Medical Tourism In Romania Ruxandra Dandoczi 26.04.2017 [309792]
CHAPTER 1. INTRODUCTION
1.1 BACKGROUND TO THE RESEARCH
Medical tourism is a [anonimizat], because it is a country that meets all conditions for development. [anonimizat]. [anonimizat] 15-20% [anonimizat], president of the Romanian Association of Medical Tourism.
Medical tourism is commonly an encountered practice worldwide. More and more people choose to travel to find the best solution in solving their health care. [anonimizat].
This study will present a proper understanding of the concept of Medical Tourism and what does it include. Which are the most important factors that attract tourist to choose Romania as a destination for their Medical Treatment.
The evolution of the Medical Tourism in Romania has its own potential of development. Medical tourism in Romania offers experienced professionals (doctors, dentists, nurses, therapists) [anonimizat], medical spa and low prices of medical procedures. [anonimizat]-quality ratio of medical tourism in Romania is very attractive to people from other countries. [anonimizat].
Romania has the potential to become at the global level an important balneal and Spa tourism destination. [anonimizat], they can take advantage of a detox Spa in spa hotels in Romania.
[anonimizat], by capitalizing the complex of natural and anthropic resources.
Medical and Healthcare treatments can be grouped in two categories. [anonimizat], nutrition, dental treatment and complex surgery. The second category covers medical and healthcare treatments that are offered by health professionals who are registered and recognized by a [anonimizat], aromatherapy, [anonimizat], [anonimizat], homeopathy, massage and balneal treatments.
[anonimizat].
1.2 AIM AND OBJECTIVES
Aim: [anonimizat]. [anonimizat], [anonimizat].
Objectives:
1. To define what Medical Tourism is and what it includes
2. To explore which areas of Romania are practicing the Medical Tourism
3. To explain why Romania is a destination for Medical Tourism
4. To determine the evolution of the medical Tourism in Romania
5. To draw conclusions and make recommendations
1.3 STRUCTURE OF THE DISSERTATION
In the literature review chapter, there will be provided a clear understanding of the Medical Tourism segments in which form is presented and what is offering (the concept of Medical Tourism, types of treatments and procedures).
Secondly, one will clear understand the most important areas of Romania that offer medical tourism services. Thirdly, the study will be completed by data collected from clinics in different Romanian areas, provided by tourists/ patients. Fourthly, through the study, one will determine the evolution of the Medical Tourism in Romania over the last years. Lastly, as a result of the data analysis, there will be given further recommendations regarding the Medical Tourism development.
In order to complete the study, the Methodology will be based on a mixture of research methods, as following:
Primary data- provided by the Romanian Medical Tourism Association (ARTM), the International Forum for Medical Tourism (FITS), the Romanian Association of Balneology (ARB), as well as collected during Conferences, extracted from Reports and from Government Publications
Secondary data- such as Books, Journals, Newspapers (Journals, textbooks, academic articles and academic writings; Media resources: Wall Street Online Newspaper, Adevarul Newspaper, Capital Newspaper, Digi24, Zf Newspaper)
Qualitative data- represented by:
Questionnaires (ended questions) applied to clinics in Romania (Dental Filip, Romania)
Questionnaires (ended questions) applied to tourists/ patients
Interviews with representatives from different clinics in Romania
CHAPTER 2. LITERATURE REVIEW
2.1 INTRODUCTION
Medical tourism is a concept that moves the centre of interest from relaxing, fun, uniqueness toward health, treatment and beauty. Initially, this form of tourism was addressed exclusively for people with high incomes who could afford trips to distant places and who could honour exorbitant costs for health services of the highest quality. Nowadays, things have changed and medical tourism turns more frequently to those destinations that offer the best quality/ price ratio.
For Connell, medical tourism develops when people often travel long distances to overseas countries for medical, dental and surgical care, being at the same time tourists, in a more conventional sense (Connell, 2006, pp. 1093-1100).
Moving along the same line of thought are Smith, Martinez and Chanda (2011), who define medical tourism as the practice of travelling to another country in order to obtain health care by way of surgery, dental treatment, reproductive treatment , organ transplants, medical check-ups, etc (Smith, Martinez, Chanda, 2011).
The present chapter will analyse the concept of medical tourism, as well as different types of treatments and procedures used in this field, on the basis of the literary review.
2.2 THE CONCEPT OF MEDICAL TOURISM
In order to have a broad vision on the role, but with implications on spa tourism, one may find necessary to frame and view it in a broader perspective. This can be achieved by determining its multiple valences, expressing the resources and activities of the destination and its relationships with two adjacent concepts in the area of health: medical tourism and wellness tourism. The delimitation of the mentioned concepts is sufficiently clear in the literature and disparities at the international level leading to a degree of knowledge are limited and hence, the inadequate perception in terms of health tourism worldwide and of course, in our country. For the marketer, this leads to a prevention of the development of tourism products and also, to the need to establish accurate comparative advantages in tourism (essential in competition analysis), as a starting point in building strategy positioning of the product, respectively, to build product strategy.
Perhaps the most important aspect concerning medical tourism is the fact that currently there is no uniformity in understanding key concepts related to its development, namely the concepts of health, healing and wellness care. The concept of health was initially defined as a "state of physical, mental and social good well beyond the mere absence of disease" (World Health Organization, 1948), but it was subsequently improved by highlighting convergence concepts of physical and mental health, considering it as a "tool for awareness and satisfaction, a resource for everyday life and a positive concept that emphasizes social resources, personal and physical abilities of a person". By correspondence, health tourism is a comprehensive concept with multiple categories of activities (activities involving the sun and fun, activities involving health, indirectly activities which are centred on health: sauna, massages and 'activities' involving medical treatment), all being inflection points to other forms of tourism: leisure, adventure, sports, medical, wellness tourism and so on. (Goeldner, 1989 cited in Hall, 2013, p. 7). Although defined internationally as a synergetic concept in Central and Eastern Europe, medical tourism is understood to be represented mainly by medical and curative aspects (Smith, Puczko, 2009, p. 6).
Thus, in the case of Romania, for example, (as part of Central and Eastern Europe), the concept of health implies the level of collective perception mainly physical healing, health, water and medical spas, fitting into the concept of medical wellness (Smith, Puczko, 2009, p. 24). This belief is totally justified if we take into account the full potential of the Romanian spa, for example, represented by the quality of mineral and thermal waters. However, to clarify the concept as well as highlighting the medical tourism, respectively, to eliminate “its amorphous image” it is necessary to relocate with the needs of tourists (hence, the reasons of visiting destinations ranked in medical and wellness tourism). The whole system involves medical rehabilitation cures, spa cures, secondary preventive cures and therapeutic climate, as well as beauty treatments, sports and fitness, primary and preventive cures. For each of these potential tourism products, which are able to outline a clear form of tourism equivalent, it is required a compatibility with the defining components of destination/ tourist resort, such as its natural and human resources, socio-cultural, infrastructure and tourist reception resources, all contributing to facilitate specific activities.
Lately, medical tourism, defined as the "action of travelling in order to improve one’s health" (Bookman, Bookman, 2007, quoted in Reddy et al., 2010, p. 510), knows an increasingly development. This form of tourism is connected to optional greater procedures (the most common procedures being cosmetic, dentistry, cardiology, orthopaedic, bariatric ones) and, if applicable, emergencies (Horowitz et al., 2007, p. 33). The main reason for the existence of medical tourism in general is the availability (price). Therefore, the current medical tourism industry is especially about patients travelling from developed countries to developing countries for surgery of the latter being less expensive than the corresponding interventions in the USA or UK (Horowitz, Rosensweig, 2008, p. 31). The trend is favourable also for Romanian spa tourism development. However, a study conducted by Ehrbeck, Guevara and Mango in 2008, indicates that for their health, tourists are more interested in the quality and speed of services than in the low prices, this leading to the need for "refining" health and wellness products or, in other words, to enrich services / activities with direct impact on health, such as sports, leisure and so on (Ehrbeck, Guevara, Mango, 2008, p.11).
Starting from this premise, specialized travel agencies created multiple tourism products, including reservation services, lodging, transportation, meals for specific surgery services and for clients’ relaxation / recreation.
Compared to other forms of travel, tourism is more noticeable in the medical system, identifying it to have much more complicated functions. Nomenclatures used in literature defines medical tourism as international medical services involving a journey (Fedorov et al., 2009), (Cormany, Baloglu, 2010, p.709), (Crozier, Baylis, 2010, p.301), outsourcing of medical services abroad (Jones, Keith, 2006, p.255), medical refugees (Milstein, Smith, 2006, p.1637) and even biotechnological pilgrims (Song, 2010, p.384)
Because medical tourism has many connotations, its analysis is more complex compared to other forms that have a structure focused only on tourism. There are numerous published studies, but the definition of medical tourism given by literature is currently not clear, so one may observe that in time, there were given the following definitions for medical tourism:
Medical tourism includes travel concept, but it does not capture the seriousness arising from patient mobility. (Glinos et al., 2010, p. 1146)
Medical tourism represents a term that suggests leisure in order to restore health, disregarding the suffering experienced by patients. (Kangas, 2010, p.350).
