This research involves discovering what are the motivations and factors that influence customers on making decision for medical tourism service in the case of Thailand.

1. Paper Format for the Proceedings of 14th ISBITM Conference, Phuket, Thailand
Abstract - This research involves discovering what are the motivations and factors that influence customers on making decision for medical tourism service in the case of Thailand. Such entities are defined by combine factors that influence foreigners who having both health and tourism activities. A theoretical analysis and empirical research using competitive advantage of the nation theory together with hierarchy of medical need theory. The result shown that there are two different groups of medical tourist, medical focused tourist and tourism focused tourist. Medical focused tourists are those who come to the country with the major purpose of having necessary medical treatment, cosmetic surgery and others optimum choice of treatment such sex-transplant. However, they also taking their time during or after medical treatment to go on vacation too. Therefore, they focus mainly on factors associated with medical treatment and service such as cost, quality and reputation of hospital and physician. While tourism focused tourists are those who come for tourism and mostly having their health check, dental care and wellness treatment. This kind of tourist emphasize on those factors associated with tourism service such as attractive destination, the convenience of hotel and travel, entertainment and leisure place. Keywords– Medical tourism, Diamond Model I. INTRODUCTION The phenomenal fast growing market of Medical tourism business is respectively gaining more attention from both academics and business field. Medical tourism is a new types of services that integrates tourism business and medical services together. Also known as a multi- disciplinary service. The scope of services is very broad because it is the view of the international Perspective. The main point of medical tourism business is that people travel outside of their home country to another country for medical or health care services and tour in that country. [1]. The medical tourism market in 2006 is estimated at 20,000 million and increased to 35,000 million dollars in 2009 [2]. Thailand's on the top ranking of countries that have been popular over the world to come to medical tourism. Making it become a national major business that generates more than revenue for the country each year. More than 3 million foreigners came to receive medical services in hospital and other healthcare facilities in 2012, which generated approximately 70,000 million baht to the nation.[3] However, is not only Thailand that focus on the medical business but India, Singapore and Malaysia and many countries around the world also announced the clear policy to be medical center of the world.
Therefore in order to maintain in the strong position and gain such competitive advantage in the global arena. Thailand need to be aware of this intense competitive situation, retain existing strengths and create another competitive advantage over rivals. Moverover, Thailand must be prepared for the Asean Economic Community in 2015. with the market side over 580 million people which worth over 1-5 This integration is very beneficial to the medical tourism of Thailand, since the population of AEC is larger than 580 million people with more than 1.5 trillion USD. of international trade value. Besides, this market will play a greater role and gain more bargaining power in the world economy as well as the European Union [4]. Moreover, the medical tourism is also expected to be the main source of income to the country. The government aims to draw more than 2 million medical tourist into the nation each year, which will flow money into the country for over 4 hundred billion baht in 5 years. Such income can be divided into medical care services over 2.8 hundred billion baht, Wellness service 7.8 hundred billion baht, traditional medicine and alternative medicine 2.8 hundred billion baht, and herbal products over 4 hundred billion baht. Therefore, it is necessary to know the motivations and factors that influence customers on making decision for medical tourism service in Thailand in order to gain more competitive advantage and also continue to be leader in medical tourism of the world.
II. CONCEPTUAL FRAMEWORKAND LITERATURE REVIEW
Medical tourism means that people traveling abroad to receive medical treatment along with the holiday or that people took advantage of his/her medical vacation abroad [1]. It also refers to the process of "leaving home" for medical treatments and healthcare abroad or elsewhere in other country. In some cases, medical tourism include such relaxed holidays with a trip of medical treatment or healthcare in the selected country. [5]. Thus, it can assume that medical tourism is the situation that the travelers who travel to foreign countries to get medical service or healthcare and traveling together [1]. Therefore, the concept of medical tourism is a concept formed by two main theories, including theories of tourism and medical services. However, since this research is to determine the motivation and the factors that affect the decide on service of a medical tourism in
Motivation and Decision on Medical Tourism Service in Thailand
Nutworadee Kanittinsuttitong
College of Innovation Management,
Rajamangala University of Technology Rattanakosin, Nakhonpathom, Thailand
(natworadee@gmail.com)

2. Paper Format for the Proceedings of 14th ISBITM Conference, Phuket, Thailand
Thailand in order to gain the competitive advantages and compete in a global market. In this study, the researcher took the Diamond Model [6], which studied about competitive advantage of the nation as the main theory along with the other theories, as follows.
