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EBHPME 2022, 6(2): 90-99 |
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Najafipour Moghadam F, Tavakoli N, Nemati K, Pak N. Evaluation of the Relationship Between Foreign Patients' Satisfaction and Financial Dimension, Treatment Quality, and Treatment and Tourism Facilities in Hospitals of Iran University of Medical Sciences. EBHPME 2022; 6 (2) :90-99
URL: http://jebhpme.ssu.ac.ir/article-1-360-en.html
URL: http://jebhpme.ssu.ac.ir/article-1-360-en.html
Department of Curative Affairs, Iran University of Medical Sciences, Tehran, Iran , Najafipoor.f@iums.ac.ir
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Background: Medical tourism provides Effective economic, political and social profits to the countries active in the field, which should be taken into account in a competitive market. This study aimed to evaluate the relationship between foreign patients' satisfaction and other aspects of health tourism in educational and medical centers of the Iran University of Medical Sciences (IUMS).
Methods: This was a descriptive correlational study with a researcher-made questionnaire. The first part of the questionnaire contained the demographic characteristics of the participants, and the second part included 30 questions about the components that affect receiving medical services by foreign nations. The reliability coefficient of the questionnaire was determined by using Cronbach's alpha (0.980). Expert judgment was used to assess the validity of the questionnaire. Out of 70 hospitals affiliated with the University of Iran in 2019, 10 hospitals from 35 licensed centers in the field of international health were randomly selected, and 300 questionnaires were delivered to foreign patients who were willing to complete the questionnaire. The received information was from Random sampling recorded in SPSS25 software. Descriptive Statistics was used to determine the effective factors.
Results: The largest numbers of foreign patients in this study were from Iraq (64 %) and Kuwait (24 %), respectively. In correlation review, there was a significant relationship between satisfaction of foreign patients and financial dimension (0.785), quality of treatment dimension (0.914), medical facilities dimension (0.799) and tourism facilities dimension (0.918) in hospitals.
Conclusion: This study demonstrates that there is a significant relationship between satisfaction of foreign patients and other aspects of health tourism (such as financial dimension, treatment quality, treatment and tourism facilities) in hospitals, Which needs to be given special attention by health tourism managers for short-term and long-term planning for its development.
Key words: Health tourism, International health, Iran, Services, tourism treatment
all of P10 McCarthy (1975) includes product, price, location, distribution, advertising, people, physical evidence, processes, partnerships, and personalization. Can be generalized to the medical tourism industry (4). Patient education, privacy, culture and medical problems of the patient have also been added to the above due to the nature of health tourism (5). In general, the above P14 can be considered a marketing mix for medical tourism (6). The relationship between health and tourism can be examined in different ways, maintaining the health of tourists is the most important relationship between them. For the first time, a conceptual framework was presented by Bushell in which the interaction between health and tourism from the perspective of health tourism was described by examining health and disease, health promotion and disease prevention. According to Allen, health and tourism are related to three categories: The health of tourists, the health of host and guest communities, and travel based on health
goals (7).
Health tourism has been welcomed by healthcare providers in other countries around the world trying to attract and accommodate medical travellers. As a result, there has been a growing concern for establishing professional standards to protect the quality and safety of patient care and the types of business opportunities available in this new industry (8). Health tourism is an opportunity to exploit the combination of tourism with medical services, which has now become an important industry (9).
Health tourism is an opportunity to use the combination of tourism medical services, which has now become an important industry (10). Globalization has brought complex cultural needs across all sectors in an already culturally diverse world. Understanding culture and behaviour is of importance in healthcare about the provision of comprehensive care with a delightful experience, but it has certainly become essential in medical tourism because patients arrive with different cultural beliefs and from different geographies. Understanding culture in medical tourism is a two-way process as the patient needs to understand the destination's cultural beliefs as much as providers need to know and understand the patients’ cultural beliefs (11). Examining such data is important to understand the level of customer satisfaction and demand. Although many studies have been conducted to find the factors that affect customer satisfaction in medical tourism, there are no studies on extensive social data and online analysis of the behaviour of medical travellers. In addition, online customer reviews by machine learning techniques in the field of medical tourism are relatively unknown (12). Behavioural intent is often influenced by mental well-being rather than experience. The moderating role of technology readiness between mental well-being and behavioural intention in people with high optimism and innovation is stronger than
their counterparts with low optimism and innovation (13).