Medical tourism involves those activities related to a person who often travels long distances across borders to receive health care services with direct or indirect involvement in leisure (Jagyasi, 2009, p. 1).
Patients travelling abroad to receive medical treatment or make periodic medical examinations are consumers of medical tourism (Yap, Chen, Nones, 2008)
Medical tourism is an economic activity involving trade in services and it represents the combination of at least two sectors: healthcare and tourism. (Bookman, Bookman , 2007, p. 1)
Medical tourism can be defined as a tourism activity involving a medical procedure combined with tourist activities that promote well-being. (Lee, Spisto, 2007, p.2)
Countries that intend to provide medical care or restoring promoting personal health through medical intervention practice medical tourism. (Carrera, Bridges , 2006, p.448)
Patients who go abroad for medical treatment or surgery are consumers of medical tourism. (Connell, 2006, p.1094)
People who go to another country for a period of at least 24 hours for treatment of disease, maintaining health (yoga, massage), beauty (plastic surgery) and fertility treatment practice medical tourism (TRAM, 2006)
Medical tourism is a product that develops vertically by tour operators tourism, containing health services (Goodrich, Goodrich, 1987, p.217)
As one may observe, there is no concrete, well- known definition for medical tourism, but most experts accept that this term is used to refer to the travel motivation that involves a medical procedure or to activities that promote physical and psychological welfare of the individual.
As defined by the World Tourism Organization (UNWTO), the main purpose of people travelling is to use advanced health services in other countries or regions. The first concepts of medical tourism refer to a variety of tourist activities in order to maintain health.
Medical tourism development depends on the following factors of demand:
the availability and affordability of quality healthcare in the receiving countries;
the trend of population aging in domestic countries correlated with the revenue growth;
the increasing incidence of cancer and other serious diseases (neurological, cardiovascular, obesity ones, for example);
the increased costs and healthcare services in domestic countries;
the high cost of health insurance (e.g. in the US) which makes middle-income, people rather preferring to be treated abroad than to conclude an insurance policy in their country;
growing concerns for a healthier lifestyle
Increasing the range of the Internet and the emergence of medical tourism associations, resulting in raising awareness about treatment options beyond the country of origin.
The advent of medical travel intermediaries who provide support ranging from information on available treatments and their quality in various destinations to travel arrangements, accommodation and post-treatment recovery.
Large market players have established development offices in third countries to attract more patients.
Tourism departments of destination countries promoting their regions as centres of excellence in specific healthcare services.
In this respect, the profile of the person who travels for health purposes is related to:
the waiting list for surgery or treatments at home,
the fact that health insurance does not cover all the treatments they need,
the fact that one lives overseas and prefers to return to his/ her home country for treatment,
the search for integrated treatments (e.g. Surgery followed by physiotherapy)
the fact that people are interested in experimental treatments that are not yet available or are illegal in their country of origin.
Concerning the European health systems, balneal resorts are important tourist destinations, especially for consumers seeking health and leisure alike. If European initially tourism products only presented basic elements of traditional type, strictly based on balneologists aspects (equivalent with the American medical Spas) were related to cures or treatments in the presence of a doctor, today, the product is complemented by other services, becoming a combination of traditional and specific services and procedures, along with rejuvenating ones (Kapczynski, Szromek, 2008, p. 1035), but in terms of marketing, one can not talk of a ”developed tourism product”, barely pausing to-market at the second level. Internationally, health tourism market has grown mainly by attracting those consumers who want to benefit from health maintenance and prevention, protecting them from the negative effects of the modern world, context in which Spas’standards are improving continuously. Even in Romania were established criteria for certifying the tourist resorts of local or national interest, covering, among other things, the location in a natural environment without pollutants; the appraisal and the value of natural healing factors; facilities and equipment for sports; events tourism, culture, sports, and health resorts: medical spa, technical equipment operation, protection and use of therapeutic mineral resources, facilities and equipment for basic services and the revive of natural resources for therapeutic purposes.
2.3 TYPES OF TREATMENTS AND PROCEDURES
Starting from the outlining clear spa / medical product, highlighting the component of treatment in spas, the next step, namely communicating the benefits of natural factors of course, involves, among other things, the need for a better collaboration between health authorities and tourism in this regard, together with doctors involvement, these ones becoming prescribers through recommendations, all these representing important factors in order to underline the decision to spend a vacation in medical tourism destinations.
The role of staff in the provision of any service in the context of medical tourism is the more important element as coordinated with the professionalism and competence of medical staff, not by items that only complements the positive tourism product but, moreover, by developing the touristic product because, without them, the purpose of recovery or maintaining health in travel is strongly affected. Therefore, any strategy to develop medical tourism, for wherever and whatever marketing strategy plan, must be perfectly consistent with the specific resources.
Since medical tourism product is extremely refined and complex, while tourists alike wishing to engage in many other activities (spa, recreation, leisure), programming and packaging strategies need to consider the construction of diversified products for different market segments, with several cultural and sports components for each one. This can be materialized with the help of events which highlights the characteristics and potential of a certain rural or urban area that belongs to the respective health resort, with the effect of strengthening the identity of the destination. In fact, there were created packages with the central factors, of course, (which differentiates resorts) such as: "One week of recovery" (a package of six nights, two treatment procedures per day, breakfast and medical advice in hotels of two and three stars), "Let's take a bath" (five nights with full board, two procedures a day, five days of treatment and medical advice), "Balneal Decade " (ten days stay, full board, not less than seven days of treatment, two procedures a day and a medical consultation, the offer including accommodation, meals and treatment in hotels of two, three and four stars) and "Wellness Spa" (three nights, two half board days, a festive meal, access to swimming pools, sauna, gym and two procedures of type wellness). However, such created programs are based only on the length of stay and include basic services, to define more clearly the profile of the program and / or activities by keywords / determinants in the decision to consumer’s purchase for "recovery", "wellness" and so on and to express the relation with such resources for those uses.According to Romanian Medical Tourism Association, the main important hospitals and clinics are situated in Bucharest , Arad, Brasov, Cluj-Napoca,Constanta,Targu Mures and Timisoara City.
The most required services in medical tourism are related to:
• Cancer treatment and palliative services
• Cardiovascular and neurologic treatments
• Diagnosis
• Interventions for plastic / aesthetic surgery – they are decreasing, but they are still an important market
• Dental Services
• Orthopaedic treatments and medical interventions
• Services of reproductive medicine, including fertility treatments
For example, cancer treatment will continue to lead the market – the number of international travellers who want a better treatment will increase; cancer treatment is costly and prolonged, but a better treatment available at affordable prices motivate more patients to choose medical tourism.
Health tourism, wellness and prevention are characterized by an increasing interest in so far as asserting a healthy lifestyle. Increasing the number of people suffering from obesity causes an increase in demand for slimming and detox treatments. The wellness services are often present in medical tourism; there are packages that integrate the two components of health tourism. It is also noted the emergence of specialized centres in Spa destinations are recognized for their potential (Hungary), or constitute an important markets for medical tourism reception (Turkey).
Thalassotherapy uses sea water whose curative properties are worldwide recognized for chemical and mechanical effects. It is practiced in a climatic and tonic environment in front of the sea. Thalassotherapy does not have any non-prescription, but it is positioned to offer medical nature.
Hydrotherapy purpose is similar to that of thalassotherapy care, but the treatment is based on the use of tap water or spring waters whose properties are limited to mechanical or thermal effects. Hydrotherapy can be practiced anywhere and it is not well positioned in the market because it is more recent, but it relies on the image of wellness and use of water in its basic form.
The cure for preventing aging and the anti-aging cure address to seniors and persons wishing to pursue a „treatment/ cure based on medication ". Ana Aslan or Gerovital are certainly a good starting point in this regard in Romania. These products of "medical tourism", therefore, are necessarily to be medicalized and are expensive. Also, they could be supplemented by general medical examinations, cosmetic surgery, diet, smoke cures, cures alcohol abuse, obesity cures and so on.
Unlike past times, medical tourism is no longer limited to thermal centres, spa or other establishments where water therapies are performed. For the development of this tourist modality, at present it is necessary to have specialized centres where medical services are combined with holidays, environment and health. Among the natural resources that are offered by the modern thermalism in Medical Tourism are the following:
Mineral-medicinal waters (Balneotherapy or Crenotherapy).
Packaged mineral waters
Natural waters in swimming pools (Hydrotherapy)
Natural waters with CO2 (Carboxitherapy)
Microalgae (Cosmetic Products)
Seaweed (Algotherapy and Cosmeceuticals)
Marine arenas (Arenotherapy)
Pickles in Salinas
Weather (Climatotherapy or Atherapy)
Marine Climate (Oceanic Cures, Coastal Cures and Health Cruises)
Marine Aerosols (Aerosol Therapy)
Sun (Heliotherapy)
Steam bath
Central heating
Hydro massage
Medical gases
Balneotherapy and Hydrotherapy techniques are represented by: bathtubs, baths, jet showers (ascendants, descendants and circulars ones), pools. Among the disciplines and / or therapies that have been incorporated into the renewed concept of medical tourism, one may highlight:
Alternative medicine represented by:
Herbalism, such as:
• Homeopathy
• Aromatherapy
• Acupuncture
Other Therapies such as:
Physical exercises (balneotherapy)
Gymnastics – Special therapeutic techniques with exercises (kinesiotherapy)
Saunas
Health and Beauty Salons
Recreational and cultural activities
Diet therapy
Other modern clinic treatments
Non-competitive dosed sports (swimming, basketball, golf, tennis)
Exercises with music (Music therapy)
At the same time, consideration should also be given to the use of technological advances in medicine, surgical interventions, highly complex treatments, as well as plastic surgeries.
