Using quantitative research we have tried to figure how each coefficient is helping respondent to reach its destination caring all the factors and its influences

1. 1
Table of Contents
Abstract:............................................................................................................................................2
Introduction .......................................................................................................................................3
Contribution:......................................................................................................................................4
Literature Review:..............................................................................................................................5
Theory:..........................................................................................................................................5
Supply chain:..................................................................................................................................6
Model Development:.......................................................................................................................6
Agency services:.............................................................................................................................7
Methodology:...................................................................................................................................10
Research approach and paradigm:.................................................................................................10
Population and sampling:..............................................................................................................10
Data analysis techniques:..............................................................................................................10
Result:.............................................................................................................................................11
Model..........................................................................................................................................17
Conclusion:......................................................................................................................................18

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Abstract:
Medical tourism is a concept of these days considered as a tourism practices. Even there is no
international consent on the definition and dimension of this trend. One of the principle groups for
medical treatment they take part directly into journey from one country to another. Medical tourism
is often called as medical travel because it added the journey from one destination to target
destination. By studying the scientific literature we find new medical tourism trends in connection
with globalization and liberalization. Now in this modern world everything has becomes so easier
than used to before depending on the requirement of the patient they preferred different destination
for treatment. To make this thing happen there are few dimension to which influences or assist to
choose destination like cost, quality ,migration papers works and the related variables which play
roles each and every stage to accomplish the journey and get a successful output. Keeping
destination as a constant variable we tried to find out which areas of variables and sub variables
directly and indirectly affect main one at the time interrelationship with each other. Using
quantitative research we have tried to figure how each coefficient is helping respondent to reach
its destination caring all the factors and its influences. This study aims to notice the actual behavior
of respondents and their demand either meets with the needed following an experiment and
structured method where every particle is talked to get a finding regarding medical tourism
concept.

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Introduction
Medical tourism refers to anyone who travels across international borders for the purpose of
receiving medical care. In the past, this usually referred to those who travelled from less-developed
countries to developed countries for treatment unavailable at home, or if service quality is poor at
home. However, in recent years it equally refers to those from developed countries who travel to
developing countries for lower-priced, or specialized medical treatments. The motivation may be
also for medical services unavailable or non-licensed in the home country.
According to Patients Beyond Borders, medical tourism market size is USD 65-87.5 billion, based
on approximately 20-24 million cross-border patients worldwide spending an average of USD
$3410 per visit, including medically-related costs, cross-border and local transport, inpatient stay
and accommodations. The number of medical tourists to all countries in 2017 was estimated at 14-
16 million. The value of the entire medical tourist business per year is approximately $439 billion.
In addition, medical tourism is growing due to population aging and becoming more affluent at
rates. In addition, out-of-pocket medical costs of critical and elective procedures continue to rise,
while nations offering universal care are faced with ever-increasing resource burdens. These
drivers are forcing patients to pursue cross-border healthcare options either to save money or to
avoid long waits for treatment. The worldwide medical tourism market is estimated to be growing
at a rate of 15-25%, with inbound patient flows highest in Mexico, Southeast and South Asia.
Lots of research work has been done on medical tourism to find driving factors for medical
tourism. Two major driving factors of medical tourism are destination preference and cost factors.
People around the world choose to go to specific places for specific treatments. Places that are
famous for a particular treatment usually see a concentration of patients for that particular
treatment or area of treatment. For example, Singapore has seen a large increase in patients who
have had heart problems or heart related diseases. Chennai has been seen to be famous for skin
disease related issues. Cost has been a huge factor too. Research shows, travelers can save up to
90% of money for travelling abroad for medical Purposes. Countries like India and Thailand have
risen rapidly over the last few years due to their affordability. Places like Malaysia and Turkey are
also gaining popularity in medical tourism.