Iran is the most potential and powerful country among its neighbours in attracting health tourism. From traditional medicine, various medicinal plants and natural resources of hot and mineral waters to medical and health specialists, as well as advanced medical centers such as dental infertility treatment, heart surgery, cosmetic surgery, etc. Low costs of services in Iran are among these capacities. The need of the people of neighbouring countries for health services in terms of the low level of medical knowledge of these countries and their fundamental problems is also one of the strengths of Iran. (14).
According to Iran's macro plans to use the capacity of medical tourism and reduce dependence on the oil industry, Iran University of Medical Sciences (IUMS) under the supervision of the Ministry of Health with important specialized and sub-specialized hospitals from previous years, used medical capacity to accept foreign patients who have paid special attention to this plan, and the number of referrals to the affiliated centers in 2019 has been significant, such that from March 1 to August 1 in 2019, there were 4928 foreign patients in government centers and 2472 foreign patients in private centers. It is necessary to explain that the registration of foreign patients in the system of the Ministry of Health was done by the affiliated centers. Most of the clients in government centers were citizens of Afghanistan. Findings of this study can generate revenue due to increasing the number of non-Iranian patients entering and applying for care and treatment services, and creation of a positive mental image and memories of Iran should be considered by doctors, staff, managers and politicians of the health system. Therefore, the present study aimed to evaluate the relationship between foreign patients' satisfaction and other aspects of health tourism in hospitals affiliated with the Iran University of Medical Sciences (IUMS).
Materials and Methods
This present study is quantitative in concept of the descriptive purpose of the correlation among factors and in terms of the data type, conducted between March and August 2019. The statistical population of the study included all foreign nations referred to the educational and medical centers affiliated with Iran University of Medical Sciences in 2019, from 35 hospitals licensed by the International Patients Department (IPD) Unit, from which 300 patients were randomly selected (based on 30 questions in the questionnaire (10 people for each question)).To identify the components which affect receiving medical services by foreign countries, after studying domestic and foreign books and resources with a topic related to the present study (15, 16), a questionnaire was used and prepared in Arabic and English. The first part of the questionnaire contained demographic characteristics of the participants, and the second part included 30 questions about the components which affect receiving medical services by foreign nations.
Expert judgment was used to assess the validity of the questionnaire and Cronbach's alpha was used to determine its reliability. The reliability coefficient of the questionnaire was obtained using Cronbach’s alpha coefficient (0.980). The data were entered into SPSS25 statistical software and analyzed version 25 of this software. To analyze the data, a correlation coefficient test was used.
The purpose of the research and the confidentiality of the information were explained to the participants. Ethical issues (including plagiarism, informed consent, misconduct, data fabrication, double publication and submission, redundancy, etc.) were completely observed by the authors. Participants were asked to complete the questionnaire items based on a five-point Likert scale, including completely agree, agree, no idea, disagree, and completely disagree.
To perform this test, all the required factors were examined concerning their normal distribution in the test. To determine the correlation coefficient, first, the items in the questionnaire were categorized into 5 groups (financial dimension, treatment quality, tourism facilities, and satisfaction) based on the analysis of the exploratory factor and the opinion of experts. (Table 1)
Then, using the correlation coefficient, the relationship between patient satisfaction and levels of health tourism was obtained. To analyze the data, a correlation coefficient test and descriptive statistics were used. To perform this test, all the factors in question were examined in terms of the normal distribution of the factors, which is attached to the results. All factors regarding the hypotheses had a normal distribution. In the following, descriptive statistics and the correlation coefficient of the factors related to this research are presented.
-The financial dimension in this research means medical expenses, travel, accommodation, medical packages and insurance.
- The quality of treatment in this study means satisfaction with the received medical services, recovery process, pleasant experience, and cost-effective treatment at a reasonable price.
- The meaning of medical facilities in this study is waiting in line for a short time, lack of treatment in the country of origin, fast track discharge from the hospital, medical guarantee, appropriate medical equipment, proper access to a doctor, proper rehabilitation and obtaining appropriate medical information.