The present chapter ensures the fulfilment of the first objective (To define what Medical Tourism is and what it includes) and the second objective (To explore which areas of Romania are practicing the Medical Tourism)..
CHAPTER 3. METHODOLOGY
3.1 INTRODUCTION
In the present research dissertation the researcher used both secondary research (literature search and review) and different primary data collection methods (questionnaire and interview).
The research approach is a deductive one, and the research strategy is represented by both the questionnaire and interview.
The purpose of a methodology chapter and the structure of this chapter may be observed as following:
1. To define what Medical Tourism is and what it includes
2. To explore which areas of Romania are practicing the Medical Tourism
3. To explain why Romania is a destination for Medical Tourism
4. To determine the evolution of the medical Tourism in Romania
The research strategy is based on the questionnaire and interview.
3.2 SECONDARY RESEARCH
3.2.1 LITERATURE SEARCH
The objective for the literature search is represented by an analysis of the methodology used from a literary point of view.
The search mechanism was a successful one and in this respect there were used data from:
Academic Journals in the area of research
Google and Yahoo search engines
National Institute of Statistics’ database
Documents collected from clinics in different Romanian areas, provided by tourists/ patients/clinics representatives
The academic papers with an important value in terms of the present research are:
LIGHT, D., & ANDONE, D. (1996). The Changing Geography of Romanian Tourism. Geography, 81(3), 193-203. Retrieved from http://www.jstor.org/stable/40572792
Steward, J. (2012). Travel to the Spas: The Growth of Health Tourism in Central Europe, 1850–1914. In Blackshaw G. & Wieber S. (Eds.), Journeys into Madness: Mapping Mental Illness in the Austro-Hungarian Empire (pp. 72-89). Berghahn Books. Retrieved from http://www.jstor.org/stable/j.ctt9qcqdr.9
Jancu, M., & Baron, P. (1984). Directions of Romanian Tourism and of Tourist Research. GeoJournal, 9(1), 75-76. Retrieved from http://www.jstor.org/stable/41143325
Dinu, M., Cioaca, A., & Zbuchea, A. (2010). Health tourism in Romania: main features and trends. Journal of Tourism Challenges and Trends, (3.2), 9-34.
Iordache, C., Ciochină, I., & Roxana, P. (2013). Medical tourism–between the content and socio-economic development goals. Development strategies. Romanian Journal of Marketing, (1).
Bookman, M. (2007). Medical tourism in developing countries. Springer.
Lee, C., & Spisto, M. (2007, March). Medical tourism, the future of health services. In 12th international Conference on ISO (Vol. 9000, pp. 1-7).
Journal of Tourism Management Perspectives
Journal of Destination Marketing & Management
Journal of Outdoor Recreation and Tourism
Journal of Environmental Management and Tourism (JEMT)
Key words and phrases used in the present research are: health tourism; balneary-spa tourism; wellness; medical tourism; Romania; spa; lifestyle limitations; special needs; tourist services; adaptive tourism; tourism supply chain; resilience; environmental dynamism; resources; supply chain performance; tourism policy; tourism destination management; adventure; relaxation; development; natural areas; sustainable; medical treatments; dental tourism.
The main limitations of the present research are represented by:
Sample size- the number of the units of analysis used in the present study is dictated by the type of research problem the researcher investigates, respectively the situation of health tourism in Romania. The sample size will be large in order to avoid difficulties in finding significant relationships from the data. Also, the sample size is relevant in the present quantitave research.
Lack of available and/or reliable data- in order to avoid the limitation of the scope of present analysis
Self-reported data- It is necessary to take what people said, to consider their opinion in interview and on questionnaires.
Access- the present depends on having access to people, organizations and documents. In case the access is denied or limited, the researcher will describe the reasons for this.
Longitudinal effects- The time available to investigate the present research problem and to measure change or stability over time very important.
3.2.2 LITERATURE REVIEW
An investigation is experimental, when it tries to be guided by the facts of observation and not by the mere reflection. The term "research" can also be used to designate purely theoretical analyses, such as the critical examination of the concepts of a discipline. The pointed distinction between theoretical and observed research has rightly been questioned.
The ability of an empirical investigation consists precisely in letting that factual something that escapes theories speak about.
3.3 PRIMARY RESEARCH
3.3.1 SECONDARY DATA
The primary research includes reinterpreted and manipulated data which has come from published statistics and hotels reports, as well as data collected from clinics in different Romanian areas, provided by tourists/ patients.
In order to analyse secondary data, there were used published statistic and hotels reports, based statistical methods.
3.3.2 PRIMARY DATA
The purpose of primary data collection in research is represented by an overview of medical tourism areas situation. The researcher will use reports specific to any hotel/ area where medical tourism is constantly practiced and analyse the data in future chapter, on the basis of valuable comments, graphics and pie charts.
3.3.3 RESEARCH INSTRUMENT DESIGN
Passing a questionnaire is not in itself an investigation. The questionnaire is only an instrument, a tool for collecting data for the purpose of using them in an investigation. A questionnaire can help the researcher to obtain the necessary information if the research aims to know the magnitude of a social phenomenon, its relation with another phenomenon or how or why it occurs, especially in the case that it is necessary to know the opinion of a large number of people.
The questionnaire presented for the consideration of the tourist, includes the following Questions and Topics:
The tour group
number of members
age structure
socio-economic conformation
place of origin
length of stay
average stay
The Tourist
destination motivation
preferred activities
performed activities
preferential sociability
mode and means of information
The used services
type of accommodation
type of recreation
information service
purchased products
The degree of tourist satisfaction
quality and price of accommodation
quality and price of recreation
quality and price of medical service
quality of the information service
The perception and valuation of the tourist
merchants and service providers
residents
urban conditions
tourist conditions
off-season attraction
medical centers
Characteristics of a good questionnaire (Patten,2016, pp.52-56)
Objectivity: The interviewer should never influence the opinion of the interviewee.
Clarity: It is important to use a language easily assimilated by the interviewee. This will avoid delays and errors in the response.
Precision: define the issues well and avoid ambiguities to get just the information you are looking for.
Correction: avoid questions that, because of their content or language, may disturb the interviewee.
Limited duration: whenever possible, the questionnaire should be reduced in size, avoiding repeated or excessively long questions, to avoid monotony in the interviewee's responses.
Strategies or techniques refer to ways or styles of collecting information, while the tools are specific tools of each technique or strategies that allow us to put into practice the collection of information. The instruments have their own entity and provide little flexibility to the researcher.
The development of these techniques and instruments must take into account two essential qualities that contribute to ensure the quality of the data collected:
Validity and reliability
"Validity" refers to the correspondence between the instrument or technique and the attribute intended to measure that instrument. An instrument or technique is valid when it measures what has been elaborated. There are different types of validity: content, predictive, concurrent and conceptual or construct. (Bryman, 2015, p.88)
The principle of "objectivity", as well as the criteria of reliability and validity, undergoes certain modifications in the methodology. The data and results obtained must be independent of the person applying the instrument or technique.(Taylor, Bogdan, DeVault, 2015, pp.55-58)
Quantitative research is based on all the numerical and statistical information obtained from reliable sources. However, it is necessary to take into account the validity of the information and the necessary amount of it to not exaggerate its information load taking only what is relevant to the research work. Techniques are used to gather information such as surveys, interviews where the analysis of the response will give the researcher a result stating the purpose of the work. It is framed within the inductive method by the use of statistics explaining the behaviour of the population.
In an interview, the interviewer is responsible for collecting the information truthfully, reliably and timely.
The interview is conducted on the basis of an specific guidelines guide. Given that the qualitative approach is more flexible than the quantitative approach, each interview may be modified according to the information collected and the interest of increasing certain aspects more than others (even when the same guidelines are always used).
Qualitative methodologies, on the other hand, focus on the understanding of unique and particular situations focus on the search for meaning and meaning that the agents themselves give to the facts, and on how individuals and groups live and experience certain episode or experiences to which we investigated. (Silverman, 2016, p.11)
To summarize, the researcher presents some of the main characteristic features of any qualitative research:
1) They are developed in a natural context, to which the researcher must often travel.
2) It uses multiple participatory, interactive and humanistic methods.
3) It is fundamentally interpretive.
4) Address social holistically experience.
5) The researcher determines the investigation.
6) The researcher uses complex, multiple aspects and simultaneous reasoning.
7) The researcher uses one or more research strategies as a guide to the process
In future chapters the researcher will develop an analysis based on valuable comments regarding the tourists’ responses at the survey and interview, represented into graphics, pie charts and explained tables.
3.3.4 PILOTING THE RESEARCH INSTRUMENT
The purpose of piloting the research instruments is to obtain a highlighted review of tourists/ patients’ opinion on different tourism medical services. The review will be presented in chapter no.4 and analysed through relevant graphic methods.
