of the Research Instrument
Techniques such as cross-case examination and within-case examination
along with literature review are adopted to ensure external validity.
The questionnaire that appears in Appendix A comprised of fifteen
questions. The design of the questionnaire was based on the literature
review analysis and as per the sample model patient survey formulated by
the Medical Tourism Association.
3.5. Data Collection Procedure
This study utilizes both quantitative and qualitative data collection tools.
The main data collection techniques used in this research study were
documentation analysis and questionnaire surveys.
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Data collection sources also include articles in academic journals, blogs,
online report publications, magazine articles, research papers and book
references.
3.6. Statistical Tool Analysis
Within-case and cross-case analysis of data are selected as analysis
techniques. Quantitative data that has been collected is used to
corroborate and support the qualitative data which is most useful for
understanding the rationale of theory.
Statistical tools include descriptive analysis in forms of tables and graphs.
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Chapter 4Presentation, Analysis and Interpretation of Data
This research paper is a combination of survey report and intense
research done over a two month period. The questionnaire (Appendix A)
comprised of fifteen multiple choice questions. A sample of 100
respondents was used and therefore the number of respondents also
symbolizes the percentage of total respondents.
Details of findings from the research questionnaire are presented below.
4.1. Demographic information
The information about demographics was taken from the first part of the
questionnaire that covered aspects such as the respondents gender, age
and nationality.
4.1.1. Breakdown by Gender
Figure 4.1 Gender distribution
Figure 4.1 shows that the gender distribution was almost equal in ratio.
However, majority of the respondents were male.
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4.1.2. Breakdown by Age Group
Figure 4.2 Age Composition
Figure 4.2 shows that 47% of the respondents were aged between 50-64
years, 26% were aged between 30-49 years, 17% were aged between 18-
29 years, and the remaining 10% were aged 65 and above.
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4.1.3. Breakdown by Nationality
Figure 4.3 Nationality chart
Figure 4.3 shows that majority of the respondents (21%) were Americans,
19% were GCC Arabs, 17% were Europeans, 15% were Asians, 13%
belonged to the Mid-East region, 9% were Africans and 6% were
Australians.
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4.2. Medical Tourism Questionnaire Survey Result
1. How did you find out about medical tourism (travelling internationally for
medical care)?
Figure 4.4 - Medical Tourism - First knowledge source
Figure 4.4 reveals how the respondents first gained knowledge about
medical tourism. The print media (Newspaper, Magazine and Book) was
clearly the leading media for 37% of the respondents, followed by
Internet at 21%. Friend and My Doctor were the next highest factors
with a score of 19% and 15% respectively. Only 6% of the respondents
first learned about medical tourism through TV, Radio and the remaining
2% via Other Conferences.
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2. How did you research your information for medical tourism on country
destinations and hospitals?
Figure 4.5 - Medical Tourism - Preferred research source
Figure 4.5 depicts how the respondents gained research information for
medical tourism on country destinations and hospitals. A huge number of
respondents (61%) selected Internet followed by Asked a Friend at 19%
and Medical Tourism Facilitator at 11% as their choice of research
source. Only 9% of the respondents consulted Magazines, Books.
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3. How many times have you travelled as a medical tourist?
Figure 4.6 - Medical Tourism - Frequency of Travel
Figure 4.6 exhibits respondents frequency of visit as a medical tourist.
Majority of the respondents (64%) have travelled only once whereas 36%
of respondents have travelled more than once.
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4. What motivated you in deciding to travel for medical purpose?
Figure 4.7 - Medical Tourism - Motivation factor
As shown in figure 4.7, Lower costs was the leading motivational factor
for 42% of respondents in deciding to travel for medical purpose. The next
top factors were Medical procedure combined with relaxation/leisure and
Better quality services with subsequent results of 24% and 21%
respectively. Access to alternative/different services was seen as a
motivation factor by 13% of the respondents.
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5. What type of procedure did you travel for?
Figure 4.8 - Medical Tourism - Type of procedure
Figure 4.8 shows the type of procedure the respondents traveled for.