- The meaning of medical tourism facilities in this study is the feasibility of obtaining a visa, proximity to Iran, proper coordination, good reputation of tourism, satisfaction with security and friendly treatment in Iran.
- Satisfaction in this study means recommendations to friends, satisfaction with the way of providing services, and going back if needed
This article reports a study in IUMS with an ethics code of IR.IUMS.REC.1398.204.
Table 3. Frequency of the foreign patients' answers to the questionnaire
**Correlation is significant at 0.050 (2-tailed).
Discussion
This research was conducted to evaluate the satisfaction of foreign patients with other dimensions of health tourism services. Overall, the results demonstrated that there is a significant relationship between satisfaction of foreign patients with financial dimension, treatment quality, and treatment/ tourism facilities in hospitals. The tourism industry is one of the l most important and productive economic activities in the world which affects other economic and cultural activities. A review of this study indicates that Iran in general, is faced with main challenges, including the existence of different political and decision-making organizations and their cultural and political status. Therefore, if Iran intends to develop medical tourism, as a strategy in line with the resilient economy, its strengths and challenges should be weighed (17). Some studies have concluded by recommending further research in future by health, medical, treatment and management scientists (18).
The attraction countries are active in the field of international health care investing in tourism as a tourist destination by combining high-quality medical services and competitive prices with tourist packages and services. Some countries almost benefit from providing services based on the organizational structure of their health system (19). The findings of a study by Han et al. (20) indicated a good fit for the proposed model. Perceived quality, satisfaction, and trust in the staff and clinic showed a significant relationship affecting intentions to revisit clinics and the destination country; and satisfaction and trust acted as effective mediators. In general, support for the hypothesized moderating impact of a reasonable price in the proposed theoretical model was evident in the results of the metric-invariance test (20). The results showed that physical, social, and symbolic landscapes positively influence health perceptions through restorative experiences. Social/symbolic landscapes and dispositional optimism positively affect health perception, while physical landscapes do not directly have an effective impact on health perception (21)
Results contribute to a few empirical researches on the consumer dynamics and underpinnings of an industry experiencing fast growth in an environment of significant change and uncertainty. Findings may also help health tourism marketers to better serve those already inclined to travel abroad for healthcare services, and develop the desire among those not currently inclined to do so (22).
Healthcare activists and government officials are expected to give Special attention and emphasis to cultural and medical challenges in developing short-term and long-term plans for improving the health tourism industry (11). The medical tourism industry would not be developed without well-known healthcare centers which popular for their therapeutic outcome, efficiency, patient-centeredness, responsive to governance and staff orientation (23). The choice of destination by outpatients based on the quality and cost of treatment as well as multiple one-stage treatment facilities and waiting time is less important (24). Despite the relative collaboration of some respondents in completing the questionnaire, they weren’t present to explain how the questionnaire was completed in person due to time constraints. This was a limitation of the study which was resolved by arranging several sessions to get their opinion. Because a limited number of studies have been conducted on health tourism at the Iran University of Medical Sciences, the present study was conducted for hospitals operating in the field of health tourism at Iran University. It is suggested that research be conducted on the awareness and skills of health care workers, managers, and health policymakers in providing health tourism services.
Conclusion
The present study demonstrates that due to the importance of customer satisfaction in the field of health tourism and the method of providing care and treatment services to foreign patients in hospitals of Iran University of Medical Sciences, addressing financial dimensions, quality of treatment, medical and tourism facilities and the customer’s satisfaction is of great importance. Despite the efforts made in the field of health tourism, there are still challenges concerning improving the status of Iran as the leading provider of medical tourism services despite
its tourist attractions, potential sources such
as an effective workforce, advanced medical equipment, etc. which calls for special attention. It is expected that this study help improves the attitudes of medical tourism activists and policymakers by emphasizing the improvement of the current situation in the financial dimension, quality of treatment, tourism and treatment facilities so that foreign clients across the world reach a positive mental image of care and treatment services in Iran.
Acknowledgements
This study is about the dimensions of medical tourism services in foreign patients and the relationship between their satisfaction and other dimensions of health tourism in educational and medical centers affiliated with Iran University of Medical Sciences (IUMS), and thanks to all the professors, and experts who have contributed to the development of this research.