3.3.5 SAMPLING STRATEGY
Study participants:
The lot the respondents consisted of 100 individuals, female and male, with ages between 18 and 60 years old.
Also, in order to complete the present study, there were interviewed representatives from various dental and spa clinics in Bucharest.
Method of analysis:
Data collection was based on the questionnaire applied by the researcher as an interviewer.
An important skill for interviews is the ability to quickly assess a situation and develop an appropriate strategy based on that assessment. The role of the interviewer is vital in developing an interview and having good results in an investigation.
The researcher is in charge of guiding and channelling the interview situation in a way that meets the goals of the research paper.
The researcher must have control of the situation, minimizing errors, surprises and prejudices that may arise.
It should be noted that not all interviewers have the same styles to do the research, each person has his particularities, his professional behaviour, his style of communication, however, it is of vital importance in the role the researcher played as an interviewer, based on characteristics that allow to facilitate the researcher work.
As an interviewer, the researcher is a good communicator, understand both oral language and body language; must be spontaneous allowing to deviate from the script, but without going beyond the goal. Also, the researcher has to know how to listen and follow the interviewee; must know how to ask, determining the right question and the precise time to do it; know how to be quiet and discreet, since prudence is fundamental, because if this is not taken into account, the study could not be done. Being able to motivate is also important, since it is not enough to ask the questions, but an active role the researcher takes in order to stimulate the participation of the interviewee.
3.3.6 CONDUCTING THE RESEARCH
To collect the data necessary for testing variables, the relations between them and, ultimately, the general model proposed for analysis, I researched a specific population whose election has been argued extensively in a section especially dedicated to them – tourists and patients in different clinics in Romania, during October 2016- March 2017.
Future recommendations will be provided in the following chapters.
3.4 DATA ANALYSIS
Key questions of the present research are as following:
In your opinion, why do you think foreign tourists come in Romania?
What is actually dental tourism?
In your opinion, what impact has dental tourism phenomenon in Romania as a host country?
Can you list some of the reasons tourists seek for medical care in Romania?
Does Romania take advantage of medical tourism?
Why you consider that in building the country brand should we focus on medical tourism?
What factors do you consider may influence you when purchasing a dental service?
When purchasing a dental or spa service during your holiday, how do you appreciate the care provided from the reception to the treatment itself?
Can you mention 5 dental or spa clinics that you know in Romania to provide high quality spa or dental services for tourists?
What is the degree of overall satisfaction with the service spa/ dental service that you visited until present?
How do you consider the service provided by the spa/ dental service in Romania, in general?
3.4.1 QUANTITATIVE DATA ANALYSIS
In order to analyse the data from a quantitative perspective, there were used both the Statistical Package for the Social Sciences – SPSS and Microsoft Office Excel.
Also, statistical techniques used in the present research are represented by:
Data tabulation
Data disaggregation
Correlation
Microsoft Office Excel spread sheets were also used to present and analyse the data
The results will be presented in chapter 4, highlighting a Presentation, an Analysis and an Evaluation of Data.
3.4.1 QUALITATIVE DATA ANALYSIS
Regarding the qualitative data analysis, there were used methods of analysis such as template and content. Also, the results are presented in the fourth chapter.
In this respect, one will clear understand the most important areas of Romania that offer medical tourism services.
Also, the study will be completed by data collected from clinics in different Romanian areas, provided by tourists/ patients/ medical centres, as well as future recommendations.
CHAPTER 4. ANALYSIS OF RESULTS
4.1 INTRODUCTION
The purpose of this chapter regards the analysis of data obtained on the basis of the applied questionnaire and interview. The results are going to be presented in a detailed manner, in order to highlight the tourists’ perception on touristic medical centers in Romania . It also emphasizes the quality of services offered by the spa and dental’s centers. The interview highlights the manner tourists are treated in Romania, the interventions and treatments costs, as well as the main reasons people choose our country as a medical destination.
4.2 HEADING
According to forecasts for future health tourism will be the tourism segment that will grow more in the coming years and where the enjoyment of Spas is expected to be the main activity and greater consideration for many tourists when it comes to choosing destination holidays. Therefore, the fact that many hotels are incorporating health-related spas or services means that such a service and its quality can be a decisive factor at the time of the election. Regarding the profile of the consumer of this tourism product, at the moment it is a consumer of middle age between the 30 and 50 years. In the future the medical clients predominate will pass the 60 years and without doubt will be more demanding. Spas and spa clients are mainly women, however, there is a growing trend towards an emergence of services focused on the man and that perfectly tune with the health tourism model. Examples of this are that there are more and more hotels besides spa, they offer activities such as golf practice or treatments for men. Despite this increase is still not enough and presents itself as a market where progress can still be made. Efforts are also being made to attract groups, mainly families, and program activities for children.
The forms of booking and hiring, no doubt as you would expect the use of internet is increasing. Being a well-informed tourist, they are always looking for more flexibility in the packages they hire, since they are always booking stays of less days, but more frequently. Therefore, a great factor that can tip the balance when it comes to hiring may be precisely the quality and quantity of health related services available to the accommodation. What are those factors or aspects that need to be taken into account and which are important for health tourism consumers? This survey establishes a relationship with the importance that the health tourist gives certain aspects when choosing a health tourism destination. The statistics collected in the survey are classified in relation to the questions asked to the interviewee. (Behrens, 2007). Each questioned aspect is divided into 3 percentages that indicate the importance that the total of respondents assigns to that aspect.
Table 4.1. Factors for choosing a medical tourism destination
Source: Developed by the author based on Secondary data
Source: Developed by the author based on Secondary data
As for factors related to the environment and climate surrounding a health tourist destination, the aspects that visitors consider most important when choosing destination "peace and quiet of the accommodation as well as its environment" is the aspect With greater importance of consideration of the respondents, followed by "favorable climatic conditions for the relaxation" no doubt, conditions come here as if it is very sunny, the temperature, hence the following aspect with more appreciation, "location and surroundings of the Accommodation "is taken into account by respondents. In terms of customer service and services, visitors are interested in factors related to the staff of the dental centers and the personalized attention they can offer, as well as efficient dental treatments.
Most popular in Romania are dental care, antiaging – for example, Ana Aslan brought tens of thousands of tourists in the country – aesthetic surgery and spa tourism. However, most spectacular spa resorts are: Olanesti resort, Ocna Sibiu, Govora, Herculane and others. Regarding the dental tourism, many of the most efficient centres are located in Bucharest (City Dent, Signature Smile, Exquisite Dent, Glamour Dent), Botoșani (Dentoson Clinic), Brașov (Classmed), Cluj Napoca (Dr. Lucian Fodor,City Dental Clinic, Luca Visage, Rodessa) and so on.
For the spa part, the Minister initiated a granting status. „One of 10 patients who come in Romania is foreign and Romanian medical tourism potential can raise the number of foreign tourists.”
Based on previous statements, one consider medical spa tourism to be divided in two important areas: Herculane and Techirghiol.
Although it is in an advanced state of decay, Herculane, the oldest spa in Romania continues to be on the wish list of tourists and those requiring treatment. At this point, according to the mayor Nicușor Vasilescu, the occupancy of the resort is more than 60% during the week, and 100% in weekend, thousands of tourists visiting the whole Cerna Valley, which proves necessary investments leisure matter.
Another major resort and benefits for treatment is Techirghiol. Employment in the summer season is about 100% and the key of treatments considered miraculous is the seaside mud of Techirghiol Lake as a result of the lake flora and fauna.
In addition to these special conditions, Techirghiol benefits from the existence of one of the most modern treatment facilities in our country, such as physio-therapy, located inside the sanatorium unit being to be gradually upgraded over the years and whose capacity can accommodate up to 900 patients.
ANALYSIS AND INTERPRETATION OF THE RESULTS
The main socio-demographic characteristics of the sample can be seen in Table 4.2. Thus, it is verified that the majority of the clients of dental or spa establishments were Romanians, specifically people living in the North-East Development Region. In addition, the typical client corresponds to a person between 35 and 54 years old, married or living in a couple, with university studies and with a medium or medium-high income (average monthly income of the family unit over 1,800 €). (National Institute of Statistics, 2016) These data vary according to the spa in question, being quite heterogeneous in their distribution, especially those related to age and average monthly income.
Table 4.2. Main socio-demographic characteristics of the sample
Source: Developed by the author based on National Institute of Statistics, 2016
Figure 4.1
Source: Developed by the author based on questionnaire analysis
Figure 4.2
Source: Developed by the author based on questionnaire analysis
The collection of information will allow us to expand our vision and to know the characteristics and determining factors of dental possible clients of clinics or spa ones, as well as to determine the existing trends in the field of dentistry.
As important factors to consider having an influence when purchasing a dental service, for example, one may observe the service and the location which tells us that the vast majority of people between 18-50 years old consider that care is the most important. On the other hand, the location is important among the people aged between 26-50 years for the little time that dispose in their lives.
Figure 4.3
Source: Developed by the author based on questionnaire analysis
It is stated that the great majority of people between the ages of 18 and 50+ consider that a recommendation in cases of health is the best option when purchasing a dental or spa service. It should be noted that the vast majority of dental or spa clinics have not focused on their communication and information forces on written media.
