Tourism, combined with the phrase medical, seems to be a new form of tourism which has gained huge popularity in recent decades. Though, a number of literatures available with regard to the tourism industry and the competitiveness of the destination, however, the major aspects which determine the satisfaction of medical tourists are hardly focused specifically on Malaysia. There is a lack of empirical evidence in this area of study which needs to be bridged. Hence, this study aimed at investigating the various factors contributing towards the development of medical tourism in Malaysia.
As the purpose of the research was to find out various factors contributing towards the development of medical tourism in Malaysia, so this study used Structural Equation modeling (SEM) for data analysis. The target population for this study consisted of the medical tourists coming to Malaysia with the primary intension of seeking medical procedures other than sightseeing. A total sample size of 266 was collected through non-probability judgment sampling during the period between December 2012 and February 2013.
The result confirms that destination competitiveness and service quality play an important role in the medical tourist’s mind towards medical tourism aspect in Malaysia. Thus, Malaysia need to promote various medical success stories together with the services they offer to attract more foreign patients.
This study contributes to the theoretical development in the tourism industry by offering the structured relationship among various aspects contributing towards the development of medical tourism in Malaysia.
Keywords: Medical tourism, Destination competitiveness, Service quality, Customer service
Venturing abroad for medical care is not a new occurrence for the elites of developed countries. For this social group, the usage of medical care offshore is part of a standard design of intake of foreign goods and services, which in turn possibly cannot be observed. It has been promoted by many countries around the world owing to the fact that the idea produces these countries many benefits. Consequently, medical tourism is not just practical but also the economic approach for people to savor their vacation and obtain medical cure within the very same time. Tourism, combined with the phrase medical, seems to be a new form of tourism which has gained huge popularity in recent decades (1). This is due to multiple reasons such as; the increased demand for better healthcare (2), rising healthcare costs in the US and many Europe countries (3) and the tough visa regulations imposed by the US and many European countries due to the 9/11 incident (4). Hence, many countries around the world have started promoting medical tourism to gain from this emerging market (1).
Among the medical tourism providers, Asian countries such as Singapore, Thailand, Hong Kong, Malaysia, the Philippines and India are viewed being probably the most likely places for producing medical tourism due to their natural recourses and excellent quality service together with reduced price (5). Due to the very low labor expense in these Asian countries, customers are able to save up to 40 to 60 percent comparing to US or Western European countries (6).
Nonetheless, the overall hospitality industry is under severe pressure due to huge competitive market (7). The author further added that, to remain competitive, focusing on customer’s satisfaction has become very important as they are core for their business success. Being part of the overall hospitality industry, medical tourism sector also requires special focus on their customers for future sustainability. Though, there is relevant literature available with regard to the tourism industry and the competitiveness of the destination, however, the major aspects which determine the satisfaction of medical tourists are hardly focused specifically on Malaysia. Thus, there is a lack of empirical evidence in this area of study which needs to be bridged. Hence, this study aimed at investigating the various factors contributing towards the development of medical tourism in Malaysia.
There is no agreed definition of the term “destination”. Hence, the task of defining and explaining what actually composes a destination is quite difficult to succinctly describe. International Association of Scientific Experts in Tourism (AIEST) proposes that, “a destination is a travel objective which the consumer wishes to visit because of certain attractions it offers. These can be natural or manmade; existing before tourism or created for the tourist” (8). Seaton and Bennett supported a different perspective of the concept. They defined it as “the catalyst link that precipitates all other industries in the tourism sector” (9). Destinations are composed of a series of values, tangibles and intangibles, in a complex system of resources (10). According to Carter and Fabricius “Destination is a physical location where the tourist spends at least one night. It contains tourist attractions, products, and related services that are necessary to meet the stay of a tourist in the place at least for one day” (11). WTO stated that, destinations are composed of specific characteristics that attract visitors because of their “factual or perceived attractiveness” (12).
The promotion of destination is widely discussed in academic literature (13–15). Moreover, special emphasis has put on the destination promotion by various National Tourism Organizations (NTO) (16–18). Furthermore, an evaluation of its effectiveness has been held by many authors (19–21). Many studies; either explicitly or implicitly, examined the influence of marketing efforts of different NTOs on the choice of destination made by tourists. For example, Webster modeled the promotional efforts of NTOs through the presence of the major size of NTO’s offices abroad (22). Lim pointed out that the marketing expenditures as one of the major explanatory variables in the growth of tourism (23), and Webster and Ivanov have assessed the effectiveness of the promotion through the number of travel tourism fairs (21). In addition, due to the tremendous development in information and communication technology (ICT), information regarding the medical procedures is now readily available and easily accessible. Moreover, various promotional campaigns through internet by the hospitals have boosted the confidence of the foreign patients as they can get their needed information much easier and faster. Internet also enabled significant cost savings for both the patients and the hospitals (24). Moreover, increasing promotional campaigns by the governments and the efforts of travel agencies related to medical tourism has significantly boosted the demand for medical tourism worldwide (25).