One of the limitations of the research is the relative willingness of some respondents and the allocation of time to complete the questionnaire, an attempt was made to participate by explaining the importance of using respondents' practical ideas for the development of international health.
Conflict of interests
The authors declared no conflict of interests.
Authors' Contributions
Najafipour Moghadam F, Tavakoli N, Nemati Kh and Pak N designed research; Najafipour Moghadam F conducted research; Najafipour Moghadam F and Nemati Kh analyzed data; and Najafipourn F wrote the paper. Najafipour Moghadam F, Tavakoli N, Nemati Kh and Pak N had primary responsibility for the final content. All authors read and approved the final manuscript.
Funding
The present study was conducted with the financial support of Iran University of Medical Sciences (IUMS).
Methods: This was a descriptive correlational study with a researcher-made questionnaire. The first part of the questionnaire contained the demographic characteristics of the participants, and the second part included 30 questions about the components that affect receiving medical services by foreign nations. The reliability coefficient of the questionnaire was determined by using Cronbach's alpha (0.980). Expert judgment was used to assess the validity of the questionnaire. Out of 70 hospitals affiliated with the University of Iran in 2019, 10 hospitals from 35 licensed centers in the field of international health were randomly selected, and 300 questionnaires were delivered to foreign patients who were willing to complete the questionnaire. The received information was from Random sampling recorded in SPSS25 software. Descriptive Statistics was used to determine the effective factors.
Results: The largest numbers of foreign patients in this study were from Iraq (64 %) and Kuwait (24 %), respectively. In correlation review, there was a significant relationship between satisfaction of foreign patients and financial dimension (0.785), quality of treatment dimension (0.914), medical facilities dimension (0.799) and tourism facilities dimension (0.918) in hospitals.
Conclusion: This study demonstrates that there is a significant relationship between satisfaction of foreign patients and other aspects of health tourism (such as financial dimension, treatment quality, treatment and tourism facilities) in hospitals, Which needs to be given special attention by health tourism managers for short-term and long-term planning for its development.
Key words: Health tourism, International health, Iran, Services, tourism treatment
Introduction
Tourism is one of the few areas which offers all the countries of the world the right context for gaining profit and has therefore been considered an industry. Tourism treatment is a new concept in which patients travel to a foreign destination to receive good quality medical treatment, which is much better or at the quality level of their own country and costs much less (1). In a study by Li, Shina et al. (2) it was found that the expansion of tourism can reduce the outputs of overcapacity in industries and reallocate surplus labour to tourism-related industries (2). Nowadays, medical tourism is rapidly developing as a part of health and wellness tourism. Many factors influence the development of medical tourism in developing countries (3). Although the nature of tourism services is different from the marketing of other services such as banking or transportation,all of P10 McCarthy (1975) includes product, price, location, distribution, advertising, people, physical evidence, processes, partnerships, and personalization. Can be generalized to the medical tourism industry (4). Patient education, privacy, culture and medical problems of the patient have also been added to the above due to the nature of health tourism (5). In general, the above P14 can be considered a marketing mix for medical tourism (6). The relationship between health and tourism can be examined in different ways, maintaining the health of tourists is the most important relationship between them. For the first time, a conceptual framework was presented by Bushell in which the interaction between health and tourism from the perspective of health tourism was described by examining health and disease, health promotion and disease prevention. According to Allen, health and tourism are related to three categories: The health of tourists, the health of host and guest communities, and travel based on health
goals (7).
Health tourism has been welcomed by healthcare providers in other countries around the world trying to attract and accommodate medical travellers. As a result, there has been a growing concern for establishing professional standards to protect the quality and safety of patient care and the types of business opportunities available in this new industry (8). Health tourism is an opportunity to exploit the combination of tourism with medical services, which has now become an important industry (9).