Figure 4.4
Source: Developed by the author based on questionnaire analysis
The culture of prevention among patients is very low due to lack of information except for those aged between 41-50 years. It was determined that on average of 65%, tourists in Romania go to the dentist or spa when they have pain or complaints for searching a quick solution (remedy).
Figure 4.5
Source: Developed by the author based on questionnaire analysis
In the case of increased demand or complaints represented in dental/ spa medical consultations, the interviewed tourists have gone to the dentist to be treated in greater proportion with the cures followed by the extractions. This indicates that the vast majority of patients have not followed a preventive culture, especially between the fluctuating ages of 18-40 years old.
Figure 4.6
Source: Developed by the author based on questionnaire analysis
One can determine a great absence in medical consultations and that the influx of tourists to dental clinics is minimal. Another important factor to consider is that patients who oscillate between 41 and 50 years old are represented by a preventive culture that generates a considerable demand.
Figure 4.7
Source: Developed by the author based on questionnaire analysis
The prices of dental/ spa touristic services in Romania, in tourists’ opinions, are the right ones in accordance with tendency towards high. An average of 60% of the respondents thinks the price for these types of services is fair.
Figure 4.8
Source: Developed by the author based on questionnaire analysis
The perception of tourists regarding the services provided by dental or spa clinics is regular with a tendency to improve. This indicates that prices justify the ones that are considered high by tourists.
Figure 4.9
Source: Developed by the author based on questionnaire analysis
Figure 4.10
Source: Developed by the author based on questionnaire analysis
Respondents also mentioned different dental and spa clinics that they know in Romania to provide high quality spa or dental services for tourists, such as: Dentoson, Classmed City Dental, Rodessa and so on.
Regarding the spa centres, the great part of tourists talked about Ana Aslan Center in Bucharest , Techirgiol,Herculane,Salis Hotel, Regina Maria clinics in Bucharest and so on. These are medical centers which by their antiquity they have been gaining market.
Among the surveyed tourists, they consider that the care provided in one of the mentioned clinics is regular or good.
Figure 4.11
Source: Developed by the author based on questionnaire analysis
The great majority of the patients of the dental or spa clinics found it by recommendation and considering the great majority, by the location of the place. These campaigns are only considered among the respondents who know and have acquired the dental/ spa treatment in the clinic.
Figure 4.12
Source: Developed by the author based on questionnaire analysis
Seventy-five % of the respondents consider themselves satisfied with the service that the company lends them and 25% are considered completely satisfied. The level of overall satisfaction with the service that the spa/ dental service provided to clients is satisfactory, but not completely, for which it is necessary to propose strategies that allow to increase the level of customer satisfaction.
Figure 4.13
Source: Developed by the author based on questionnaire analysis
Half of the surveyed tourists consider that the spa/ dental center has provided excellent service, the remaining half considering it good. In general terms and according to the answers of the surveyed tourists, the services offered by different medical centers are at a good level, since none of the respondents rated this aspect as regular or bad.
Figure 4.14
Source: Developed by the author based on questionnaire analysis
Twenty –five % of the surveyed tourists consider that the time from the request of a service to the company until the answer is excellent. On the other hand the remaining respondents, representing 75% of the total, consider this response time to be good.
Spa/ dental centers in Romania are at a considerably satisfactory level in terms of time to respond to customer requests; however it is necessary to work this aspect because of the difference regarding data between excellent and good is significant, the "Good" answer being predominant.
Figure 4.15
Source: Developed by the author based on questionnaire analysis
40% of the total respondents consider it appropriate that 1 day would be the ideal time to respond to the solution that the client requested for, 26% of the total respondents consider that 2 days would be the ideal time, 17% of the respondents consider relevant 3 days and the remaining 17% consider that the ideal time to give a response would be immediately.
Most respondents consider that 1 day would be the maximum prudent waiting time for the response of any request made by the client when on average it takes 2 to 3 days.
Figure 4.16
Source: Developed by the author based on questionnaire analysis
54% of the respondents rated the ease of communication with the spa/ dental provider as excellent and the remaining 46% considered it "good". In general terms, the ease of communication with the provider is defined as excellent; this means a strength because besides this, none of the respondents rated as regular or bad this aspect.
Figure 4.17
Source: Developed by the author based on questionnaire analysis
Fifty % of the total respondents consider that the staff's attention is Excellent and the remaining 50% qualify it as Good. To give a qualifying average in terms of the attention that the staff has provided can be considered to be satisfactory, since all the respondents gave a positive criterion in this aspect, to which none of them rated it badly, nor regular.
Figure 4.18
Source: Developed by the author based on questionnaire analysis
The opinions of the respondents focus on the lack of advertising, this being one of the main weaknesses of the medical centers and why many customers do not feel satisfied enough to continue with the services that the center offers.
According to the answers, it can be seen then that there are not many clients who complain about the response time when making a request, however it is something that must be corrected although it does not seem then to be the priority problem as well as the suggestion to develop clearer documentation.
The interview answers’ analysis can be observed below, organized by questions.
Being asked about their opinion regarding foreign tourists’ visits in Romania, respondents considered that medical services are the most requested, in this category being included aesthetic and plastic surgery, spa services, dental tourism services and so on. Also, according to respondents’ opinion, health care in private Romanian medical centres includes cosmetic surgery, plastic rises, dental treatments/ implants and even spa treatments to highest quality standards with the latest technology and highly trained medical professionals. This manner, foreigners appreciate the offered services and often come in Romania take advantage of them.
Respondents were also asked about choosing Romania as dental tourism destinations and their answers were related to the price competitiveness of dental treatments, along with the quality of techniques and materials that are used. For example, they considered that in Romania, prices are twice or three times lower than in Western European region is to the same standards of treatment as those in clinics in the United States or Western Europe.
Being interviewed about the reasons tourists choose SPA as a medical service during their trip in Romania, respondents considered that visits to day spas represent the first step toward a healthy, simple, flexible and convenient lifestyle for visitors. Relaxing massages, wraps, facials, are just some of the procedures that Romanian specialized centers can offer. Also, one considered that in Romania, medical SPA makes available comprehensive wellness programs and preventive care, together with techniques of alternative medicine or a combination of the two.
Regarding the actual meaning and reasons of practicing dental tourism in specialized medical staff opinion, they considered that an increasing number of people travel around the world to benefit from cheaper dental services than the ones provided in their country. During such trips, tourists have the chance to visit Romania, dental problems can be treated in a short time and respecting schedules are agreed with the dentist. Also, in Romania, tourists benefit for quality services at much lower prices than the ones in their countries.
Regarding the reasons dentistry and cosmetic surgery occupy the first places in the top of touristic medical services, respondents considered that healthcare benefits underlie those reasons. Also, there were observed some gaps in these domains, one of the most representatives being the need for a better communication between professional organizations of dentists and companies operating in the health tourism.
Talking about the impact that dental tourism phenomenon has in Romania as a host country, one may consider that the phenomenon of dental tourism is becoming increasingly popular. Popular treatments such as dental implant procedures, bleaching or fillings at channel level make the difference in this niche of dental tourism.
Nowadays, while tourism market is in a great expansion, there may be observed a growing number of patients coming to different Spa or dental clinics in Romania, a good example being Ana Aslan or Regina Maria centres, these two offering a lot of medical specialties.
From respondents’ point of view, dentistry remains among attractions in our country. In this respect, foreigners coming to Romania for such services generate a market of tens of millions of Euros while the number of patients coming from outside Bucharest is increasing compared to previous years, according to a study of Insight Market Research Solutions.
Authorities play a key role concerning the development of medical tourism in Romania. In respondents’ opinion, among the things that the authorities should do for the private sector to grow, one may emphasize the investments supported by the system and adopted by a legislation to facilitate private health sector development.
According to all the interviewed specialists, the reasons tourists seek for medical care in Romania are related to:
1. Low Costs
2. Avoid long waiting list
3. The procedure is not available in the country of origin
4. Tourism and vacations
5. Privacy and confidentiality
The procedures most demanded by health tourists are as following:
Dental work;
Cosmetic dentistry;
Dental reconstruction;
Cosmetic Surgery;
Bust increase / reduction;
Face Lift;
Liposuction.
Cardiology and Cardiac Surgery;
Heart valve replacement.
Orthopedics;
Replacement and reconstruction.
Body contour;
In vitro fertilization;
Gender reassignment.
Organ and tissue transplantation;
Transplantation of solid organs;
Bone marrow transplantation;
Stem Cell Therapy.
Eye Surgery;
Cancer treatment.
With respect to the company's progress on medical tourism market, the interviewed medical staff observed an increase in applications over the previous year, the number of tourists using medical services followed an accentuate tendency last year. Regina Maria medical center is a good example in this respect.
Being asked about the peak period for dental tourism, respondents considered medical tourism is growing in the summer when Romanians in foreign countries and foreigners come in large numbers in Romania and take advantage of low prices. Also, dentists said that most requested interventions are dental implants and ceramic crowns.
Practicing lower prices in comparison with other countries and offering quality services, Romania takes advantage of medical tourism. However, there are some gaps concerning the issues related to infrastructure, trust and safety, as some respondents declared.
