Mainland Chinese Tourists Perception of Medical Tourism in Thailand

Transcription

1 Research Journal of Social Sciences (2): 8-13 ISSN: EISSN: Journal home page: RSEARCH ARTICLE Mainland Chinese Tourists Perception of Medical Tourism in Thailand 1 He Ye and 2 IlianAssenov 1,2 Faculty of Hospitality and Tourism, Prince of Songkla University, 80 Moo 1, Vichitsongkram Rd.Phuket Address For Correspondence: He Ye, Faculty of Hospitality and Tourism, Prince of Songkla University, 80 Moo 1, Vichitsongkram Rd. Phuket Received 12 June 2016; Accepted 25 September 2017; Published Online 10 October 2017 A B S T R A C T Medical tourism a combination of medical service and traveling - has developed rapidly in recent years. The development of medical tourism has not only brought the vigorous development of the tourism industry, but also promoted and improved the medical technology and service in host countries. Thailand as a world famous tourism destination is actively building its "Asian Health Tourism Center" international medical tourism brand. In 2016, Thailand attracted about 12.2 million Chinese tourists, making China the largest tourist source market for Thailand. In 2017, the Thai government launched a visa-free policy for Chinese residents for entry into Thailand for medical treatment to attract more Chinese tourists for medical tourism services industry. The purpose of this research is to explore mainland Chinese tourists perception of medical tourism in Thailand. This research adopted mixed methods approach.200questionnaires were collected from mainland Chinese tourists in Phuket and Bangkok, Thailand. Interviews were conducted with hospitals and a medical traveling agency and observations conducted on hospital websites. The results indicated that the majority mainland Chinese tourists were interested in medical tourism in Thailand. The most significant and important factors influencing respondents decision making included accreditation, quality of treatment, excellent doctors skills and accessible language communication. Key words: Medical tourism, medical tourists, decision-making process, medical service suppliers, medical tourism in Thailand, Chinese medical tourists INTRODUCTION With the rapid development of an economy, the living standards of people can improve significantly. People pay more attention on their living quality and health status. A new trend has emerged that can be called well-being. This word can be explained as a contented state of being happy and healthy and prosperous. Thus, the purpose of traveling is not only for vacation but also combined with medical service. This kind of new trend is widely called medical tourism. Medical tourism is identified by Turner [1] as a movement of patients across borders and culture in order to get healthcare. In recent years, the medical tourism industry has developed rapidly all over the world. According to the report of Asian Medical Tourism Outlook in 2015, the Asia medical tourism market consists of 6 countries including Thailand. The medical tourism industry is becoming accepted by more and more mainland Chinese people. Traveling to South Korea to do plastic surgery, going to Switzerland for sheep placenta extract injection for anti-aging, getting cancer prevention check-ups in Japan and other medical tourism products have become the main promotion tourism programs for some outbound travel agencies. Thailand has launched a visa-free policy for Chinese residents for entry into Thailand for medical treatment in order to attract more Chinese tourists for the medical tourism services industry. The annual number of medical tourists in 2016 was five times higher than during the previous year, with the average price of a medical tour package more than 50,000 Yuan per person ( Open Access Journal Published BY AENSI Publication 2017 AENSI Publisher All rights reserved This work is licensed under the Creative Commons Attribution International License (CC BY). ToCite ThisArticle: He Ye and IlianAssenov., Mainland Chinese Tourists Perception of Medical Tourism in Thailand. Research Journal of Social Sciences, 10(2): 8-13, 2017

2 9 He Ye and IlianAssenov, 2017/Research Journal of Social Sciences 10(2), July, Pages: 8-13 Significance of the research: There are many previous studies on the motivation and perception of Chinese tourists in Thailand. Many of them are on general medical tourists in Thailand, mostly western countries. As for Chinese studies on medical tourism, they mostly focus on how to use the example of other famous medical tourism destination countries to develop the medical tourism destination image of China. There are also some studies on the motivation of mainland Chinese medical tourists in Korea and Taiwan. This research on the intention of mainland Chinese tourists to undertake medical tourism in Thailand can fill the gap on study of potential mainland Chinese medical tourists and their specific requirements. This research focuses on the intention of Chinese tourists coming to Thailand to get medical service based on tourism