Amin Dinarvand¹, Abbas Ghavam^2*, Abbas Yazdanpanah³

 

^{2, 3}Assistant professor, ¹Department of Healthcare Management, Marvdasht Branch, Islamic Azad University, Marvdasht, Iran.

Email: ghavam39@gmail.com

item	organizational post title	age	gender	Occupation  history	related activity record
1	laboratory expert	29	man	3	no
2	senior expert of management	35	man	7	yes
3	laboratory in-charge	51	man	25	no
4	senior manager	48	man	17	yes
5	senior expert of laboratory sciences	50	man	24	no
6	senior manager of financial affairs	49	man	25	no
7	university lecturer	47	man	15	yes
8	technical in-charge	36	man	10	no
9	installations director	39	man	18	no
10	head nurse	43	woman	22	yes
11	director of public relations	47	man	21	no
12	director of accounting	50	man	27	yes

item	Theme	subtheme	Items
1	motives and factors of demand	providing high-quality and appropriate services	High-quality clinic and Para clinic services welfare services and hoteling
		providing facilities for patients	up-to-date and advanced facilities and equipment financial facilities and discounts
		role and position of the government	support from medical tourism supervision on related processes
2	Marco motives and factors	creating infrastructure and public facilities	transportation, hotel, airport creating medium companies and translators reinforcing inter-sector cooperation
		factors relating to transportation	obviating visa between countries reduction of entrance and exit dues
		factors relating to health system	creating health villages creating recreational facilities in medical environment development of human resources reinforcing insurance system
3	motives and factors of promoting patients awareness		Easy access to information by patient economic marketing in health
		advertisement in media	advertisement in various media virtual space and related potentials
4	individual motives and factors	behaviors considerations	respectful behavior observing patients' rights
5	medical advantages of tourism	increase of economic prosperity	creating exchange employment
		optimal interaction with the world	familiarity with the culture of other countries positive advertisement of the country in international level

Motives and factors of demand: The first step in the provision of quality services was the most important factor affecting the demand for medical tourism. "If tourists suffer from illness and provide good facilities and the cost of their treatment is reduced, as well as better quality services, then tourists will surely be more likely to go over the course of the year" (p.12) Participants said most health tourists seek quality services at the lowest possible cost and benefit from side-travel to their destination country to receive medical services. "Ultimately, if the services provided are of a quality or in a financially convenient way for the consumer, they are more likely to be considered by the tourists. I even tell you that if there is a high quality hotel service provided by the patients, it will surely attract the tourist. Will increase significantly "(p.2) The provision of up-to-date facilities and facilities along with financial facilities for patients, including demand stimuli, was introduced in the form of quality services.".If tourists are ill, we have good facilities and the cost of their treatment is reduced, and we also offer better quality services. Certainly, the number of tourists will increase over the course of the year." (Participant3) The most important facilities in the study were financial facilities and discounts. "Financial facilities, including the provision of discounts, play a very important role, for example, I can visit the country 100% if I know that I am treated in a much better and cheaper country." (participant 2) The role of the government in providing support for medical tourism was among the factors that influenced the stimulation of demand for medical tourism. "Of course, the role and support of the government in this field cannot be ignored, because when a system has a strong backing, it would be better to grow up in this area." (participant 2)

Macro motives and factors: In this group, the focus was on the macro infrastructure of the community, such as airport, hotel, transportation and more. According to some of the participants, the first concept of good tourism is arriving at the airport. "A person can easily and easily use railroad, airborne, and other means of transport, whether he or she will return and not be able to receive a good service, but will be in trouble due to problems in transportation and transportation." (participant 2) In issues related to the health of tourists, the participants referred to the two main reasons for visa refusal and reduced or eliminated entry and exit accidents. "Withdrawal of visas, maybe I can say that the biggest problem of people's problem is that if this problem is easy, we will certainly have a great transformation in this industry" (p.1) One of the most important macro infrastructures in the health field was the creation of health villages. "Of course, the idea of ​​creating a health village can be an important step towards the development of medical tourism, as these villages, in addition to having tourist attractions, have the capacity to build specialized collections and clinics with the natural conditions of those areas so that whatever the patient wants to be available to him. (participant 2) The development of human resources and the insurance system were among the components emphasized by the participants. "Training and empowering human resources to be accountable and fluent in effective communication that can best meet patient's rights is the principle of the accountability unit that, in my opinion, can be a very influential factor in the development of medical tourism." (participant 10)