Results clearly show that the most popular procedures were Cosmetic
and Surgical or invasive procedures with subsequent respondent results
of 36% and 26% respectively. The next top procedures sought-after were
Rehabilitation at 16% and Medical spa services at 13%. Only a small
percentage of respondents travelled for Elective procedures and
Preventive services (6% and 3% respectively).
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6. What was the duration of your stay period?
Figure 4.9 - Medical Tourism - Duration of stay
Figure 4.9 shows the duration of the respondents stay period abroad as a
medical tourist. 46% of the respondents stayed for one month, 33%
stayed for less than one month and 21% of the respondents stayed for
more than one month.
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7. What was your total expenditure budget for the entire stay period?
Figure 4.10 - Medical Tourism - Total expenditure budget
Figure 4.10 depicts the total expenditure budget of the respondents for
their entire stay period abroad as a medical tourist. For 42% of the
respondents it was USD 10,000, for 38% of the respondents it was more
than USD 10,000 and for 20% of the respondents it was less than USD
10,000.
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8. Did you travel alone or with a companion?
Figure 4.11 - Medical Tourism - Traveling
Figure 4.11 shows whether the respondents traveled alone or were
accompanied with a companion. A whooping number of respondents
(79%) travelled along with a companion and only 21% opted to travel
alone.
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9. Did you or your companion do any tourism such as site-seeing,
shopping, fine-dining or enjoying the local culture?
Figure 4.12 - Medical Tourism - Performed tourist activities
Figure 4.12 shows whether the respondents and/or their companions
engaged in tourism activities such as site-seeing, shopping, fine-dining or
enjoying the local culture. Results from the survey show that a huge
majority of the respondents (97%) were involved in tourism activities and
only a small number of respondents (3%) did not partake in any extra
activities.
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10. How would you rate the hospital you received medical care at?
Figure 4.13 - Medical Tourism - Hospital rating
Figure 4.13 shows how the respondents rated the hospital they received
medical care at. Results from the survey show that 48% of the
respondents rated the hospital as very good, 36% of the respondents
rated the hospital as excellent and a small number of the respondents
rated the hospital as average (9%), below average (4%) and poor (3%).
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11. Did you use a medical tourism facilitator (a company that was an
intermediary and helped coordinate your care)?
Figure 4.14 - Medical Tourism - Facilitator used
Figure 4.14 shows whether the respondents used a medical tourism
facilitator to help coordinate with care. 45% of the respondents gave an
affirmative response whereas 55% of the respondents didnt use the
services of a medical tourism facilitator.
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12. How helpful did you find the medical tourism facilitator?
Figure 4.15 - Medical Tourism - Facilitator service rating
Figure 4.15 shows how the respondents rated the services of their medical
tourism facilitator. Results from the survey show that 21% of the
respondents rated the facilitator as Extremely Helpful, 19% of the
respondents rated the facilitator as Helpful and a small number of the
respondents rated the facilitator as Somewhat Helpful (3%) and Not
Helpful (2%).
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13. Was there a language barrier or communication problem at the
hospital?
Figure 4.16 - Medical Tourism - Communication problem
Figure 4.16 shows whether the respondents faced any language barrier or
communication problem at the hospital. A whooping number of
respondents (82%) didnt face any communication problems at all.
However, 15% of the respondents faced occasional problems, but that did
not significantly affect their experience whereas 3% of the respondents felt
significant language barrier which also affected their experience.
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14. Do you feel the service you received was more personalized compared
to your country?
Figure 4.17 - Medical Tourism - Personalized service
Figure 4.17 shows whether the respondents received more personalized
service compared to their country. Results from the survey show that a
huge number of respondents (94%) gave an affirmative response whereas
only a small number of respondents (6%) didnt find the service they
received being more personalized compared to their country.
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15. Were you concerned about medical malpractice and the possibility of
having to sue in a foreign country in the event of an adverse result?
Figure 4.18 - Medical Tourism - Malpractice concern
Figure 4.18 demonstrates whether the respondents were concerned about
medical malpractice and the possibility of having to sue in a foreign
country in the event of an adverse result. Results from the survey show
that 49% of the respondents were concerned; for 36% of the respondents
it was a matter of small concern and 15% of the respondents were not
concerned at all. This shows the confidence level of tourist in the services
they are being offered and the overall system.