Health tourism is an opportunity to use the combination of tourism medical services, which has now become an important industry (10). Globalization has brought complex cultural needs across all sectors in an already culturally diverse world. Understanding culture and behaviour is of importance in healthcare about the provision of comprehensive care with a delightful experience, but it has certainly become essential in medical tourism because patients arrive with different cultural beliefs and from different geographies. Understanding culture in medical tourism is a two-way process as the patient needs to understand the destination's cultural beliefs as much as providers need to know and understand the patients’ cultural beliefs (11). Examining such data is important to understand the level of customer satisfaction and demand. Although many studies have been conducted to find the factors that affect customer satisfaction in medical tourism, there are no studies on extensive social data and online analysis of the behaviour of medical travellers. In addition, online customer reviews by machine learning techniques in the field of medical tourism are relatively unknown (12). Behavioural intent is often influenced by mental well-being rather than experience. The moderating role of technology readiness between mental well-being and behavioural intention in people with high optimism and innovation is stronger than
their counterparts with low optimism and innovation (13).
Iran is the most potential and powerful country among its neighbours in attracting health tourism. From traditional medicine, various medicinal plants and natural resources of hot and mineral waters to medical and health specialists, as well as advanced medical centers such as dental infertility treatment, heart surgery, cosmetic surgery, etc. Low costs of services in Iran are among these capacities. The need of the people of neighbouring countries for health services in terms of the low level of medical knowledge of these countries and their fundamental problems is also one of the strengths of Iran. (14).
According to Iran's macro plans to use the capacity of medical tourism and reduce dependence on the oil industry, Iran University of Medical Sciences (IUMS) under the supervision of the Ministry of Health with important specialized and sub-specialized hospitals from previous years, used medical capacity to accept foreign patients who have paid special attention to this plan, and the number of referrals to the affiliated centers in 2019 has been significant, such that from March 1 to August 1 in 2019, there were 4928 foreign patients in government centers and 2472 foreign patients in private centers. It is necessary to explain that the registration of foreign patients in the system of the Ministry of Health was done by the affiliated centers. Most of the clients in government centers were citizens of Afghanistan. Findings of this study can generate revenue due to increasing the number of non-Iranian patients entering and applying for care and treatment services, and creation of a positive mental image and memories of Iran should be considered by doctors, staff, managers and politicians of the health system. Therefore, the present study aimed to evaluate the relationship between foreign patients' satisfaction and other aspects of health tourism in hospitals affiliated with the Iran University of Medical Sciences (IUMS).
Materials and Methods
This present study is quantitative in concept of the descriptive purpose of the correlation among factors and in terms of the data type, conducted between March and August 2019. The statistical population of the study included all foreign nations referred to the educational and medical centers affiliated with Iran University of Medical Sciences in 2019, from 35 hospitals licensed by the International Patients Department (IPD) Unit, from which 300 patients were randomly selected (based on 30 questions in the questionnaire (10 people for each question)).To identify the components which affect receiving medical services by foreign countries, after studying domestic and foreign books and resources with a topic related to the present study (15, 16), a questionnaire was used and prepared in Arabic and English. The first part of the questionnaire contained demographic characteristics of the participants, and the second part included 30 questions about the components which affect receiving medical services by foreign nations.
Expert judgment was used to assess the validity of the questionnaire and Cronbach's alpha was used to determine its reliability. The reliability coefficient of the questionnaire was obtained using Cronbach’s alpha coefficient (0.980). The data were entered into SPSS25 statistical software and analyzed version 25 of this software. To analyze the data, a correlation coefficient test was used.
The purpose of the research and the confidentiality of the information were explained to the participants. Ethical issues (including plagiarism, informed consent, misconduct, data fabrication, double publication and submission, redundancy, etc.) were completely observed by the authors. Participants were asked to complete the questionnaire items based on a five-point Likert scale, including completely agree, agree, no idea, disagree, and completely disagree.
To perform this test, all the required factors were examined concerning their normal distribution in the test. To determine the correlation coefficient, first, the items in the questionnaire were categorized into 5 groups (financial dimension, treatment quality, tourism facilities, and satisfaction) based on the analysis of the exploratory factor and the opinion of experts. (Table 1)
Then, using the correlation coefficient, the relationship between patient satisfaction and levels of health tourism was obtained. To analyze the data, a correlation coefficient test and descriptive statistics were used. To perform this test, all the factors in question were examined in terms of the normal distribution of the factors, which is attached to the results. All factors regarding the hypotheses had a normal distribution. In the following, descriptive statistics and the correlation coefficient of the factors related to this research are presented.