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Medical tourism is soon to be a 100 Billion Dollar a year industry. It is soon becoming one of the
modern phenomenon of the world. Although medical tourism is extremely important, not much
has been done in terms of research. Most of publications are medical journals, articles, case
studies, perspective of medical providers, published presentations and results of seminars or
conferences organized by medical tourism associations. There are also several books which trait
the theory of this niche tourism, but we still need more scientific contributions such as
statistical, strategies and economic impact measurements. Our research attempts to dive into this
industry to find some facts about the medical tourism industry. We have tried to identify the two
major factors of this industry: destination preference, and cost. The research question we have tried
to answer is: What are the reasons a traveler chooses a particular destination over some other
destinations?
Contribution:
 TheoreticalContribution
For manager, contribution of research findings is a big part of success in any stage. The main
purpose of research is to inform action, to prove a theory, and contribute to developing knowledge
in a field or study.
A we have seen that, so many paper already has been published on medical tourism. They have
tried to prove so many variables with using inter related communication. From earlier day’s
Managers also has been taken help from medical tourism research findings.
From our research findings demonstrated that medical service affordability, availability, Medical
quality and advanced technology has positive influences on customer satisfaction that followed by
medical service quality such as the professionalism of the medical practitioners.
This study will be concluding important contributions to both research and practice. It has
contributed to the body of knowledge by enhancing the understanding of the relationships and
factors that drive customer satisfaction in the medical tourism industry in their destination
preference. Some situations where a manager eagerly needed findings of research:
 The first thing is the ability to connect the firm’s strategic goals with the individual
performance of employees.

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 This impacted on the second area, which was the ability to create clearly defined and
achievable goals.
 In third place will be the firm’s management’s ability to deal with failure.
 Fourth place will be to take corrective action against underperformance.
The most interactive forces those are influenced Destination Preference of medical tourist is the
affordability of a person, followed by other service as well as some variables which are availability,
privacy, better quality, quicker access.
There are some variables which are directly affecting the main destination preference.
V1. Affordability, in terms of cost is directly affecting or influencing to choose the destination
preference.
V2. Availability of doctors or treatments is also affecting the destination preference.
V3. Now a days Advanced technology is the main priority for choosing the destination, cause
customer wants better quality treatment in a cheap rate so that also influencing to choose the
destination.
LiteratureReview:
This is about the plan for getting information, ideas, data and evidence from research for any
topic.
Theory:
Social exchange:
This theory talks about whenever we receive something or some value from someone it is
customary that we return the same value or show the same benefit to the person we are getting. .
This is just a give and take relation. This theory involved between the times of the treatment when
most patient passes time in particular place for treatment. For calculating this we need to analyze
cost and benefit. We can relate this theory with our research for getting the research about the
patents relation, communication, financial and non-financial factors. In detail what they actually

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get from their cost for the treatment. We can explain this theory by the cross sectional study of the
experiences of medical travelers, Whichshowsthe studyof satisfactionlevelfor International Patients
and to compare the cost of the treatment in Chennai with foreign countries.
Citations:
(Beena and Venkatrama Raju 2018)
(Beena and Venkatrama Raju 2019)
(Chakraborty and Poddar 2018)
Supply chain:
My variable supply chain related with the particular theory because none of them will help us
unless some sort of collaboration. They will provide us their services if we full fill their
demands. Simply stated, an agency relationship is one in which there is a contractual relationship
agent to take action on behalf of the principal.
We can anticipate that all of the things under supply chain practice information; co-operation
cost is helping them to choose the destination.
Citations:
(Cohen 2010)
(Abubakar and Ilkan 2016)
Perceptions:
This theory can easily apply for our research topic and it will create inter relation among the
variables like destination, employees, facilities.
Model Development:
Sometime we call it hypotheses development. Let’s see the other service related variables
Service Related:

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Travel Agency is the most popular choice if it comes to visit for the 1st time and people are not
aware of the other country so most of the the they prefer different travel agency, Online Agents
Insurance Companies also come in front for their support and give their customer all the trust and
motivation for the best destination preference.
Citation:
(Mohamad 2016)
(Fetscherin and Stephano 2016)
Anticipation & Consequence:
The performance of getting introduction of travel agency are highly influential in terms of
preferring a particular destination, the way you are going may not for only for medical purposes
it may be for luxury holiday packages but people may enjoy it more for using medical tourism
purposes, it is found in many papers for example,
Citations:
(Turner 2010)
(Mohamad 2016)
(Chakraborty and Poddar 2018)
Agency services:
With the most of services, tour access for Bangladeshi travelers became straight forward and
effortless over the time. Because for going on some country that don’t have Embassy or High
Commission like Cambodia in Bangladesh, Bangladeshi travelers had to apply for visa at the
nearest Cambodian embassies in India or Thailand. Like this many agency work with in some
indirect way to do the job, for example a travel agency “Arnim Holidays Bangladesh give their
medical tourism support in Vibharam Hospital, Vibhavadi Hospital, Kamol Hospital,Synphaet
Hospital, and Bangkok Smile Dental etc.
Agency example https://www.obokash.com/
https://www.ticketshala.com/