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Chapter 5Summary of Findings, Conclusion and Recommendations
This chapter presents the synopsis of the findings of the research.
Furthermore, this chapter also includes conclusions derived from the study
and presents few recommendations related to the field of medical tourism.
The substantial results of the research have been generalized. They are
analyzed according to the theoretical knowledge concerning basics of
medical tourism.
5.1. Summary of Findings
People seek medical tourism for various reasons. For many cost is the key
factor, for others convenience and quality of healthcare service are the
leading aspects. People are drawn to certain countries because they have
some of the most high-esteemed hospitals and proficient healthcare
professionals. Presently, the most sought-after purpose for medical
tourists who seek treatment abroad is for cosmetic surgeries and for
procedures which are often significantly cheaper in a foreign country. This
is especially true for US, Western European patients and GCC Arabs.
For numerous medical tourists, the availability and ease of access to
certain medical procedures and treatments is an extremely important
consideration.
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Moreover, the quality of healthcare treatment and services being offered
at a destination is also deemed to be of great significance and value.
Advance and sophisticated technology in combination with contemporary
medical science and the capacity and capability to provide a high success
rate and a pleasing and satisfying overall experience are fundamental
components for the development and popularity of a top sought-after
medical tourism destination.
Planning for medical tourism can certainly prove to be a challenging task
for a prospective medical tourist. It involves vital arrangements, such as
locating reliable providers, ensuring hassle-free travel arrangements and
having a complete understanding of any pre-operative and post-operative
requirements, amongst many others.
For many patients, using a facilitator is more suitable and convenient
rather than planning on their own. Facilitators have crucial experience in
the medical tourism field and are able to offer expert advice and are
capable of proficiently handling patients concerns and queries. They can
also offer support with logistics and travel plan arrangements. Moreover,
another added advantage of using the services of medical facilitators is
that patients might be able to obtain lower rates from clinical programs
abroad rather than if they approached directly.
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The health care industry is one of the world's largest and fastest-growing
industries. The medical tourism industry can be a product for any country.
However, numerous nations have significantly benefited from this
business more than others.
Generally, Medical Tourism is a fairly new concept, where two essential
service industries are coming together to catch the attention of people who
are seeking healthcare services located out of their own country.
Moreover, attractive tourism packages make the entire offer more
appealing to people who plan to travel for their healthcare treatment.
5.2. Conclusion
Medical tourism is frequently recognized as an industry where developing
countries, such as India, possesses enormous potential due to their
relative advantage based on providing outstanding treatments at low
prices along with attractive resorts for the period of recovery. Hence, the
added benefit of a luxurious vacation and recovery in an exotic locale are
also part of the appeal.
A blend of three key factors quality, availability and cost has been vital in
fuelling the exceptional growth observed in the medical tourism industry.
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Nations offering Medical Tourism are increasingly dedicated to providing
top-notch services at affordable prices. Sophisticated and superior
healthcare services are now easily available without compromising on the
quality and standards of the medical treatment and care.
Medical tourism is not only beneficial to international patients; it also
presents a broad range of benefits to numerous other industries such as
the pharmaceutical industry, travel and tourism sector, commercial sector,
amongst others.
Both positive and negative impacts of medical tourism on healthcare,
economic, social and environmental sectors generates opportunities and
challenges for this budding industry which in turn also requires organized
and effective mutual work between various stakeholders associated with
the medical tourism industry.
Overall, medical tourism is considered to have a positive impact directly
due to improvements in the health care system within a country, and
indirectly because of all the new related economic activity that is
generated and the prospects for growth are immense.
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Numerous governments and service providers have promptly
acknowledged and recognized the prospects and potential of medical
tourism and are using firm schemes to structure it as a key revenue
generator for their countries' economies. Many developing countries are
pursuing medical tourism as an economic growth strategy.
Three players dominate the medical tourism sector, namely -
Tour Operators
Hotels
Hospitals and medical centers
Medical tourism is expected to boost further over the next decade as more
individuals are able to access the Internet and obtain information related
to medical care being offered world-wide at an affordable price within their
budget.
The following Table 5.1 - summarizes the impact of medical tourism on a
countrys economic growth.