-The financial dimension in this research means medical expenses, travel, accommodation, medical packages and insurance.
- The quality of treatment in this study means satisfaction with the received medical services, recovery process, pleasant experience, and cost-effective treatment at a reasonable price.
- The meaning of medical facilities in this study is waiting in line for a short time, lack of treatment in the country of origin, fast track discharge from the hospital, medical guarantee, appropriate medical equipment, proper access to a doctor, proper rehabilitation and obtaining appropriate medical information.
- The meaning of medical tourism facilities in this study is the feasibility of obtaining a visa, proximity to Iran, proper coordination, good reputation of tourism, satisfaction with security and friendly treatment in Iran.
- Satisfaction in this study means recommendations to friends, satisfaction with the way of providing services, and going back if needed
This article reports a study in IUMS with an ethics code of IR.IUMS.REC.1398.204.
Table 1. Categorizing the items in the questionnaire
| Questionnaire dimensions | Questions by number |
| Financial | 1, 2, 3, 4, 8 |
| Quality of treatment | 17, 19, 24, 28 |
| Treatment facilities | 5, 6, 7, 9, 10, 13, 15, 16, 21, 25 |
| Tourism facilities | 11, 12, 14, 20, 22, 23, 26 |
| Satisfaction | 18, 27, 29, 30 |
Results
Frequency of the demographic information of the respondents according to the country of origin is as follows: 192 (64 %) from Iraq, 12 (4 %) from Azerbaijan, 12 (4 %) from Qatar, 12 (4 %) from Bahrain and 72 people (24 %) were from Kuwait.
In terms of gender frequency, there were 216 women (72 %) and 84 men (28 %) in terms of education, 12 were non-graduated ,24 were technician,120 were diploma, 84 had bachelors' degrees, 36 were postgraduates, 24 had PhD. Most of the participants had a Diploma 120 (40 %) degree. In terms of age, most of the participants 96 (32 %) were in the age group of 40-49. (Table 2)
According to the survey conducted, to determine the correlation coefficient, the items in the questionnaire were first classified into 5 groups as described in Table 3. Then, using the correlation coefficient, the relationship between patient satisfaction and different dimensions of health tourism was studied.
Regarding the relationship between the financial dimension and patient satisfaction (r= 0.785), indicate that, there is a significant relationship.
Regarding the relationship between treatment quality and patient satisfaction (r= 0.914), indicate that, there is a significant relationship.
Regarding the relationship between treatment facilities and patient satisfaction (r= 0.799), indicate that, there is a significant relationship.
Regarding the relationship between tourism facilities and patient satisfaction (r= 0.918), indicate that, there is a significant relationship (Table 4).
Findings indicated that due to the importance of customer satisfaction in the field of health tourism and the methods of providing care
and treatment services to foreign patients in hospitals of IUMS, addressing financial dimensions, quality of treatment, medical and tourism facilities and satisfaction is of great importance.
Frequency of the demographic information of the respondents according to the country of origin is as follows: 192 (64 %) from Iraq, 12 (4 %) from Azerbaijan, 12 (4 %) from Qatar, 12 (4 %) from Bahrain and 72 people (24 %) were from Kuwait.
In terms of gender frequency, there were 216 women (72 %) and 84 men (28 %) in terms of education, 12 were non-graduated ,24 were technician,120 were diploma, 84 had bachelors' degrees, 36 were postgraduates, 24 had PhD. Most of the participants had a Diploma 120 (40 %) degree. In terms of age, most of the participants 96 (32 %) were in the age group of 40-49. (Table 2)
According to the survey conducted, to determine the correlation coefficient, the items in the questionnaire were first classified into 5 groups as described in Table 3. Then, using the correlation coefficient, the relationship between patient satisfaction and different dimensions of health tourism was studied.
Regarding the relationship between the financial dimension and patient satisfaction (r= 0.785), indicate that, there is a significant relationship.
Regarding the relationship between treatment quality and patient satisfaction (r= 0.914), indicate that, there is a significant relationship.
Regarding the relationship between treatment facilities and patient satisfaction (r= 0.799), indicate that, there is a significant relationship.