1) National Competitive Advantage
The theory argue that the competitiveness and success of companies in each industry which can brings the ability to compete to the nation depends on the efficiency of production factors which are labor, capital and natural resource. Thereby each country must compete by creating a business environment of the nation to gain the highest competitiveness. Although government agencies and private organizations have different roles, but it is relevant and work together to build strength to country. When applied national competitive advantage theory to the medical tourism business of Thailand, four coherence key elements can be identified as follows:
Fig. 1. Determinants of National Competitive Advantage
(1) Factor Condition, which can be consider as pulling factors. It consist of beautiful landscapes, warm climate suitable for physical rehabilitation, economic development with a low cost of living, politics relatively calm, the health law less restrictive than many countries, Being social and cultural services, people are friendly (2) Demand Condition which consider as push factors that make people travel to get medical services outside their home country along with tourism. It can be divided into two major part medical need and tourism need. Medical need consist of reputation of the hospital, the expertise of doctors and therapists, quality and medical standards, the speed of service, modern medical technology, wide range medical services and not illegal, affordable/cost-effective price, privacy, and excellent of care. Tourism part consist of famous and interesting destination, comfortable hotels, the availability of food, recreation facilities, and provide entertainment. (3) Related and supporting Industries consist of tour agency, hotel, airline, transportation, entertainment business, restaurant leisure business, embassy, and other related business. (4) Firm strategy, structure and rivalry consist of improvement of quality and medical standards , hiring medical professionals , providing fast service , focus on service excellence , providing value added services such as interpreters, visa extension , money exchange, offering special promotion / package, Advertising / publicity through various media, opening overseas branches, contracting business partnerships with international hospitals, insurance companies, foreign governments agencies, and co-market with partners such airlines, tour agencies.
2) Hierarchy of Health Care Needs
Review of the literature on Medical Tourism [7] proposed hierarchy of health care needs by using the theory of Maslow's hierarchy of need as a main theory. People who have different level of healthcare need will seek for different form and characteristic of healthcare providers. When analyzed hierarchy of healthcare need in conjunction with the medical tourism can be summarized and comprised of 4 level as follows.
Fig. 2. Hierarchy of Health Care Needs
(1) Basic Healthcare that is medical tourists who want basic medical care such as health checkups, dental care, immunization and preventive screening. Medical tourists who have the health needs at this level will focus primarily on tourism. For medical services, they seek for standard medical service, affordable price, specifically a promotion or special packages and they often choose those health provider that located in tourism area. (2) Medically-Necessary Treatment that is medical tourists who are required to obtain medical treatment. such treatment, surgery, treatment of various diseases. So, medical tourists with the healthcare needs at this level will mainly focus on medical treatment and other relating service. For the issue of tourism, they mostly will take a short trip nearby hospital or choose travel destinations that suitable for their recuperation. (3) Health enhancement that is medical tourist who need additional medical service. Whether to remove, to fill, to modify, or to surgery some of the body such as Lasik, cosmetic

3. surgery, lose weight, and sex reassignment surgery. Medical tourist who have healthcare need at this level will mainly consider the conditions of medical services, while they will arrange the tourism to be during or after receiving medical treatment. (4) Optimum Health that is medical tourist who have such fine health condition, but there is a need to maintain in good health or to be in a better health condition. Healthcare service that always chosen by this group of tourist are spa, massage, acupuncture, traditional medicine, detoxification, and holistic healthcare treatment. The focus of medical tourist who have healthcare need at this level is primarily for tourism and often use health care services that located in tourist areas.