Considering that in building the country brand one should focus on medical tourism, because currently, Romania has a major advantage over other countries in the region to other countries in the European Community so that medical art is represented by some cost much lower than the European community, creating a competitive advantage, which is basically a resource of the country. Currently, doctors in Romania are highly trained and appreciated overseas, and there is a need to keep them in the country, being prepared, being able to treat people in Romania. In conclusion, in building the country brand, one should focus on medical tourism, but also on promotions, private initiative, keeping human capital in our country, quality treatments.
As a last question of the interview, being asked if there is any difference in tourist requesting dental services in Romania, besides the price one, respondents considered that there are some major differences, starting with the quality. Also, another aspect in this respect is the Internet speed along with the advancing technology. In conclusion, private initiative points out, therefore, not only a series of proposals that would increase the availability of dental services for Romanian, but an important direction for brand country, medical tourism and health tourism concept already successfully implemented Romanian private clinics.
The interview and the content of the present chapter validate the fulfillment of the third objective (To explain why Romania is a destination for Medical Tourism).
4.3 SUMMARY
The annual growth rates of dental and spa tourism are growing year by year, thus being a product to be taken into account both now and in the future, and where in Romania, precisely the tourist sector has suffered a stagnation with its traditional models of sun and beach, and high seasonality, can be an alternative to complement other tourism models. That is why it must try to anticipate the tendencies that are observed in the demand and to be able to offer good quality products and competitive, making them different from other products related to health.
Undoubtedly, the growing increase in the average age of the population will contribute to this sector continue to develop and in the case of Romania where it is a relatively recent phenomenon is still an option to consider within the tourism industry. Not only is it a market with possibilities for the aging of the population, but, more and more people of the early ages are demanding this type of products, because the population is becoming interested in their health and well-being.
The main objective in the future is to try to stop the tourist from associating the health tourism product as a complement to another tourist trip for different reasons, and for those who choose to travel for health reasons as the main motivation and not as a complement to a cultural motivation, beach or skiing one. However the changing nature of the preferences and tastes of the tourist who today is very demanding since it knows the offer and the different possibilities that it offers, they do not make that objective easy, therefore one would have to opt for a model in constant adaptation to the needs of the client.
CHAPTER 5.
CONCLUSIONS, RECCOMMENDATIONS AND REFLECTIONS
5.1 INTRODUCTION
The purpose of this chapter is to highlight the main conclusions, recommendations and reflections regarding the Medical Tourism in Romania. In this respect, it is structured into four parts, respectively: Conclusions, Recommendations, Reflections & Evaluation of Methodology and Suggestions for Further Research.
5.2 CONCLUSIONS
Medical tourism is considered an activity in which people move from their home country to other nations to receive medical treatment, and at the same time they take advantage of travel to know or find healthy, recreational activities. The most outstanding advantages in health tourism are the easy access and the low costs that are being handled through packages that are offered by the tourism companies of the recipient countries, the great majority of which are developing nations, and from the comfort of the house the tourist makes the necessary steps to access the required services. Globalization encourages interaction between different cultures in the world, which makes medical care difficult, since this is two-way: both the patient needs to understand the cultural beliefs of the destination and the providers must know and understand the cultural beliefs of the patient, in order to gain mutual understanding and benefit.
Another disadvantage is not being clear about the treatment to receive, not to establish or discuss possible negligence, misdiagnosis or incompetence on the part of the medical staff, since responsibility of the medical staff is not limited to the act as such. The trends that can be evidenced in Romania with respect to the tourism in health range from the geographical aspects of the recipient country, the technology that offers in dental medicine or Spa, among others; the infrastructure of the medical centers and their accreditation, the costs of treatments, without ignoring the economic contribution to the provision of health services for the nation. Tourism in health is a true industrial and economic activity that has a great impact on the social and economic development of the receiving countries thanks to the improvement of infrastructure, medical conditions and environment. Romania has understood the need to grow in the field of medical tourism, thus stimulating the improvement in the quantity and quality of the provided services such as Spa or Dental ones.
The attributes proposed to measure the quality of service in Romanian tourism centers have proved to be adequate, boasting the high levels of reliability and validity. In this respect and in line with other researches, evidence has been found of the multidimensionality of service quality, composed in this case by four dimensions or critical factors (Professionalism, Spa/ Dental center offer, Hotel Offer and Location).
With respect to the research hypotheses, the relationships proposed in the measurement model have been partially confirmed. It was found that the quality of service is an important antecedent of the satisfaction, on which it exerts a clear and significant influence, thus being positively contrasted the hypothesis. The opposite relationship has been rejected because the standardized load reaches a non-significant critical coefficient. Based on these results, managers of medical (Spa or dental) establishments should give greater importance to perceived quality because it will improve customer satisfaction and hence company results.
One can identify that tourism in Romania has adapted to the diverse socio-economic environment, emphasizing the use of this economic activity to promote growth and development. Faced with this situation of accessibility in the environment by the tourist activity, it has led to the promotion of alternative tourism that adapts to different areas emphasizing product quality and sustainability. The tourist activity in Romania has been for years in development, the clear example of the importance of the capital as center of cultural tourism, but the insecurity and economic effects directly impact the tourist activity.
Tourism is an activity that can be promoted from the territorial potential located in a specific environment. Although it is currently emphasized in alternative tourism for its rational use of resources. In addition, health tourism that uses the hot spring resource is a potential in areas where activity is concentrated as a means of development and growth in the area.
Medical tourism is a concept that moves the center of interest from relaxing, fun, unique, towards health, treatment, beauty. Initially, this form of tourism was designed exclusively for high-income people who could afford trips to places distant and exorbitant costs only to health services of the highest quality. Today things have changed and medical tourists are returning more frequently to those destinations that offer the best quality / price ratio.
5.3 RECOMMENDATIONS (IF APPROPRIATE)
Recommendations are proposed related to each point identified in the survey and interview.
Design a web platform for the promotion and commercialization of health tourism in Romania, as has been done by other countries directly competing here.
Medical clinics should be supported at international events, congresses and other forums of global health tourism
Advance collaborative agreements with national health systems and insurers in these countries, argued for lower prices
There should be encouraged the participation of health service providers in medical tourism platforms and facilitators with special impact on potential sending countries
There should be a structure of the tourism product health, taking into consideration the following:
To do this, it is necessary to have a single contact. Unify the different local projects in a single national platform that combine interests and can be unique interlocutor of the public administrations;
The public administration should promote, to the extent of its powers, agreements between health agents, welfare agents, tourist agents and intermediaries.
Finally, it would be advisable to create a national product club, led by the Ministry of Tourism, in which closed tourist packages are designed, integrating the health and complementary offer
There should be created a health tourism observatory:
Regarding the lack of health tourism data, it is recommended to put into operation an observatory of statistics on the volume and characteristics of the health tourist, similar to that which exists for other tourism results.
It should be a platform representing the interests of the sector in Romania, working on the promotion, professionalization and innovation of agents integrated into the medical tourism industry.
One should support the improvement and adaptation of health care to the needs of tourists
There should be an improvement of health providers infrastructures
There should be an improvement of training and training of professionals involved in health tourism.
5.4 REFLECTIONS & EVALUATION OF METHODOLOGY
The realization of the survey, taking into account the motivation of the tourist, the balneal opportunity of the stay and the conditions of the destination, implied the adoption of those guidelines that appealing to the tourist on the balneal and wellness centers allow to have information regarding the tourist group in the different centers.
The Survey whose results are reported and considered in this document includes the investigation of dimensions whose expression confers uniqueness in the conditions that resemble and differentiate them.
Within the purpose and diversity of the study, the survey of tourists who visit the spa and dental centers in search of rest, fun and recreation, but also treatments not only know the profile of the tourist, but also provides information regarding the perception, projection and valuation of the tourist for the purposes of resources, services and center, designed to consider the future of medical tourism in Romania. So the questions are the result of issues about the tourist, the socio-economic profile, his expectations and behaviors, his uses and consumption, his degree of satisfaction, his perception and appreciation, with relation to activities, services and balneal centers. When defining the questions, topics and questions of the questionnaire under investigation, it is part of a previous reflection on the problematic object of inquiry that consults the general objectives of the study and the possibilities and restrictions of the survey to obtain information.
5.5 SUGGESTIONS FOR FURTHER RESEARCH
Regarding the further research and recommendations, one may future study the medical tourism area in Romania, as well as worldwide, realizing study cases on the most important spa and dental centers in the country and making comparisons.
Also, one should:
To develop the dental and spa areas from the perspective of their contribution to the prevention and improvement of people’s health as they have been demonstrating numerous scientific investigations and on their welfare benefits developed in the whole world from the perspective which is also recommended by the World Health Organization.
To promote medical tourism through different public programs
To guarantee reinforced protection of different medical tourism areas through legislation, planning and public management, preventing the development of activities that may lead to contamination of the recharge areas
To provide technical and financial support from the public administrations to create or improve, as the case may be, the medical supply, its touristic or recreational facilities, as well as the complementary offer of destinations or villas, such as sustainable productive investments with a major impact for rural and urban development.
To ensure the awareness of local communities to be involved in the governance of the medical resources of certain territories as a strategy to ensure their protection and social use.