Regarding the relationship between tourism facilities and patient satisfaction (r= 0.918), indicate that, there is a significant relationship (Table 4).
Findings indicated that due to the importance of customer satisfaction in the field of health tourism and the methods of providing care
and treatment services to foreign patients in hospitals of IUMS, addressing financial dimensions, quality of treatment, medical and tourism facilities and satisfaction is of great importance.
Table 3. Frequency of the foreign patients' answers to the questionnaire
| Dimension | I choose treatment in Iran because | I completely disagree | I disagree | Neither agree nor disagree | I agree | I completely agree |
| Financial | Paying for treatment in Iran is less than that of my own country. | 16.800 % | 12.000 % | 23.340 % | 37.600 % | 10.260 % |
| Paying for travel (air, land and sea) and travel agencies in Iran is relatively convenient. | ||||||
| It is economical to pay for accommodation, transportation and travel in Iran. | ||||||
| Specific service packages include: Costs of treatment, surgery, accommodation, international flights and complete and clear information about transportation in Iran. | ||||||
| In Iran, medical services provided to international patients are covered by insurance. | ||||||
| Quality of treatment | The quality of medical services in Iran is satisfactory. | 7.000 % | 9.000 % | 14.000 % | 55.000 % | 15.000 % |
| I think treatment and recovery are more efficient in Iran. | ||||||
| I have seen people satisfied with their treatment in Iran. | ||||||
| Treatment in Iran is comprehensive and cost-effective. | ||||||
| Treatment facilities | Waiting time for treatment in my country is long. | 15.200 % | 14.800 % | 19.600 % | 41.600 % | 8.800 % |
| There is no treatment I want in my country. | ||||||
| My treatment is prohibited in my country. | ||||||
| It doesn't take too long to receive medical services in Iran. | ||||||
| Discharge from the hospital is done faster in Iran. | ||||||
| There is no guarantee for my treatment in my country. | ||||||
| Access to the required medical, pharmaceutical and treatment equipment is easy. | ||||||
| It is possible to communicate with the Therapist's physician (in person, by phone, email, etc.) before, during and after treatment. | ||||||
| It is suitable follow up for after-treatment in Iran and during recovery | ||||||
| I have easy access to the information I need about doctors, treatment and hospital facilities. | ||||||
| Tourism facilities | It is easy to get a visa to travel to Iran. | 11.000 % | 5.000 % | 20.000 % | 50.000 % | 14.000 % |
| Because my country is in proximity to Iran, travelling there is convenient. | ||||||
| Access to local accommodation for me and my companions in Iran is easy. | ||||||
| Iran is famous for tourism and hospitality. | ||||||
| Iran has religious destinations and tourist attractions. | ||||||
| Security in Iran is satisfactory. | ||||||
| The staff is friendly and respectful to patients and clients. | ||||||
| Satisfaction | Friends and relatives were satisfied with the treatment in Iran. | 9.000 % | 15.000 % | 11.000 % | 48.000 % | 17.000 % |
| I am satisfied with travelling to Iran and receiving medical services. | ||||||
| If necessary, I will return to Iran for treatment. | ||||||
| I recommend travelling to Iran for treatment to my relatives and friends. |
Table 4. The relationship between satisfaction and financial dimension, treatment quality and facilities, and tourism facilities in hospitals of Iran University of Medical Science
| Correlations | Financial dimension | Treatment quality | Treatment facility | Tourism facility | |
| Satisfaction | Pearson correlation | 0.785** | 0.914** | 0.799** | 0.918** |
| Sig. (2-tailed) | 0.000 | ||||
| N | 300.000 | ||||
Discussion
This research was conducted to evaluate the satisfaction of foreign patients with other dimensions of health tourism services. Overall, the results demonstrated that there is a significant relationship between satisfaction of foreign patients with financial dimension, treatment quality, and treatment/ tourism facilities in hospitals. The tourism industry is one of the l most important and productive economic activities in the world which affects other economic and cultural activities. A review of this study indicates that Iran in general, is faced with main challenges, including the existence of different political and decision-making organizations and their cultural and political status. Therefore, if Iran intends to develop medical tourism, as a strategy in line with the resilient economy, its strengths and challenges should be weighed (17). Some studies have concluded by recommending further research in future by health, medical, treatment and management scientists (18).