experience in Thailand. Medical tourism in this research is defined as people going abroad to get higher quality, better service and affordable price medical treatment and combine medical service and vacation. Objectives of the research: Three objectives are presented in this research: To explore mainland Chinese tourists perception of medical tourism in Thailand; to explore the requirements and motivation of current and potential mainland Chinese medical tourists in Thailand; to investigate the current marketing strategy to target Chinese market from both medical agencies and international hospitals. Literature Review: Definition of medical tourism and related items In recent years, a growing number of patients are traveling from their home countries to other countries in order to get medical or health care [2]. This includes elective surgery, dental treatment, reproductive treatment, organ transplant and special medical check-up. Patients crossing nationalities and culture in order to get health care have been popularly called as medical tourism [1]. Researchers have different views on the concrete definition and the classification of medical tourism. Goodrich & Goodrich [3] comment that medical tourism is part of health tourism, and is related to specific medical treatments, while wellness tourism aims at making people live a healthy life, such as going to a spa center and learning yoga. The three points of pursuit of wellness are exercise, healthcare and nutrition. Hall and Anderson [4] hold that medical tourism is a form of special interest tourism, where the core motivation is health. Bies and Zacharia[5] hold the view that medical tourism is the outsourcing of medical service, typically to lowincome destinations. Medical tourism is about people undertaking specific treatments that can be only provided by doctors [6,7,8]. Treatments can be separated into 3 categories: preventative medical service such as medical check-up and health screening, minor surgery such as cosmetic surgery and dental surgery, and major invasive procedures such as knee replacement and gender transformation [10,7]. Medical tourism in Thailand: Southeast Asian and East Asian countries are among the leaders in medical tourism [11]. India, Malaysia, Singapore and Thailand are known as the most popular medical tourism destination countries in Asia [6]. Medical tourism in Thailand successfully combines the tourism and healthcare industries with great competitive advantage created by good medical service, affordable price and high reputation [6]. After the 1997 Asian Financial Crisis, the local private hospitals lost revenue from the declining number of local patients. The Thai government began to promote the private hospitals abroad. Under the support of the Thai government, the Tourism Authority of Thailand (TAT) opened a new website especially for promoting medical tourism ( In order to allow retired foreigners to get retirement visa, the Thai government also has extended the medical legal duration of stay from 30 days to 90 days in a number of countries, including the United Arab Emirates, Qatar, Kuwait, Oman and Bahrain (Immigration Bureau Thailand). There are six cities identified as medical tourism destinations: Bangkok, Chiang Mai, HuaHin, Phuket, Pattaya and KohSamui ( Among these six cities, Bangkok, Phuket and Chiang Mai are the main centres of the with medical tourism industry. In the past 10 years, the number of hospitals has increased quickly. According to the Department of Export Promotion (2009), 17,792 private healthcare service providers including more than 330 hospitals provided medical service in In 2010, 197 healthcare providers with 41 hospitals and 156 specialist clinics were recommended as medical service suppliers. Nowadays, many hospitals are accredited by the Hospital Accreditation of Thailand, ISO 9001:2000, ISO 14001, ISO and some are accredited by the U.S.-based Joint Commission International (JCI). Some of the leading medical service suppliers in Thailand include Bumrungrad International Hospital, Bangkok Hospital, BNH Hospital, Samitivej Hospital etc. According to estimates the number of medical tourists in Thailand in 2003 was more than 730,000, in ,000 and in 2010 to 2012, the number of foreign medical tourists was 1,980,000, 2,240,000 and 2,530,000 (Thai Ministry of Public Health). Although the recording practice is inaccurate, about 65% of the patients were