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Table 5.1 Economic impact of medical tourism on a nation
Directly Related to Product:The revenue that is generated from medical
tourists who are traveling to the host country for their treatment and
healthcare requirements goes into developing and building the nations
healthcare system and tourism infrastructure.
Indirectly Related to Product:Since medical tourism is associated with
various other types of businesses, the revenue generated also ultimately
aids these other sectors indirectly as well. While this practice mainly
promotes the healthcare and housing industries, the service and leisure
industries also profit immensely.
Not Related to Product: Medical tourism industry offers extensive results
and provides a substantial increase in the nations economic health on the
whole. Revenue generation associated with this industry aids in increasing
the countrys Gross Domestic Product (GDP). This consequential growth
supports the development of the countrys infrastructure and its residents
quality of life.
Related to Process:Revenue generation associated with this industry is
expected to promote further expansion and improvement of the related
infrastructure. Development of the healthcare system, as well as the travel
and tourism infrastructure, will overall benefit the country and its citizens.
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5.3. Recommendations
The term Medical Tourism is often switched and exchanged with other
terms such as 'Medical Travel', 'Health Travel', 'Healthcare Travel', 'Health
Tourism' and 'Global Healthcare'. This results in a conceptual confusion
and hence hinders the growth of the medical tourisms industry by
inconsistent, confusing terminology and conceptual intermingling.
There is an immediate need to establish clear, reliable and consistent
definition worldwide. Furthermore, cultural barriers and language,
including medical terminology, may be challenging even with the aid of
interpreters. Severe error and confusion may arise between the patient
and the provider. It is imperative that both the parties should share
amongst each other all the essential information before starting the
procedure in order to obtain quality outcomes.
Furthermore, another matter of concern is the quality of the hospital s
environment. Medical tourists should cautiously evaluate the quality and
the standards that they expect and have been promised. This evaluation
should take account of the environment and atmosphere outside the
hospital. In some countries the quality of water and air, as well as hygienic
standards, may be quite different from patients' expectations and may
hinder their period of recovery.
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One of the enormous challenges faced by the medical tourism industry is
to reach prospective patients by creating marketing strategies that will
effectively extend to those who require medical attention and are eager to
learn about receiving medical treatment in a foreign country.
Medical tourism marketers need to capitalize on/promote their true
medical specialties. Medical facilitators should function actively in tackling
this challenge. This can be done by creating and launching effective
marketing campaigns in order to gain prospective benefits of this industry.
Additionally, facilitators should offer services that are attractive and
tempting to international patients. Facilitators should be capable of offering
all the assistance and support that a traveling patient needs and must do
everything on behalf of the patient.
Facilitators should also focus on developing relationships with other key
industry players to create mutually beneficial joint ventures. This will help
in promoting business opportunities for local companies who are engaged
in activities related to medical tourism.
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There are some obstacles in promoting medical tourism in developing
countries. International regulations and international standards for
accreditation and licensing are problems around which countries will have
to navigate.
Countries should establish regulatory boards for monitoring the standard
of care in their hospitals and the professional quality of their medical
practitioners when possible.
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Bibliography
Books / Periodicals
Connell, J. (2006) Sun, Sea, Sand &Surgery. Tourism Management,
School of Geosciences, University of Sydney, Australia.
Connell, J. (2011) Medical Tourism. Wallingford: CABI.
Cortez, N. (2008). Patients without borders: The emerging global
market for patients and the evolution of modern health care. Indiana
Law Journal, 83, 1-24.
Donnelly, L., & Sawer, P. (2007). Record numbers go abroad for
health, The Telegraph.
Gopal, R. (2008).The Key Issues and Challenges in medical tourism
sector in India (A Hospital Perspective). Presented at the Conference
on tourism in India-Challenges Ahead.
Herrick, D.M. (2007). Medical tourism: Global competition in health
care.Dallas, TX: National Center for Policy Analysis.
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Jones, C.A., & Keith, L.G. (2006). Medical tourism and reproductive
outsourcing: the dawning of a new paradigm for
healthcare. International Journal Fertility Women's Medicine, 51, 251-
255.
MacReady, N. (2007). Developing countries court medical
tourists. Lancet, 369, 1849-1850.