To develop research and training activities for professionals in the area of medical tourism
Word Count: 10.996 words
REFERENCES
Anderson, James C., David W. Gerbing. "Some methods for respecifying measurement models to obtain unidimensional construct measurement." Journal of marketing research (1982)
Airey, D. (1999). Education for tourism — East meets West. International Journal of Tourism and Hospitality Research, 1(1), 7-18. Retrieved from http://www.jstor.org/stable/42919207
Behrens, Anja. The internationalization process of wellness tourism. 2007.
Bookman, M. Z., & Bookman, K. R. (2007). Medical tourism in developing countries. New York, Palgrave Macmillan.
Bryman, Alan. Social research methods. Oxford university press, 2015.
Behrens, Anja. The internationalization process of wellness tourism. 2007.
Bookman, M. Z., Bookman K.R. (2007), Medical Tourism in Developing Countries, New York, Palgrave Macmillan.
Carrera, P. , Bridges, J.F.P. (2006). Globalization and Healthcare: Understanding Health and Medical Tourism. Expert Review of Pharmaco-economics and Outcomes Research, 6, (4).
Cormany, D., Baloglu, S. (2010), Medical travel facilitator websites: An exploratory study of web page contents and services offered to the prospective medical tourist. Tourism Management, 32.
Crozier, G. K. D., Baylis, F. (2010), The ethical physician encounters international medical travel. Journal of Medical Ethics, 36.
Carrera, P. , Bridges, J.F.P. (2006). Globalization and Healthcare: Understanding Health and Medical Tourism. Expert Review of Pharmacoeconomics and Outcomes Research, 6, (4).
Connell, J. (2006), “Medical tourism: sea, sun, sand and …surgery”, Tourism Management, 27, (6).
Connell, J. (2006). Medical tourism: sea, sun, sand and…surgery. Tourism Management 27.
Cormany, D., Baloglu, S. (2010), Medical travel facilitator websites: An exploratory study of web page contents and services offered to the prospective medical tourist. Tourism Management, 32.
Crozier, G. K. D., Baylis, F. (2010), The ethical physician encounters international medical travel. Journal of Medical Ethics, 36.
Dinu, M., Cioaca, A., Zbuchea, A. (2010). Health tourism in Romania: main features and trends. Journal of Tourism Challenges and Trends, (3.2), 9-34.
Ehrbeck, T., Guevara, C., Mango, P. D. (2008). Mapping the market for medical travel. The McKinsey Quarterly, 11.
Fedorov, G., Tata, S., Raveslooy, B., Dhakal, G., Kanosue, Y. Roncarati, M. (2009), Medical Travel in Asia and the Pacific: challenges and opportunities. Bangkok, UN ESCAP.
Fowler Jr, Floyd J. Survey research methods. Sage publications, 2013.
Glinos, I. A., Baeten, R., Helble, M. & Maarse, H. (2010), A typology of cross-border patient mobility. Health & Place, 16.
Goeldner, C. (1989), "39th congress AIEST: English workshop summary." Revue de Tourisme, 44.4.
Goodrich, J. N., Goodrich, G. E. (1987), Health-care tourism – an exploratory study, Tourism Management, 8(3).
Goeldner, C. (1989), "39th congress AIEST: English workshop summary." Revue de Tourisme, 44.4.
Hair, Joseph F., et al. Multivariate data analysis: A global perspective. Upper Saddle River, NJ: Pearson, 2010.
Hall, M. (2013). Medical Tourism – The ethics, regulation and marketing of health mobility, Routledge, London.
Horowitz, M. D., Rosensweig, J. A. (2008). Medical tourism vs. traditional international medical travel: a tale of two models. International Medical Travel Journal, 3(3).
Horowitz, M. D., Rosensweig, J. A., & Jones, C. A. (2007). Medical tourism: globalization of the healthcare marketplace. MedGenMed, 9(4).
Hildebrandt, Lutz. "Consumer retail satisfaction in rural areas: A reanalysis of survey data." Journal of Economic Psychology 8.1 (1987)
Hildebrandt, Lutz. "Consumer retail satisfaction in rural areas: A reanalysis of survey data." Journal of Economic Psychology 8.1 (1987)
Horowitz, M. D., Rosensweig, J. A. (2008). Medical tourism vs. traditional international medical travel: a tale of two models. International Medical Travel Journal, 3(3).
Horowitz, M. D., Rosensweig, J. A., Jones, C. A. (2007). Medical tourism: globalization of the healthcare marketplace. MedGenMed, 9(4).
Iordache, C., Ciochină, I., Roxana, P. (2013). Medical tourism–between the content and socio-economic development goals. Development strategies. Romanian Journal of Marketing, (1).
Jagyasi, P. (2009). Medical Tourism Blue. Medical Tourism Magazine.
Jancu, M., Baron, P. (1984). Directions of Romanian Tourism and of Tourist Research. GeoJournal, 9(1), 75-76. Retrieved from http://www.jstor.org/stable/41143325
John, George, Torger Reve. "The reliability and validity of key informant data from dyadic relationships in marketing channels." Journal of marketing research (1982)
Jones, C. A., Keith, L. G. (2006), Medical tourism and reproductive outsourcing: The dawning of a new paradigm for healthcare. International Journal of Fertility and Women's Medicine, 51, 6.
Jagyasi, P. (2009). Medical Tourism Blue. Medical Tourism Magazine.
Jones, C. A., Keith, L. G. (2006), Medical tourism and reproductive outsourcing: The dawning of a new paradigm for healthcare. International Journal of Fertility and Women's Medicine, 51, 6.
Kangas, B. (2010), Traveling for Medical Care in a Global World. Medical Anthropology: Cross-Cultural Studies in Health and Illness, 29.
Kapczyński, Adrian, Szromek R. Adam, (2008), "Hypotheses concerning the development of Polish spas in the years 1949–2006." Tourism Management, 29.5.
Kangas, B. (2010), Traveling for Medical Care in a Global World. Medical Anthropology: Cross-Cultural Studies in Health and Illness, 29.
Kapczyński, Adrian, Szromek R. Adam, (2008), "Hypotheses concerning the development of Polish spas in the years 1949–2006." Tourism Management, 29.5.
Lee, C.,, Spisto, M. (2007). Medical Tourism: The Future of Health Services . 12th international Conference on ISO 9000 and TQM, Taichung.
Light, D., Andone, D. (1996). The Changing Geography of Romanian Tourism. Geography, 81(3), 193-203. Retrieved from http://www.jstor.org/stable/40572792
Luque-Martínez, Teodoro, et al. "Determinants of the use of the internet as a tourist information source." The Service Industries Journal 27.7 (2007)
Lee, C.,, Spisto, M. (2007). Medical Tourism: The Future of Health Services . 12th international Conference on ISO 9000 and TQM, Taichung.
Luque-Martínez, Teodoro, et al. "Determinants of the use of the internet as a tourist information source." The Service Industries Journal 27.7 (2007)
Milstein, A., Smith, M. (2006), America's New Refugees — Seeking Affordable Surgery Offshore. New England Journal of Medicine.
Maloles, Cesar M. The determinants of customer retention. Diss. City University of New York, 1997.
Nunnally, J. C. 1978 Psychometric theory. New York: McGraw-Hill
Oh, H. (1999): “Service quality, customer satisfaction, and customer value: A holistic perspective”, Hospitality Management, Vol. 18
Parasuraman, A.; Zeithaml, V.; Berry, L. (1991): “Refinement and Reassessment of the SERVQUAL Scale”, Journal of Retailing, Vol. 67, No. 4
PATTERSON, P.G.; Johnson , L.W. (1993): “Disconfirmation of expectations and the gap model of service quality: an integrated paradigm”, Journal of Consumer Satisfaction, Dissatisfaction and Complaining Behavior, No. 6
Patten, Mildred L. Questionnaire research: A practical guide. Routledge, 2016
Patterson, P.G.; Johnson , L.W. (1993): “Disconfirmation of expectations and the gap model of service quality: an integrated paradigm”, Journal of Consumer Satisfaction, Dissatisfaction and Complaining Behavior, No. 6
Reddy, S.G., York, V.K., Brannon, L.A. (2010). „Travel for treatment: Students’ perspective on medical tourism”, International Journal of Tourism Research, 12.
Smith, M., Puczko, L. (2009). Health and Wellness Tourism, Elsevier.
Smith, R. Martinez, M. , Chanda, R. (2011). Medical tourism: A review of literature and analysis of a role for bi-lateral trade.
Silverman, David, Qualitative research. Sage, 2016.
Smith, M., Puczko, L. (2009). Health and Wellness Tourism, Elsevier Journal.
Smith, R. Martinez, M. , Chanda, R. (2011). Medical tourism: A review of literature and analysis of a role for bi-lateral trade.
Song, P. (2010), Biotech Pilgrims and the Transnational Quest for Stem Cell Cures. Medical Anthropology: Cross-Cultural Studies in Health and Illness, 29.