There is also an enormous influence of marketing behind the new trends of medical tourism in Malaysia. Realizing its tremendous potential and its enormous economic benefits, the Government has and is still actively promoting medical tourism to various countries to induce foreign patients to seek medical treatment in Malaysia, all in the aim to make Malaysia a medical tourism hub in the region. Adding to this, the Malaysian government has also launched its official website (www.medicaltourism.com.my) to promote medical tourism through the internet. Moreover, to expedite medical tourism, the Malaysia Healthcare Travel Council (MHTC) was officially launched on 21 December 2009 with the purpose of restructuring the healthcare sector to attract more foreign patients (26). In addition, various promotional activities were held in different countries to boost the country image for Malaysia by various authorities (e.g. Ministry of Health, Ministry of Tourism, Association of Private Hospitals of Malaysia, Malaysian Association of Tours and Travel Agencies, Malaysia Airlines, and Malaysian External Trade Development Corporation) (27). Due to these extreme efforts, Malaysia has gained much popularity as a medical tourism destination in recent years.
H1: There is a significant relationship between destination image and medical tourism in Malaysia.
In this rapidly growing consumer-oriented health industry, quality has become the integral part. Without providing quality services, no business can survive. Bookman and Bookman stated that people from rich countries are traveling to less developed countries because of less expensive but high quality medical care (28). Quality is a very important concern for patients while planning to get treatment.
Grönroos focused on two major components of the service quality in the healthcare sector: one is technical or mechanical quality and the other is serviceable or functional quality (29). In the healthcare industry, technical equipment and other related medical diagnoses systems is core for patients’ checkup for their treatment. Functional quality measured by the service offered by the healthcare centers such as services of staffs, nurses, administrations and most importantly the doctors towards the patient and their assistants are of vital importance. It has been found, from different healthcare research, that patients mostly give priority to the functional quality rather than the technical quality though the technical quality may not be satisfactory (30). However, for the medical patient, the technical quality should be a prime object because the proper treatment of patients largely depends upon the proper diagnoses of the diseases through up-to-date equipment.
Thus, delivering quality services to the customers is a must in order to attract more foreign patients (31, 32). Lam found in his study that many patients could differentiate the performance in caring and curing that are provided by the medical center service providers (33). Thus, the personnel support service are expected to be approachable, dependable, gracious, sincere and capable by the customers. Kiran also found in his study that the staff perceives quality as the core for customer satisfaction (34). Co-operative and helpful staffs will be able to instill confidence among the customer of the industry. Staffs have to provide error free recording for the patients.
There are a number of hospitals subsist in Malaysia which provide quality care with an affordable price. Moreover, competitive offerings are creating a center of attention for the customers not only from within the country but also from abroad. As the quality is a fundamental issue in medical tourism, the Malaysian government has also emphasized on improving the overall healthcare quality for both public and private hospitals with an aim to attract more medical tourists (35). Moreover, Malaysian government also encourages both private and public hospitals to acquire Malaysia Society for Quality in Health (MSQH) accreditation and quality (ISO 9000, 9002) certification with the purpose of meeting international standards (36, 37).
H2: There is a significant relationship between service quality and medical tourism in Malaysia.
Medical tourism, a consumer-driven pattern (38) involves service sectors that posits itself as the low-cost, high-quality and comfortable access medical option for people around the world (39). On account of these kinds of qualities, this kind of new service industry provides obtained international attention, impressive to a lot of patients for considering it as a probable substitute. As establishing nations around the world positively promote tourism, heavy investment goes into replacing their healthcare system. For that reason, the quality of healthcare in the country can be enhanced and a nearby people, who constitute the mass of the individuals, find benefitted. Nevertheless, this investment and the particular demand inspired by the foreign patients’ position the particular risk of increased healthcare price and overlooked needs of the neighborhood residents, hence indicating pejorative to the healthcare system of the actual vacation spot countries (40).
With a option of nations around the world similar to Costa Rica, Brazil, Indian, Thailand, Singapore, Malaysia, Taiwan and a lot more, patients stay in order to consider their own options and choose a vacation spot for the healthcare requirements. Hence, customer service became very important where patients may draw a line between their choices among the available options. This becomes very important for patients that affect their choice of nation, medical facility and the doctor. However, healthcare is actually a very individual and critical service (41) and a whole lot of deliberation needs to be exercised in the particular decision of turning to medical vacation. Healthcare is actually an area where the end result of the actual service will be shared between the service provider and the particular patient. Hence, the proper allocation of time toward the patients should be consistent in terms of service. Therefore, individual focus should be given to customers. A certain amount of time should be provided to the customers for their proper treatment (42).
It is additionally a great emotionally depleting knowledge, more so in times when the actual healthcare intervention sought is a bit more complicated. A patient’s behavior, cognitive and emotive factors influence the actual readiness in order to co-create (43). As a result, achieving a profitable result can be simply achievable when the patient feels safe in the encompassing, and will be in handle of his emotions. Thus, relying on medical tourist is a subjective decision that is determined by mental and mental factors how the patient is encountering back then of decision making.
In line with the current trend of this customer oriented healthcare industry, Malaysian hospitals also emphasizes on the customer services in order to attract more medical tourists. Besides, to ensure sufficient accommodation for this rising number of medical tourists, Malaysian government has aimed to source an additional RM 335 million from the private sector hospitals in upgrading their infrastructures (e.g. increasing the number of beds) (44).
H3: There is a significant relationship between customer service and medical tourism in Malaysia.