Information factors and motives: Participants in the study also emphasized the importance of advertising and information. "When the patient himself has comprehensive information from the medical service provider, it is undoubtedly easier to access the facility, and this is a two-way win-win issue, As an example, the lack of proper information on a hospital site, especially in the international language Can create problems in the development of medical tourism." (participant7). Economic marketing participants also identified the information components that affect the awareness of patients. "Of course, you should not have neglected the attention to the marketing issue in this area, as if we were going to make the hospital a business-centered one" (participant. 4) The sub-component of other propaganda was required in a variety of media. "Advertising in the media is imperative for attracting tourists. Of these variables, information communication mechanisms have only a meaningful relationship with the promotion of media by attracting medical tourists." (Pparticipant. 12) Advertising in other health care centers was an effective component. "Today, given the public's access to cyberspace and the community's need for general information; people have a special interest in sites and cybercafe, so advertising in this space has a huge impact on tourism and tourism." (P. 11)

Individual factors and motives: Principles and behavioral factors are effective in attracting medical tourism. "Certainly the initial encounter in each health center by the first person (and admission) can be a good source of returning tourists" (p. 11) Observing patients' rights is one of the most important determinants of the health of the tourist. "If they are dearly treated and treated well in different treatment centers, they will be more comfortable choosing the country of treatment" (p. 5)

Benefits of Medical Tourism: Medical tourism in the first place will increase the value. "I strongly believe that this industry (medical tourism) leads to the growth of the income and the entry of foreign exchange into the economic cycle of the Ministry of Health, which is a significant source for this part of the country" (ICE 8) Participants said that foreign exchange has an impact on job creation in the country. "Accordingly, the style of foreign exchange earnings will increase the quality of its work and its health sector, including the climate and the nature of the cultural and historical attractions of renowned doctors, and the advanced therapeutic and advanced therapies" (p.12) Therefore, the most important benefits of medical tourism are economic growth, employment growth and rising exchange rates. Therefore, the most important benefits of medical tourism are economic growth, employment growth and rising exchange rates. "I emphasize the belief that the reputation of the destination country is presented in the internationally acclaimed and can be seen in the light of medical tourism. When we see all of our experts' knowledge and expertise, of course, there must be other conditions, respect for their rights. And so on Then see what kind of propaganda we get from the world "(p.5) The health system is affiliated with the public budget of the state. By incorporating part of the health system's income into the medical tourism industry, it can be an inexhaustible source in this regard, which can be done with the plan.

DISCUSSION

The present study showed that for the development of medical tourism, the existence of strong therapeutic and health infrastructures, reasonable doctors, prices, and the proper quality of services within the country should be developed to expand medical tourism. Various studies have shown that a combination of factors has contributed to the growth of medical travel, including the high cost of living in industrialized countries, the easing of international travel, and the improvement of the level of technology and medical standards in many countries of the world¹⁰. One reason for stretching for medical travel is to reduce the treatment time in other countries¹¹ The most important factors in health tourism are the low cost of medical care, the search for a qualified and expert physician, a good medical care, safety, and a shorter waiting time for treatment¹². The study of Petrazin and Stefano as the index of medical tourism: indicators such as high quality, affordability and the availability of all services as a prerequisite for the development of medical tourism, which are consistent with the findings of the present study¹⁴. Among the important points in countries that are mostly hospitable tourists, provision of special facilities for patients, including renting housholds, is free of charge between the airport and the hospital of the place of service¹⁵. In India, after the software industry, medical tourism can be considered the most successful industry. The current market size of this tourism market in India was more than $ 333 million and by 2014 it was more than $ 1 billion¹⁶. With regard to providing financial facilities, successful countries put in place various measures, including special discounts for medical and insurance tourists. Singapore, for example, is one of the leading countries in medical tourism¹⁷, in which the findings of this study can be explained. Also, good behavior in their study also considered the demand factors, including the provision of quality facilities and facilities for tourists, which were consistent with the findings of the present study¹⁸ The prevailing view in many health tourism researches has been the emphasis on infrastructural and economic components, and refers only to variables such as the development of economic infrastructure¹⁹. Studies have shown that access to appropriate transport is a necessity for economic development in each country²⁰. Sadr Momtaz et al., In his study, considered the development of transport infrastructure and amenities as essential for the development of medical tourism, which is consistent with the findings of this study²¹. Different studies in the world have been carried out to identify the most important factors influencing the development of health tourism and one of the most important factors known as advertising. In these studies, the advertising factors affecting the growth and development of health tourism are as follows:

- branding

- Special attention to policy making in this section

- Full harmonization of public and private sector related to health tourism

- Investment to strengthen health tourism infrastructure

- Establishing a private health tourism organization

- Special support for active collections in this field

- Holding and participating in different exhibitions of health tourism (22-24)

According to studies, the most important source of health tourism is their friends and relatives. According to Nilsson's statistics, 92 percent of those who went for treatment suggested that friend and family suggestions were more valid in their decision-making. The second source of online searches, about 70% of health tourism is specifically considering the views of other therapists. Many health tourism institutes provide full information on doctors, experts and sometimes those who have been treated, on social networks that use those information to those who plan to travel to that country.