Steward, J. (2012). Travel to the Spas: The Growth of Health Tourism in Central Europe, 1850–1914. In Blackshaw G. & Wieber S. (Eds.), Journeys into Madness: Mapping Mental Illness in the Austro-Hungarian Empire (pp. 72-89). Berghahn Books
Steenkamp, Jan-Benedict EM, Hans CM Van Trijp. "The use of LISREL in validating marketing constructs." International Journal of Research in marketing 8.4 (1991)
Silverman, David, Qualitative research. Sage, 2016.
Taylor, Steven J., Robert Bogdan, and Marjorie DeVault. Introduction to qualitative research methods: A guidebook and resource. John Wiley & Sons, 2015.
TRAM (2006), Medical Tourism: A Global Analysis. Bruxelles: Tourism Research and Marketing.
Vandenbosch, Betty, Chris Higgins. "Information acquisition and mental models: An investigation into the relationship between behaviour and learning." Information Systems Research 7.2 (1996)
Voss, G.B.; Parasunaman, A.; Grewal, D. (1998): “The Roles of Price, Performance, and Expectations in Determining Satisfaction in Service Exchanges”, Journal of Marketing, Vol. 62, No. 4
Whittaker, A. (2008), Pleasure and pain: Medical travel in Asia. Global Public Health: An International Journal for Research, Policy and Practice, 3.
World Health Organization. (1948). World health organization constitution. Basic documents, 1.
Yap, J., Chen, S. S., Nones, N. (2008). Medical tourism: The Asian chapter. Singapore: Deloitte.
JOURNALS
Journal of Tourism Management Perspectives
Journal of Destination Marketing & Management
Journal of Outdoor Recreation and Tourism
Journal of Environmental Management and Tourism (JEMT)
ONLINE PAGES
www.anat.ro
www.citydent.ro
www.citydental.ro
www.classmed.ro
www.dentson.ro
www.drfodor.ro
www.exquisitedent.ro
www.glamourdent.ro
www.ins.ro
www.journals.elsevier.com
www.jstor.org
www.lucavisage.ro
www.omicsonline.org
www.onlinelibrary.wiley.com
www.sciencedirect.com
www.scimagojr.com
www.scitechnol.com
www.signaturesmile.ro
www.turism.gov.ro
www.zambetul.ro
APPENDICES
APPENDIX 1: THE QUESTIONNAIRE ADDRESSED TO TOURISTS IN ROMANIA
What factors do you consider may influence you when purchasing a dental service?
Service
Price
Location
When looking for a dental or spa clinic what are the means that you consult before visiting it?
Magazines
Television
Internet
Recommendation
On what occasions do you usually go to a dental or spa center?
For prevention
For pain or complaints
I do not go to the dentist/ spa treatments
The last time you went to a medical center with dental/spa profile what was the specific reason?
Cures
Extractions
Endodontics
Preventive consultation
When was the last time you followed a treatment in a medical center with dental/ spa profile?
6 months
1 year
2 years
more than 3 years
Considering the prices of dental/ spa touristic services in Romania, they are:
Very high
High
Fair
Low
Very low
When purchasing a dental or spa service during your holiday, how do you appreciate the care provided from the reception to the treatment itself?
Very good
Good
Fair
Bad
Very bad
Can you mention 5 dental or spa clinics that you know in Romania to provide high quality spa or dental services for tourists?
_________________________
_________________________
_________________________
_________________________
_________________________
How do you consider the care provided from the reception to the treatment itself in one of the mentioned clinics? (If you have purchased the service)
Very good
Good
Regular
Bad
Very bad
How do you get to know the most visited Dental / Spa Clinic?
By recommendation
Written media
Campaigns
By location
What is the degree of overall satisfaction with the service spa/ dental service that you visited until present?
Completely satisfied
Satisfied
Unsatisfied
Completely unsatisfied
How do you consider the service provided by the spa/ dental service in Romania, in general?
Very good
Good
Average
Bad
Rate the time from the request to the response of the service
Very good
Good
Average
Bad
How much would you consider the ideal time for answer to be?
Immediate
1 day
2 days
3 days
Rate the ease of communicating with the spa/ dental tourism provider:
Very good
Good
Average
Bad
How did you find the staff attention of the spa/ dental centre?
Very good
Good
Average
Bad
17.Rate the ease of communicating with the spa/ dental tourism provider:
Very good
Good
Average
Bad
18.How did you find the staff attention of the spa/ dental centre?
Very good
Good
Average
Bad
APPENDIX 2: THE INTERVIEW QUESTIONS
THE INTERVIEW APPLIED TO MANAGERS AND DOCTORS FROM DENTAL CLINICS IN ROMANIA
In your opinion, why do you think foreign tourists come in Romania?
Why dental tourism in Romania?
Why SPA?
What is actually dental tourism?
Why are Dentistry and cosmetic surgery in the top?
In your opinion, what impact has dental tourism phenomenon in Romania as a host country?
Are there a growing number of patients who come to your clinic?
Is it true that dentistry remains among 'attractions'?
What should the authorities do?
Can you list some of the reasons tourists seek for medical care in Romania?
What can you tell us about your company's progress on medical tourism market?
In your opinion, when is the peak period for dental tourism?
Does Romania take advantage of medical tourism?
Why you consider that in building the country brand should we focus on medical tourism?
What is the difference? Why foreign tourists choose to fix their teeth in Romania? Besides the price one, are there any differences?
Dear participants,
My name is Dandoczi Ruxandra and I am student at American Hotel Academy, studying International Hotel Business Management. I have chosen to make a research about Medical Tourism in Romania.
The interview should not take longer than 15 minutes to complete it. I totally understand that some questions you might find personal, that is why the information given will be confidential. Therefore the interview answers will be used only for purpose of the research.
If you have any questions or comments, you are welcome to contact me via e-mail: ruxandra.dandoczi@gmail.com
Thank you for your participation!
Yours sincerely,
Ruxandra Dandoczi
In your opinion, why do you think foreign tourists come in Romania?
I consider that the most important factor that brings foreign tourists to our country is the highest quality standards, the latest technology, highly trained medical professionals and the beauty of our country.
Why dental tourism in Romania?
Romania, prices are twice or three times lower than in Western European region and we offer the same standards of treatment as those in clinics in the United States or Western Europe so I think that this is the decisive factor and to avoid a long waiting list.
Why SPA?
Romania is known for the spa treatments in regions like Herculane, ,Felix, ,Olanesti and so on.
The procedures are modern and complex and on the market are many packages at low prices that offer different treatments, excellent accommodation, meals included and so on.
What is actually dental tourism?
An increasing number of people travel around the world to benefit from cheaper dental services than the ones provided in their country. During such trips, tourists have the chance to visit Romania, dental problems can be treated in a short time and respecting schedules are agreed with the dentist. Also, in Romania, tourists benefit for quality services at much lower prices than the ones in their countries.
Why are Dentistry and cosmetic surgery in the top?
Because are the most popular and in Romania there are quite good prices for this practices and we have professionals in this industry.
In your opinion, what impact has dental tourism phenomenon in Romania as a host country?
The phenomenon of dental tourism is becoming increasingly popular. Popular treatments such as dental implant procedures, bleaching or fillings at channel level make the difference in this niche of dental tourism.
Are there a growing number of patients who come to your clinic?
We can observed a growing number of patients coming this year, comparing with the past.
Is it true that dentistry remains among 'attractions'?
Yes, is true this statement.
What should the authorities do?
The authorities should facilitate private health sector development.
Can you list some of the reasons tourists seek for medical care in Romania?
Low costs,. avoid long waiting list,the procedure is not available in the country of origin, tourism and vacations and privacy and confidentiality
What can you tell us about your company's progress on medical tourism market?
I observed an increase in applications over the previous year so I think that we are going in the wright direction
In your opinion, when is the peak period for dental tourism?
In the summer period, when Romanians in foreign countries and foreigners come in large numbers in Romania and take advantage of low prices.
Does Romania take advantage of medical tourism?
Yes,because we are practicing lower prices in comparison with other countries and offering quality services.There are some gaps concerning the issues related to infrastructure, trust and safety.
Why you consider that in building the country brand should we focus on medical tourism?
Romania has a major advantage over other countries in the region, to other countries in the European Community so that medical art is represented by some cost much lower than the European community, creating a competitive advantage, which is basically a resource of the country. Currently, doctors are highly trained and appreciated overseas, and there is a need to keep them in the country, being prepared, being able to treat people in Romania. In conclusion, in building the country brand, one should focus on medical tourism, but also on promotions, private initiative, keeping human capital in our country, quality treatments.
What is the difference? Why foreign tourists choose to fix their teeth in Romania? Besides the price one, are there any differences?
Another aspect in this respect is the Internet speed along with the advancing technology, Romania has many things to offer like high standards services in hotels, good food, landscapes.
People can combine the medical treatments with the pleasure of relaxing, visiting and understanding a new culture.
Copyright Notice
© Licențiada.org respectă drepturile de proprietate intelectuală și așteaptă ca toți utilizatorii să facă același lucru. Dacă consideri că un conținut de pe site încalcă drepturile tale de autor, te rugăm să trimiți o notificare DMCA.
Acest articol: Medical Tourism In Romania Ruxandra Dandoczi 26.04.2017 [309792] (ID: 309792)
Dacă considerați că acest conținut vă încalcă drepturile de autor, vă rugăm să depuneți o cerere pe pagina noastră Copyright Takedown.