3) Push-Pull factors in Tourism
This theory states that the factors that affect the rise of tourism consists of two main factors [8] First is push factors that makes people travel out of their home country even more. Which consist of a good economy of home country that make their purchasing power quite high, a society that value or infatuated in tourism, demographic changes such as smaller family size thus making it easier to travel together, the advancement of technology especially communication technology like internet, the country allow their citizens to travel aboard. Second is pull factors that attract tourists to come the destination country. Include good country image, beautiful landscaped, good transportation, no legal limitation, variety of service, low or affordable cost, peace and stability , and support by government's policy.
When apply this theory into medical tourism it can be imply as follows; (1) Push factors consist of long waiting time, high cost, unavailable or forbidden treatment such sex reassignment surgery, and lack of confidence. (2) Pull factors consist of country reputation in both tourism and medical service, variety of medical and tourism service, affordable/valuable cost
III. RESEARCH METHODOLOGY
The study of motivation and decision on medical tourism service in Thailand is a qualitative research using in-depth interviews as a tool to collect data. The research framework as figure 3.
Researchers have synthesized and integrated theory of the competitive advantage of the nation with hierarchy of healthcare need theory and tourism push-pull factors theory. And taken as a conceptual framework for this research by using competitive advantage of the nation factors in diamond model as independent variables which are factor condition, demand condition, related and supporting industry and firm strategy, structure and rivalry. And as the study found that medical tourists who have different level of healthcare needs will decided to use a different medical tourism service. Therefore, the researcher took the hierarchy of health care needs as mediator variable in the framework of this research.
Fig. 3. Research framework
Researchers have integrated push-pull factors in tourism theory with factor condition and demand condition of diamond as independent variable. Dependent variable in this research frame work are groups of medical tourists who are motivated and decided to use a different medical tourism. This study found that it can be divided into two groups (1) Medical focus tourist who come into Thailand to receive medical treatment as the main purpose. (2) Tourism focus tourist who come into Thailand to travel as the main purpose.
1) Sample, population and data collection
Population in this study are business owner, international marketing officers or other related position of healthcare providers and other related business that mainly focus in international market. The population can be divided into three groups (1) Private hospital which receive medical license from ministry of public health under the nursing act, 1998. (2) Clinic, cosmetic surgery, dental clinic, and specialized services such as, sex reassignment (3) Wellness institution such as spa house, holistic treatment providers, massage service providers.
Representative sample are international marketing officer who work in three group of healthcare providers above. In this study, researchers specialty select only those located in Bangkok, and main tourist area such Chaingmai, Pattaya, Samui Island, and Hua Hin.
The process of data collection of this research is as follows. (1) Information searching and list the name of international healthcare provider in target area. (2) Make a contact to hospital and other healthcare provider by phone and email. (3) Waiting for their reply. (4) Make an appointment with assigned authorities. (5) In-depth interview by using various tools such personal meeting, telephone interview, and emailing (6) Transcripts the interview (7) Compiled, analyzed and summarized.
Hierarchy of Health Need
Factor
Condition
Firm Strategy, Structure &Rivalry
Demand
Condition
Related & Support Industry
Medical
Focus
Tourism
Focus

4. 2) Research limitation
Concept limitation, this research focus only on medical tourist who come to Thailand and have both healthcare service and take a tour in our nation for a while and go back to their home country Therefore, it exclude those who are expatriate, retirement, and exchange student or officers. Scope limitation, this research aim to study of motivation and decision on medical tourism service which only limit in the nation of Thailand. 3) Research Tools
This research uses in-depth interviews as a research tool to collect data from international marketing officer of healthcare service providers in Thailand. Content of the interview was divided into two major components. First part are questions asking for his/her opinions toward factors and motivations that make foreigners come for medical tourism in Thailand and for his/her company. Second part are questions asking about organization strategy, structure, and marketing direction.