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Citation:
(Ross et al. 2018)
(Nikitina 2018)
Anticipate: We can assume as normal people who are going only for holiday or business without
any hustle and they have a great tour by these agency supports so that people who will go for
medical purpose can go by travel agency too.
Diagram:

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Other service
Travel Agency, Online
Agents
Employees
Insurance Companies
Affordability
Availability
Opportunity to
Vacation
Privacy &
Anonymity
Advanced
Technology
Better Quality
Quicker access
Medical facilities
Supply Hotel &
resources
 Invasive
 Diagnostic
 Lifestyle
Destination
Supply chain
Practices
Collaboration
Co-operation
Co-ordination
Information Sharing
Trust
Commitment
Mutual
Financial
Non-financial

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Methodology:
Research approach and paradigm:
The selection of appropriate research approach and paradigm is dependent on the context of
research and the study question. We haven’t choose quantitative analysis because sample variation
need more
Population and sampling:
We tried to do an exploratory research and have taken 24 interview of our target sample. It is a
qualitative research .our target sample profession was mostly teachers of north south university
and general people as well. And they have visited foreign countries for medical purposes. It was
established that a sample of 24 sample and its findings and information which is adequate and
meaningful to meet our purposes of research demands. The opinions of participants were obtained
regarding benefits of medical tourism. It is a very good sample because of repetition of variable
which is called saturators.
Data analysis techniques:
In this study each responder is a unit of analysis and considered as a case, the responses of
interviewees were recorded on audio devices and saved into a repository that was used for making
transcription. In the second step the coding scheme was developed to capture the relevant text
regarding the use of medical purpose .based on the codes major theme were developed they were
rechecked and ensure coherency and named later regarding in a thematic framework
The discussion about medical tourism in the context to interviews conducted from interviewees
revealed in
Code:
We have done codedonthe basisof model andthe respondentsharedexperiencedincludinggender
age whichclearlyidentifiedthe propertiesof respondentanda collectionof all relationshipInasingle
table.

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Result:
From the findings of the respondent we have developed this theme which
proved that particular variables are interconnected to each other at the same
time they influence to make decision about our principle variable destination
preference
Theme 1:
Formedical tourismDestination preference is the principlevariable
It is evident from the interview responses that, destination preference is the focused variable under
which many sub variables and influencing variables are interconnected to each other .the view
point is as follows
Actually, Chennai used to be called Madras. Chennai always had best treatment [destination] at
cheap quality. [Affordability] So, for us who cannot travel to Singapore or other places due to cost
factors,[destination] choose Chennai.[001] (male –age-26)code001
It is important because of the fact that under destination preference factors like. Affordability,
quality of doctors, hospital services and advanced technology is included as sub variables
Other interviewees said,
No 1. It is very close to our country. No 2. It is easier to get VISA. No 3. Cost is very similar to
Bangladesh. [Cost affordability] It is not costly as other countries as like as [destination preference]
Singapore which is very expensive. And I think Bangkok’s doctors don’t give unnecessary
treatment as like antibiotic and other medicine.[Medical facility] They took that test which is
necessary. Based on what I mean, they give suggestions. Code001
From another script we have found,

