By Wanvipha Nuke Hongnaphadol Medical Tourism in Thailand ‘ Consumer choice and motivation of medical tourism in Thailand: a case study of healthcare consumers visiting a private healthcare provider in Pattaya’ The York Management School University of York, UK
all kind of treatments enhancing a state of well being both physically and psychologically , ranging from the spa experience through cosmetic surgery to lifesaving surgery like heart transplant (Caballero-Danell & Mugomba, 2007)
Medical Tourism in Thailand
Medical Tourism in Thailand Health Tourism Wellness Tourism Medical Tourism Non-Elective Medical Care/Illness & Elective Medical Care Preventive Medical Care Enhancement/ Beauty Surgery Spa Tourism e.g. Aromatherapy Acupuncture Massage Yoga etc. e.g. Heart Surgery Bypass Operation Neurosurgery Cancer Treatment Transplants Hip replacement etc. e.g. Medical Check-ups Health Screening etc. e.g. Cosmetic Surgery Sex Change Operation Liposuction etc. (Adapted from TRAM, ATLAS, 2006)
No empirical study identifying the motivation of travellers to Thailand (Rittichainuwat et al., 2008) except the very recent study ‘A factor-cluster analysis of tourist motivations: a case of U.S. senior travellers’ (Sangpikul, 2008).
Answering the question of why people travel is the most challenging in tourist behaviour (Crompton, 1979).
A recent report Asian Medical Tourism Analysis (2008-2012) shows the revenues generated by the region of US$ 3.4 bn from medical tourism in 2007, accounting for nearly 12.7% of the global market and ‘ Thailand has emerged as the largest medical tourism market in Asia ’ (Velasco, 2008: 13).
‘ Thailand is the largest medical tourism hub (in Asia) in total volume and in both high-end and low-end procedures’ (Runckel, 2008).
Five top tourism destinations i.e. BKK, Chonburi ( Pattaya ), Phuket, Chiang Mai and Songkhla (Hat Yai)(Thailand Development Research Institute, 1997)
Perception of low risk
A survey conducted by Visa International Asia Pacific & the Pacific Asia Travel Association of 5,000 international travelers from 10 markets around the world found 52% considering Asia as their next travel destination and Thailand to be the number-one preferred destination (Travel Agent, 2007).
Freedom of choice and the use of healthcare facilities in many countries are predominant in the current healthcare consumer’s framework when they can benefit from shorter waiting times and better quality services .
The significant increase in ‘ consumerism ’ owing to consumer expectations regarding the favourable outcome of medical intervention encourage more people to seek medical care—patients more aggressively seek services that match their expectations.
Healthcare is no longer defined by people receiving services when they are ill—the stereotypical patient.
Cross border healthcare/ patient mobility : citizens of the European Union may go to another EU country for specialist treatments that are not available in their own country, or because the waiting lists are shorter (Hogg, 1999).
A market-oriented healthcare system—people have free choice in selecting a healthcare facility (Janjaroen & Supakankunti, 2002)
All Thai citizens have been covered by 3 main public health financing schemes:
Medical Tourism in Thailand Public health financing schemes Who eligible?
Social Security Scheme (SSS)
Formal sector employees
Civil Servant Medical Benefit Scheme (CSMBS)
Government employee and their dependents Universal Coverage Scheme (30 Baht Scheme) The rest of the population
Healthcare system in the UK and the US Medical Tourism in Thailand Healthcare approach Health insurance Characteristic System Most common problem in healthcare service UK Public driven (tax based)—independent & public providers Universal Health Insurance Welfare state National Healthcare System (NHS) Long waiting list (access) Recent NHS reform, i.e. the introduction of market-style competition into the provision of healthcare; government defines a new role for patients US Private/ market driven Private Health Insurance individualistic A mixed system Price (affordability)
Sources: Blank and Burau (2004); Weitz (2004); World Health Organisation (2007)
Medical Tourism in Thailand Dimension US UK Citizen rights to healthcare? Negative rights Positive rights Individual relates to society? Individualistic Egalitarian Nature of system Mixed and fragmented: free market with governmental insurance for special vulnerable populations Centralised with a national health system Role of free market Very high Low but rising Payment for care Mixed: government through taxes, private insurance, out-of-pocket government through general taxes Extent health system publicly funded (2004) 44.7% 86.3% Universal coverage No Yes Ownership of facilities (hospitals, nursing homes, etc) Mixed: private for-profit, nonprofit, government Predominately government National policy on consumers involvement in healthcare system No: variable policies for different diseases, government jurisdictions, myriad of health insurance companies Yes: consumers involvement mandated
Medical Tourism in Thailand The Access to NHS (National Health Service)
A literature review on tourist motivations indicates that the push-pull theory is a useful approach to understand travel motivations to visit a particular destination of various traveler groups (You et al., 2000; Klenosky, 2002).