The attraction countries are active in the field of international health care investing in tourism as a tourist destination by combining high-quality medical services and competitive prices with tourist packages and services. Some countries almost benefit from providing services based on the organizational structure of their health system (19). The findings of a study by Han et al. (20) indicated a good fit for the proposed model. Perceived quality, satisfaction, and trust in the staff and clinic showed a significant relationship affecting intentions to revisit clinics and the destination country; and satisfaction and trust acted as effective mediators. In general, support for the hypothesized moderating impact of a reasonable price in the proposed theoretical model was evident in the results of the metric-invariance test (20). The results showed that physical, social, and symbolic landscapes positively influence health perceptions through restorative experiences. Social/symbolic landscapes and dispositional optimism positively affect health perception, while physical landscapes do not directly have an effective impact on health perception (21)
Results contribute to a few empirical researches on the consumer dynamics and underpinnings of an industry experiencing fast growth in an environment of significant change and uncertainty. Findings may also help health tourism marketers to better serve those already inclined to travel abroad for healthcare services, and develop the desire among those not currently inclined to do so (22).
Healthcare activists and government officials are expected to give Special attention and emphasis to cultural and medical challenges in developing short-term and long-term plans for improving the health tourism industry (11). The medical tourism industry would not be developed without well-known healthcare centers which popular for their therapeutic outcome, efficiency, patient-centeredness, responsive to governance and staff orientation (23). The choice of destination by outpatients based on the quality and cost of treatment as well as multiple one-stage treatment facilities and waiting time is less important (24). Despite the relative collaboration of some respondents in completing the questionnaire, they weren’t present to explain how the questionnaire was completed in person due to time constraints. This was a limitation of the study which was resolved by arranging several sessions to get their opinion. Because a limited number of studies have been conducted on health tourism at the Iran University of Medical Sciences, the present study was conducted for hospitals operating in the field of health tourism at Iran University. It is suggested that research be conducted on the awareness and skills of health care workers, managers, and health policymakers in providing health tourism services.
Conclusion
The present study demonstrates that due to the importance of customer satisfaction in the field of health tourism and the method of providing care and treatment services to foreign patients in hospitals of Iran University of Medical Sciences, addressing financial dimensions, quality of treatment, medical and tourism facilities and the customer’s satisfaction is of great importance. Despite the efforts made in the field of health tourism, there are still challenges concerning improving the status of Iran as the leading provider of medical tourism services despite
its tourist attractions, potential sources such
as an effective workforce, advanced medical equipment, etc. which calls for special attention. It is expected that this study help improves the attitudes of medical tourism activists and policymakers by emphasizing the improvement of the current situation in the financial dimension, quality of treatment, tourism and treatment facilities so that foreign clients across the world reach a positive mental image of care and treatment services in Iran.
Acknowledgements
This study is about the dimensions of medical tourism services in foreign patients and the relationship between their satisfaction and other dimensions of health tourism in educational and medical centers affiliated with Iran University of Medical Sciences (IUMS), and thanks to all the professors, and experts who have contributed to the development of this research.
One of the limitations of the research is the relative willingness of some respondents and the allocation of time to complete the questionnaire, an attempt was made to participate by explaining the importance of using respondents' practical ideas for the development of international health.
Conflict of interests
The authors declared no conflict of interests.
Authors' Contributions
Najafipour Moghadam F, Tavakoli N, Nemati Kh and Pak N designed research; Najafipour Moghadam F conducted research; Najafipour Moghadam F and Nemati Kh analyzed data; and Najafipourn F wrote the paper. Najafipour Moghadam F, Tavakoli N, Nemati Kh and Pak N had primary responsibility for the final content. All authors read and approved the final manuscript.
Funding
The present study was conducted with the financial support of Iran University of Medical Sciences (IUMS).
Type of Study: Original article |
Subject:
Health Policy
Received: 2021/09/29 | Accepted: 2022/05/20 | Published: 2022/07/3
Received: 2021/09/29 | Accepted: 2022/05/20 | Published: 2022/07/3
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