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Absolutely if you don’t trust your doctor you don’t go to that hospital or doctor. [Affordability,
availability, opportunity, vacation, privacy, better technology, trust, commitment] {Male, age-26}
code001
Affordability of cost medical facility and better quality of the doctor’s efficiency choosing on
destination
Theme: 2
Medical facilityis a vital objective fordestinationpreference:
The result of relationship between variables are very connected to each other’s on choosing
destination preference .we found from the interview that medical facility is an important reason
which influence greatly on destination preference. For example from,
“Mainly I choose there because of their treatment quality and also it is really cheaper than
Singapore and Thailand” [male, age-31] code-006
Another respondent explain that,
They have state of the-art equipment’s. They have got everything. They have different
equipment’s. Which is technologically advanced? [Advanced Technology] My mom was a
Muslim, so for her privacy is very important. If you compare with Bangladesh, it was top-class.
The nurses would treat you as your parents, if you are an elderly. Or like children, if you are young.
The process was really smooth. Any time we wanted medicine, or other information, they were
very helpful.[Quality of staffs services] My mother at the end was in ventilation, then ICU. They
were always very helpful. The negative thing is, it is very expensive. The last time when we were
there, we were only there for one and a half days, and we were charged 65 thousand dollars. [Co-
operative co-operation, collaborative][Female, age-29] code 006
From this result it can be proved that in terms of medical facility advanced technology, quality of
staff service, cooperative, cooperation, collaborative are directly interconnected to each other
which influences on medical facility to choose destination preference

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From the respondent point of view, these sub variables are very influencing to medical facility.
Where they claim that if these requirements doesn’t fulfill there is no question to choose that
particular service.
Theme3:
Travel agency isa way of accomplishingthejourneyin an easier way:
Travel agency is a major variable in our region people love to take the help of travel agency to
move from one place to another. From getting visa to all required things done by the travel agency.
Like, yes we do. Coz we are all busy. We take help from Sky Travel. [Travel agency] They have
been here since 1997. They shifted to Bashundhara recently, which became more convenient. They
have all our information. We have been using them for 7 years. So, they are basically our resident
travel agents. [female-age-26] code000
Yes, I was helped by a travel agency which is located at Ghulsan.[travel agency] I have a uncle,
Hisab Uddin who worked there, helped me a lot for VISA and ticket purpose and suggested me
the best which is easier[easy access] to me[male,age-25]code000
Yes I have a travel agent, TBBD (Travel Booking Bangladesh). [Travel agency]It is physically
presented not online agent, located at Banani. It is formed by Tasreef vai who is an alumni of North
South University. So we always traveled by his agency.code000
From this we can easily understand that, travel agency plays a vital role to make the journey
confirm and make sure it is safe because they have that sort of potential to do the task like 90% of
the respondent take the advantage of travel agency.In terms of the destination preference .It has
inter -relationship with destination preference directly according to the view point of the
respondent
Theme 4
Doctor’s qualityismajor significantvariableformedical treatment:

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Most of the cases in qualitative interview it has been seen that due the doctors quality people get
biased and also which directly links to the hospital services. Respondent always focused on the
treatment quality where its doctor’s quality under medical facilities works as an influencing one
to choose destination preference.
Extremely specialist. [Doctors quality]I have thyroid issues and initially saw doctor. After their
treatment I have no issues. It was very experienced [female, age-33] code006
Another respondents says,
Most doctors we saw studied in US. And most of them have 10 years of experience. Another thing
you'll notice is, even Americans visit Singapore for medical purposes as they are very good.
[Specialized Doctor][Male, age-31] code006
Yes, there are lots of specialist doctors.[doctors quality] I appointed the best Konia specialist
doctor Milan Lokkhipati. I was sugared by her. My 5-10 % Kornia was damaged and the sugary
was successful [doctor quality] .[male,age-25]code006
From this discussion we can realize that doctors quality directly respondent influencing to choose
destination preference, hence with medical facility there is inter relationship to doctor’s quality
Theme 5
Supplychainpractices astools to success a medical tour entire journey:
Supply chain is part where the entire journey get support following the element of supply chain
how fast and efficiently they managed to done the works done like collaboration, co-operation ,co-
ordination ,information sharing ,mutual understanding like the respondent mentioned in the
interview
Nurses' behavior was very good. Their service is very good. But they had a communication gap.
They usually speak in their language. So my mom understands English. But she doesn’t know their
language. Even though they tried to make us understand with sign languages and did a good job.