III. RESULTS
The synthesis and integration of three theory; (1) Competitive advantage of the nation theory (Diamond Model), (2) Hierarchy of healthcare need which adapt from Maslow's hierarchy of need theory, and (3) Push- Pull factors in tourism theory can be applied into medical tourism business. Thus the result of this study shown that motivation and decision of medical tourist depends on the major purpose of the journey, which can be divided into two groups (1) Medical focus tourist, who come for medical treatment as a main purpose. This group include those who are in the level of medically-necessary treatment and health-enhancement in hierarchy of healthcare needs. This medical tourist group will focus primarily on medical factors, including the speed of the service, reputation of the hospital, expert of physician and therapist, medical standards at the international level, modern medical technology, a wide range of medical services, available and legal medical treatment, the privacy of the service, excellent of care, and affordable/valuable price. Other factors that affect to the motivation and decision of this group are distance that not too far to be an obstacle, affordable travel price, climate that suitability for rehabilitation, Furthermore, having additional services such as interpreters, visa extension, money exchange will help facilitate and create quicker procedure for medical treatment. Coordination with the insurance company, home country hospital, were also key factors affecting the consideration of medical tourism services of this group. (2) Tourism focus tourist who come for tourism as a main purpose. This group include those who are in the level of basic healthcare and optimum health in hierarchy of healthcare needs. This medical tourist group will focus primarily on tourism factors, including good country image, famous and beautiful landscape, suitable weather, the convenience of a hotel, the availability foodservice, a place of recreation, entertainment service, affordable cost of travel and living, no political situation, The society and culture of service and hospitality.
IV. DISCUSSION
According to the literature review and the interview, there are issue to be concern. (1) Although Thailand is the leader of medical tourism in the world but there are only a few medical tourism agencies in the nation. (2) There are still gaps in medical tourism cluster that need to be fill-in such as transportation, interpreter, and food service provider. (3) Connection between medical providers and tourism providers not as good as it should. Thus the opportunity was lose in many cases.
V. CONCLUSION
The study found that medical tourists who come into Thailand can divided into two major groups, which are medical focus tourist and tourism focus tourist. The first group, medical focus tourist, mainly emphasize on medical treatment and other factors related to medical services while less focus on tourism factors. In contrast, tourism focus tourist, mainly pay attention on tourism factors while less focus on medical or healthcare factors. This findings will enable healthcare providers, a travel service provider and other related businesses as well as government agencies to formulate the policy, set marketing plan, and operational plans in effectively satisfy the needs of each medical tourist group
ACKNOWLEDGMENT
I am greatly grateful and thankful to Assoc.Prof. Dr. TatreJantarakolica, Dr. Kobkul Jantarakolica, and Miss Jutamas Wongkantarakorn. for providing advice and guidance in this research. Moreover I would like to thank you all of the respondents for the kindly cooperation in answering all questions. Nevertheless, I cannot complete this paper without the scholarship from Rajamangala University of technology Srivijaya
REFERENCES
[1] E. Cohen, Medical Tourism in Thailand, AU-GSB e- journal, 2008; 1(1) page 24-37
[2] The Tourism Authority of Thailand, project study to increase the market potential for groups of medical tourist, 2012
[3] Office for National Statistics, Survey of private hospitals and nursing homes, 2012, the Ministry of Information and Communications, 2013
[4] SCB, Insights impact on private hospital business.,
Economic Intelligence Center, Journal, February, 2011, page 18-22
[5] Deloitte Center for Health Solutions, Medical Tourism ; Consumer in Search of Value, 2008
[6] M. Porter, The Competitive Advantage of Nations, Harvard Business Review, 1990
[7] P. Carrera and R.Vivien, Why do patients engage in medical tourism ?, Maturitas Journal, page 73, 2012
[8] D. Weaver and M. Oppermann, Tourism Management, John Wiley & Sons., publishers, Milton, Brisbane, 2000