The push-pull theory has prevailed over other paradigms in investigating motivation underlying tourist and visitation behaviour (Dann, 1977, 1981; Crompton, 1979).
As the role of market raises the significant issue of identity , in terms of healthcare market, the identity of health service users is considered whether they are patients receiving services passively; consumers shaping and controlling the receipt of services; or citizens utilising their rights to free healthcare.
It is essential to explore how health service users have engaged with these identities as these words can be differently conceptualised due to different healthcare systems.
Medical Tourism in Thailand
Identity: patient, consumer, citizen (2) Medical Tourism in Thailand Identity Description Characteristic s consumer
A user of products and services in both public and private sectors (Needham, 2007)
People who are able to make their own decisions about the care they receive, express opinions about the care and perhaps evaluate the care (Henderson, 2002)
Ability to exercise choice , shape and control services they are about to buy
As a market and economic participant
Those who seek healthcare in an active role, and perhaps make their own decisions
Healthcare consumer-provider relationship
As a political actor in the public sector
People with particular health problems who may be taking medicines or receiving treatment (Hogg, 1999)
1. passive patients 2. patients who have low expectations of their physician 3. patients who behave as consumers , with expectations and ability to critically evaluate the quality of treatment received and ability to make changes (Baron-epel et al, 2001)
Stereotypical patient with passive role seeking and following physician advice
“ Medical care is uncertain and unpredictable ; many consumers do not desire it, do not know they need it, and cannot know in advance what it would cost them. They cannot learn from experience; they must rely on the supplier to tell them if they have been well served, and cannot return the service to the seller and have it repaired.”
(Hogg, 1999: 169)
Consumers are uncertain of their health status and need for healthcare in any particular time
A product uncertainty as consumers may not know the expected outcomes of treatments without their physicians’ advice
The consumers cannot test the product before using it
What are the significant motives that influence the decision of medical tourists from the UK and the US to travel toThailand?
How are these motives different with respect to age, nationality and gender?
How does Bangkok Pattaya Hospital (BPH) perceive the consumer motivation from these countries?
To what extent does BPH applied perceived consumer motivation to service provision for medical tourists? How is a healthcare provider’s service provision related to what motivates medical tourists to visit the hospital?
2. What are the major keys influencing consumer choices about provider and destination? Why does a medical tourist choose one destination over another?
3. To what extent do medical tourists take tourism component as a part in their decision making process?
Is medical tourism in Thailand about tourism? Is medical tourism likely to utilise the tourism component?
What is about the tourist part of medical tourism?
To what extent do medical tourists participate in tourism?
In search of the research subject (1) Number of foreign patients being serviced at Thai private hospitals JAN-DEC 2007 Medical Tourism in Thailand Source : Department of Export Promotion Oceania Australia 36,472 Newzealand 8,175 Others N/A Total 44,647 Middle East UAE 81,713 Oman 32,898 Kuwait 5,746 Bharain 3,013 Qatar 16,722 Yemen 2,440 Others 9,828 Total 70,647 South Asia Bangladesh 28,979 India 34,661 Pakistan 3,648 Srilanka 1,485 Maldieves 5,038 Others 7,191 Total 81,002 Country Number of foreign patients North America US 127,552 Canada 23,244 Total 150,796 Europe UK 109,179 Germany 43,879 France 35,453 Sweden 22,288 Others 46,769 Total 257,568 East Europe Russia 9,585 Others 2,161 Total 11,746 East Asia Japan 116,475 China 46,980 South Korea 27,181 Taiwan 5,127 Others 4,400 Total 200,163 ASEAN Cambodia 24,163 Burma 36,257 Vietnam 4,483 Indonesia 7,164 Philippines 12,527 Others 16,179 Total 100,773
Patients from the US and Europe constitute about 20 % of the total inflow of foreign patients with a higher proportion seeking for cosmetic surgery , hip and knee replacement and organ transplant to Thailand—the same is growing every year by around 40% for the US and 50% for Europe patients (Teh, 2007).