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However, in case of Mount Elizabeth, they had Bangla recording in the room, giving instructions.
[Quality of staff’s services] [Collaboration] [Co-operation] [female-age-29] code002
Due to the information sharing between doctors and staff it made them too easy to do the operation
quickly and in a comfortable manner ,sometime because of this lacking of this it might cause fail
to achieve goal so its plays a very important role
The collaboration, coordination, cooperation between me and the staves was very good. I was very
afraid about that. But they suggested me that they were very free so I can share [collaboration,
coordination, cooperation] anything to them [male, age-25] code002
There is an internal relationship between information sharing and co-operation ,co-ordination
which gives a support all the stakeholders to make the things done .Mutual understanding, trust
,commitment also influences this variable without this the entire journey can’t be successfully
done
Theme 6
Costaffordabilityfactorsdirectlyinfluencethe destinationpreference:
Due to the cost factor respondent always has picked the destination variation like in order to choose
Australia, USA they have chosen like India, Bangkok Singapore
Respondent held the followings view about the cost affordability and comparing with others
option,
Affordability yes. Definitely now if you ask me, I'll choose India over Thailand. I choose Thailand
over Singapore then, due to cost. [Male, age-26] code004
Because, I suffered Keratoconus disease. And this disease treatment is good in Chennai. B

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angladeshi doctor suggested me to go Chennai for this medical purpose. They suggested me that
Chennai will be the best decision for this treatment. And the cost of Singapore is very high] what’s
why I went to Chennai [Male, age-26] code004
Because at that time I wasn't aware whether India was good at this. Reason for choosing Thailand.
I did some research and a friend of mine told me that “Bamurnath Hospital” was pretty good for
this surgery. I went there, but their price was little high. So we went Bangkok General Hospital, I
think. But they were charging even higher. So I went back to “Bamurnath Hospital”, since it had
a good reputation too.[Male ,age-26]code004
This is how described by the respondent and explained the inter relationship with cost affordability
which directly linked to influence destination preference.
Theme 7
Advancedtechnologytakes control ofrespondent destinationchoosingbehavior
Advanced technology of the particular hospital relative to medical equipped has always been a
sensitive felling to make sure they are heading to that particular hospital. There are few views of
the respondent regarding advanced technology stated below,
Availability, we don't know. We don't know if the doctors are available. But yes, service plays a
part. I did not choose Bangladesh, because we have a track record of messing up surgeries. I did
not want to take that chance. Quality of doctors, nurses, they all play a part when you are making
such a huge decision. Honestly now, everyone will prefer India over Thailand. Firstly because it's
affordable. Secondly, better quality of doctors. Technology also always matters. We all want better
equipment’s [male, age-26] code005
In this case we can observe technology has interrelationship with better equipment’s, affordability
and also better doctor’s quality.
I talked you an example about B scan. [Technological] This scan can identify the position of your
Konia. At that time this scanner was not in Bangladesh. And after that scan I am suggested to go
for surgery [Male, age-25] code005

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Model
Other service
Travel Agency, Online
Agents
Employees
Insurance Companies
Affordability
Availability
Opportunity to
Vacation
Privacy &
Anonymity
Advanced
Technology
Better Quality
Quicker access
Medical facilities
Supply Hotel &
resources
 Invasive
 Diagnostic
 Lifestyle
Destinatio
n
Supply chain
Practices
Collaboration
Co-operation
Co-ordination
Information Sharing
Trust
Commitment
Mutual
Financial
Non-financial

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Conclusion:
Medical tourism is an opportunity for developing countries that should take advantage of
the favorable international context and invest in creating and promoting a competitive medical
touristic offer. This quantitative research explain the behavior of the medical patient while
choosing any destination how they think and by overcoming all situation they come to their goal
and take services from the particular hospital. Before taking all the necessary step they focus on
their preference and flexibility it describe some variables like financial, technical, moving rules
and regulation and many other dimension included in the papers according to model they consider
those thing positively and negatively on the whole it affect to choose destination preference.
1. The AmericanJournal of Medicine. MedicalTourists:Incoming and Outgoing. JamesEDalen,JosephS
Alpert. https://www.amjmed.com/article/S0002-9343(18)30620-X/fulltext
2. Patients Beyond Borders. Medical TourismStatistics & Facts.
https://patientsbeyondborders.com/medical-tourism-statistics-facts
3. Tigu, Gabriela;Larisa,Florente. Medicaltourismmarkettrends-an exploratory research.
https://www.researchgate.net/publication/319328898_Medical_tourism_market_trends-
an_exploratory_research
Appendix:

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