3 10 He Ye and IlianAssenov, 2017/Research Journal of Social Sciences 10(2), July, Pages: 8-13 from the Asia-Pacific region [12]. Thailand is the leader in medical tourist arrivals, holding more than 40% in Asia medical tourists in The top five markets were Japan, U.S., UK, GCC and Australia. The motivation of medical tourists: In recent years, a growing number of patients are traveling to other countries in order to get medical care motivated by high costs or inadequate or unavailable treatments in their home country [2]. A range of researchers have explored the motivation of decision making for the medical tourists. The reason for medical tourism also include: health need or insurance not covered in home countries; avoiding waiting for a long queue; privacy concerns [13]; annual or routine medical check-ups for healthy people [14]; screening for specific disease in family history. Another study of the medical tourists to India, China and Jordan identifies as most popular reasons cost, physician, facility reputation and hospital accreditation [15]. In home country long waiting and lack of access to treatment is the push factors motivation; urgency of the treatment is another reason [16]. Rozée and Rochebrochard [17] explore traveling among French patients who got treatment in France but who went abroad to obtain oocyte donation due to inadequate medical care and oocyte shortage in France. Decision making depends on different kinds of information resources: brochures, flyers and guidebooks produced by Medical Tourism Foundation or international hospitals, the internet, information from friends and relatives [16,12,19]. Medical tourism by mainland Chinese tourists: The development of medical tourism in China started in Shanghai in Shanghai Development and Bureau and Shanghai Commission, Shanghai Municipal Health Bureau jointly initiated Shanghai Medical Tourism Products & Promotion Platform (SMTPPP). According to statistic from SMTPPP, approximately 60,000 Chinese travelled oversea in order to find medical services ranging from anti-aging therapy, cancer screening and treatment, giving birth and chronic disease treatment in A report by Hurun [20] indicated that 66 percent of Chinese 1.18 million wealthy millionaires would consider medical tourism. According to MTA (2015) the top three outbound medical destinations for Chinese medical tourists are the United States, Japan and Germany and the main medical treatments are cancer and pediatric cancer treatments, cardiovascular procedures, stem cell treatments and comprehensive health check-ups. The China National Tourism Administration (2016) comments that outbound medical treatment has become new trend of Chinese tourists following "explosive buying abroad", large number of affluent class people spend a lot of money on outbound medical tourism. The top 10 medical tourism destination for Chinese are: Japan, Korea, USA, Taiwan, Germany, Singapore, Malaysia, Switzerland, Thailand and India. Mainland Chinese medical tourists in South Korea: The number of Chinese tourists traveling to South Korea to receive medical service there is rapidly increasing and Chinese have surpassed the Americans as the main market of Korean medical tourism (Yuan, 2014). Korea Health Care Industry Promotion Institute released data that of the nearly 160,000 foreigners to visit the Korean for medical tourism in 2012 the Chinese medical tourists were the largest group ( Mainland Chinese medical tourists in Taiwan: The central government of Taiwan has carried a three-year strategy marketing plan that was called the Taiwan Task Force for Medical Travel (TTFMT). This strategy provides the medical service to the international markets ( The main target is mainly Mainland tourists because of the shared language and culture. In 2013, 220,000 medical tourists traveled to Taiwan to get medical treatment, and 100,000 of them came from the mainland ( Starting from January 2012, Taiwan has introduced medical tourism visas, and there are 53 medical institutions approved by the Ministry of Health and Welfare of Taiwan where mainland Chinese can directly apply for medical examination or medical treatment, and stay for up to 15 days. Mainland Chinese medical tourists in Japan: Japan is another popular medical tourism destination for mainland Chinese people, although the real number is unknown. The latest statistics was 22,000 medical tourists in 2011 and 27,000 in 2012 (IMTJ, 2016). A subsidiary of the travel agency JTB promotes inbound medical tourism and declared that 90% of these customers come from China. Another popular medical service website from Japan is MRSO; it is the largest booking medical service website in Japan which has cooperation with more than 700 hospitals. It has business cooperation with Ctrip (the largest online traveling company in China) and provides convenient payment methods including Union Pay, Wechat Pay and Alipay to attract Chinese customers. The main medical service they provide is detailed medical examination, PET test, precise brain examination and gynecological examination (