Medical tourism association. (2008).
www.medicaltourismassociation.com/
Nautiyal S. & Dogra S. (2005). Medical tourism set to take off in a big
way. Pharma Pulse Express: Indias No. 1 Weekly For The
Pharmaceutical Industry, Mumbai/New Delhi.
Ramrez de Arellano, A. B. (2007), Patients without borders: the
emergence of medical tourism. International Journal of Health
Services, 37, 193-8.
Terry, N.P. (2006). Under-regulated health care phenomena in a flat
world: Medical tourism and outsourcing. Western New England
Law, 26, 421-426.
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Timmermans, K. (2004), Developing countries and trade in health
services: which way is forward? Int J Health Serv, 34, 453-66.
Turner, L. (2007), 'First World Health Care at Third World Prices':
Globalization, Bioethics and Medical Tourism. BioSocieties, 2, 303-325.
Electronic Resources
http://en.wikipedia.org/wiki/Medical_tourism
http://www1.american.edu/ted/medical-tourism.htm
http://www.drprem.com
http://www.frost.com/prod/servlet/cpo/175354611
http://www.growthconsulting.frost.com
http://www.investopedia.com/terms/e/economicgrowth.asp
http://www.medicaltourismassociation.com
http://www.medicaltourismmag.com
http://www.merinews.com/article/medical-tourism-and-its-impact-on-our-
gdp/130884.shtml
http://www.nursingworld.org
http://www.reportlinker.com/p0349309/Booming-Medical-Tourism-in-India.html
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Medical Tourism - Survey Questionnaire
Page 1 of 4
As part of the evaluation of the impact of Medical Tourism, please complete the followingquestions. Information will be treated confidentially.Please be objective all comments will be taken into account.
I. General Questions
(Please choose one answer only and mark the appropriate boxes with)
GENDER:
M
F
AGE:
18 29 years
30 49 years
50 64 years
65 and Above
NATIONALITY:
ASIAN
EUROPEAN
AMERICAN
AUSTRALIAN
AFRICAN
MID-EASTERNGCC ARAB
OTHER:
II. Questions related to Medical Tourism
(Please choose one answer only and mark the appropriate boxes with)
1. How did you find out about medical tourism (travelling internationally for medical care)?
Internet
Newspaper, Magazine, Book
TV, Radio
My Doctor
Friend
Other conferences
2. How did you research your information for medical tourism on country destinations andhospitals?
Internet
Magazines, Books
Medical Tourism Facilitator
Asked a Friend
Other
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Medical Tourism - Survey Questionnaire
Page 2 of 4
3. How many times have you travelled as a medical tourist?
Once
More than once
4. What motivated you in deciding to travel for medical purpose?
Lower costs
Access to alternative/different services
Medical procedure combined with relaxation/leisure
Better quality services
5. What type of procedure did you travel for?
Cosmetic procedures
Surgical or invasive procedures
Preventive services
Medical spa services
Rehabilitation
Elective procedures
6. What was the duration of your stay period?
Less than one month
One month
More than one month
7. What was your total expenditure budget for the entire stay period?
Less than USD 10,000
USD 10,000
More than USD 10,000
8. Did you travel alone or with a companion?
Alone
Companion
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Medical Tourism - Survey Questionnaire
Page 3 of 4
9. Did you or your companion do any tourism such as site-seeing, shopping, fine-diningor enjoying the local culture?
Yes
No
10. How would you rate the hospital you received medical care at?
Excellent
Very Good
Average
Below Average
Poor
11. Did you use a medical tourism facilitator (a company that was an intermediary andhelped coordinate your care)?
Yes
No
12. How helpful did you find the medical tourism facilitator?
Extremely Helpful
Helpful
Somewhat Helpful
Not Helpful
Not Applicable
13. Was there a language barrier or communication problem at the hospital?
Not at all
Occasional problems, but did not significantly affect my experience
Yes, significantly affected my experience
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Medical Tourism - Survey Questionnaire
14. Do you feel the service you received was more personalized compared to yourcountry?
Yes
No
15. Were you concerned about medical malpractice and the possibility of having to sue ina foreign country in the event of an adverse result?
Yes, I was concerned
I was not concerned at all
It was a small concern
Thank you very much for taking the time to fill out this survey!
FURTHER COMMENTS / OPINIONS