4 11 He Ye and IlianAssenov, 2017/Research Journal of Social Sciences 10(2), July, Pages: 8-13 Methodology: In order to add more credibility of this study, both quantitative approach and qualitative approach are applied. The survey was conducted through questionnaires, interview (face-to-face interview and online interview) and observation. The target population for the questionnaire survey was mainland Chinese tourists who were in Thailand during the data collection, or had visited the country before. The respondents were asked to rank and reason for choosing according to their preference and requirements. Qualitative information was collected by face-to-face interviews with staffs in a medical traveling agency and private hospitals. The collected data were analyzed by SPSS program, through descriptive statistics, independent sample t-test and ANOVA analysis; content analysis was used for the qualitative information. In order to check whether respondents of questionnaires are consistent or not, the research conducted reliability analysis. The Cronbach s Alpha Coefficient on the factors important for selecting medical tourism services is.819, which indicates high reliability and credibility. Results: Profile of respondents: The sample included 85 male (42.5%) and 115 (57.5%) female respondents. Most of the respondents are at the age of years 150 (75%). This bias was created due to the fact that younger people were more willing to provide responses than medium-aged and older people. The marital status of respondents is 117 single (58.8%) and 82 married (41.2%). The respondents with bachelor degree were 86 (43.4%), followed by college diploma - 55 (27.8%), high school or lower - 33 (16.7%), master degree - 20 (10.1%) and higher than master degree - 4 (2%). In terms of occupation, most respondents are privately employed 77 (38.7%), followed by students and government employees - 33 (11.6%). The respondents come from seven areas, among them east China (25.8%), central China (22.7%), southwest China (15.7%), southern China (14.6%), north China (13.1%), northeast China (7.6%) and northwest China (5%). Mainland Chinese tourists perception on medical tourism in Thailand: Among the 200 respondents, only 59 (29.5%) have ever been heard about medical tourism in Thailand while most of respondents never got any information on medical tourism in Thailand; hence the publicity of medical tourism in Thailand by Chinese is not enough. When asked whether they are interested on medical tourism or not, 134 (67%) of them say Yes. The reason for respondents not considering coming to Thailand for medical tourism can be attributed lack of information and language barriers. Twenty-nine factors important in influencing potential medical tourists decision making are shown in table 1. These items are divided into four main parts: infrastructure and brand of the medical tourism destination, medical service suppliers, medical institutions online publicity and medical support service. In part 1, the top 3 factors that influence decision making is Good climate for treatment (M=4.44), Short waiting time (M=4.43) and Comfortable environment (M=4.42). In part 2, the top 3 factors are Accreditation (M=4.77), Quality of treatment (M=4.70) and Excellent doctor skills (M=4.68). In part 3, the most important factor is Medical service provider have official website (M=4.55). In the last part, the most important factor is Accessible language communication (M=4.67). T-test analysis was used to determine the difference in the level of importance of factors that influenced potential medical tourists decision between genders. The only statistically significant differences were the higher mean for men for Entertainment activities surroundings and the higher mean for women for Follow-up treatment. One-Way ANOVA tests were also used to determine the difference in level of importance of factors that influenced potential medical tourists decision making among different demographic locations, education background and current occupations. When compared with different demographic locations, people in Southern China were more concerned about local transportation while people in Northeast China were more concerned about quality of treatment and people in North China were more concerned about facilities for the families of patients. When looking at different occupations, government employees showed more consideration on convenient local transportation, Comfortable environment and Medical dispute resolution.

5 12 He Ye and IlianAssenov, 2017/Research Journal of Social Sciences 10(2), July, Pages: 8-13 Table 1: Importance of factors influencing potential medical tourists decision making Variable Item Mean Std. Deviation 1. Infrastructure and Good climate for treatment brand of the medical tourism Short waiting time destination Comfortable environment Facilities for families of patients The diversity of medical tourism products Accommodation Convenient local transportation Tasty food Entertainment activities surroundings Distance between home country Medical service suppliers 3. Medical institutions online publicity 4. Medical support service Similar culture Accreditation Quality of treatment Excellent doctors skill Medical dispute can be good resolved Good service attitude Sophisticated medical skill Reputation of medical service provider Cheaper price Follow-up treatment Provide insurance during the stay in Thailand Privacy Medical service providers have official website Information on doctors can be found on website Medical treatment information can be found on website Information on medical facilities can be found on website Accessible language communication One-stop service Online payment Notes: Likert-scale was used to mark the importance of each factor: 5 - Very Important, 4 -Important, 3 - Neutral, 2 - Somewhat Important and 1 - Not at all Important. Conclusion: It is promising that the Thai government has undertaken policies to attract mainland Chinese medical tourists. Understanding the requirements of potential medical tourists is vitally important for the development of medical tourism. In this aspect, this paper has come up with several conclusions. The majority of mainland Chinese tourists have interest in medical tourism in Thailand, although many of them don t have sufficient knowledge on the issue. The preferred medical tourism destinations are Phuket and Bangkok. Medical check-up and beauty treatment are the most popular medical service for potential mainland Chinese medical tourists. The most important factors they will consider when choosing medical tourism included accreditation, quality of treatment, excellent doctor skills and easy language communication. The majority of respondents prefer as the source of information introduction by colleagues or friends. Most of respondents would choose traveling with families or friends. In order for Thailand and its medical service providers to attract more mainland tourists and to remain competitive, they should take into account a number of factors. The motivation for medical tourism is different among people, thus, medical tourism providers should provide diversity and target products to meet the requirements of medical tourists. Cross communication barriers are important, and providing more professional Chinese translators will make the medical service providers more attractive. In the use of social media, focus should be on Chinese social media, such as Wechat and Weibo. Most importantly, word of mouth is the most important communication channel, and positive word of mouth is the result of high quality, professional and responsible medical treatment. REFERENCES 1. Turner, L., Canadian medical tourism companies that have exited the marketplace: Content analysis of websites used to market transnational medical travel. Globalization and health, 7(1): Connell, J., Contemporary medical tourism: Conceptualisation, culture and commodification. Tourism Management, 34: Goodrich, J.N. and G.E. Goodrich, Health-care tourism An exploratory study. Tourism Management, 8(3): Hall, M.A. and G.F. Anderson, Health insurers' assessment of medical necessity. University of Pennsylvania Law Review, 140(5):

6 13 He Ye and IlianAssenov, 2017/Research Journal of Social Sciences 10(2), July, Pages: Bies, W. and L. Zacharia, Medical tourism: Outsourcing surgery. Mathematical and Computer Modelling, 46(7): Connell, J., Medical tourism: Sea, sun, sand and surgery. Tourism Management, 27(6): Pope, J., The globalisation of medicine: the emerging market of medical tourists estimates, challenges, and prospects. Medical Tourism: Perspectives and Specific Country Experiences, TheIcfai University Press, Hyderabad, pp: Reed, C.M., Medical tourism. Medical Clinics of North America, 92(6): Alsharif, M.J., R. Labonté and Z. Lu, Patients beyond borders: A study of medical tourists in four countries. Global Social Policy, Journal of Public Health Policy, 31: Heung, V.C., D. Kucukusta and H. Song, A conceptual model of medical tourism: Implications for future research. Journal of Travel & Tourism Marketing, 27(3): ESCAP, U., Medical Travel in Asia and the Pacific-Challenges and Opportunities. Bangkok: United Nations Economic and Social Commission for Asia and the Pacific. 12. Ormond, M. and D. Sulianti, More than medical tourism: lessons from Indonesia and Malaysia on South South intra-regional medical travel. Current Issues in Tourism, 20(1): Horowitz, M.D., J.A. Rosensweig and C.A. Jones, Medical tourism: globalization of the healthcare marketplace. Medscape General Medicine, 9(4): O Hagan, H.C., Medical tourists opting for sea, sand, sun and surgery. Abu Dhabi: National Abu Dhabi Media Co. 15. Alsharif, M.J., Z.J. Sun, X.M. Chen, S.P. Wang and Y.F. Zhao, Benign fibro-osseous lesions of the jaws: a study of 127 Chinese patients and review of the literature. International Journal of Surgical Pathology, 17(2): Crooks, V.A., K. Cameron, V. Chouinard, R. Johnston, J. Snyder and V. Casey, Use of medical tourism for hip and knee surgery in osteoarthritis: a qualitative examination of distinctive attitudinal characteristics among Canadian patients. BMC health services research, 12(1): Rozée, V. and E. de La Rochebrochard, Cross border reproductive care. Human Reproduction, 28(1): i137-i Crooks, V.A., L. Turner, J. Snyder, R. Johnston and P. Kingsbury, Promoting medical tourism to India: Messages, images, and the marketing of international patient travel. Social Science & Medicine, 72(5): Lunt, N., R. Smith and M. Exworthy, Medical Tourism: Treatments, Markets and Health System Implications: A Scoping Review. Paris: Organisation for Economic Co-operation and Development. 20. Hurun., White Paper on the Chinese Luxury Traveler. ILTM Asia., Shanghai.