According to Nielsson's research, which was conducted in 56 countries by reviewing 28,000 respondents, between 2009 and 2011, people's trust in television advertisements (47%), journals (47%), and newspaper advertisements (46%) were each as high as 24, 20 and 25 percent respectively^25,26. The present study also indicated that the emphasis on informing such as promoting awareness of the patients and advertising in the media would affect the development of medical tourism in the research environment that would affect the social welfare hospital. As one of the factors contributing to the development of medical tourism in the country, increased media advertising and interaction with neighboring countries, confirms the findings of the present study, as was done in Thompson's Wenckett and McCarlcher study (27). Also, in the study of Delghashi et al., The development of advertising is a factor affecting the development of health tourism especially in Tehran and for tourists in the United Arab Emirates, which confirms the findings of this study (28). Finally, according to the results of the interviews conducted with the participants in the study, it can be said that advertising has a very significant effect on the expansion of medical tourism, especially advertising on the level of cyberspace and national and international media. Therefore, the necessary mechanisms must be defined and used to make the most of this advertising space in the media and cyberspace. Today, the countries that plan to expand their gross national income through the expansion of the market for services have found the tourism market to be the most important market for turnover, generating productive labor and marginal profits, the direct benefits of tourism, the creation of new employment opportunities, the sale of services and monetization, and the promotion of living standards and economic development in the region. In areas where there is stagnation and unemployment. Tourism development promotes economic mobility, recruiting young forces and preventing immigration. With the circulation of economic circles in the region, the government also creates infrastructure through tax payments, and the general economic situation in the region improves. In thriving economic areas, tourism also boosts prosperity and continues to grow. The indirect benefits of tourism are the development of other industries and other economic sectors²⁹. Among the different sections of tourism, the health tourism area, due to its specific characteristics, has a higher rate of growth than other areas and needs special attention. Although it is difficult to estimate the volume of business in the world due to the emergence and lack or absence of accurate statistics, the growing trend of these figures is well illustrated by the fact that some countries in the world are well aware of the timely investments in large In the industry, they are monetized and rapidly expanding. According to the latest figures, the health tourism turnover in the world is estimated at about $ 100 billion, an increase of 20% per year (29-31). In the present study, two major economic advantages of health tourism have been considered. The main advantage of income and foreign exchange earnings and other advantages of employment have been mentioned in other studies. The findings suggest that the Iranian government considers all the factors affecting the medical tourism industry to develop medical tourism. By developing a comprehensive and coordinated plan, the country's medical tourism industry will be expanded²¹.

 

Figure 1: final template of development of medical tourism

 

CONCLUSION

Given the issues raised by the motivators and factors related to the field of demand, it will be clear that the provision of quality services and facilities, including modern and advanced equipment, along with the provision of financial incentives and grants, when conducted under the supervision of the government and supported by it, can be Significantly increases the growth of medical tourism. Because of the factors affecting the development of medical tourism, it can be argued that the most important factors in the development of infrastructure such as hotels and airports and transportation have improved the access of health tourists to targeted country services, and when these infrastructures are equipped with border crossing facilities Such as visa waivers and the reduction or elimination of entry and exit requirements, the result will be more tangible. In this format, it was recommended that governments contribute to the development of health tourism through infrastructure related to the health system, including the development and creation of health villages and the establishment of an appropriate system of insurance between countries, and ultimately the development and development of qualitative human resources. Various internal studies have argued that health tourism in Iran, despite the high quality of healthcare services and low prices, has not yet reached its place in the market due to the lack of appropriate advertising, and has taken the first steps. While the government, based on its plans, should provide 30% of the country's health care needs through the export of goods, medical services and health tourism by the end of the fourth plan^23,32,33. Accordingly, based on the findings of this study, the following pattern is proposed for exploitation in the promotion of medical tourism.

Strengths and weaknesses of the study: This study is part of a small study that studies the development of medical tourism industry in Iran. The study is also one of the only studies that has examined the tourism industry at the Social Security Hospital, which has provided significant results in this regard. In the end, the study is one of the few studies that have been carried out in the field of medical tourism after the changes in the health system, especially the health plan. Among the limitations of this study, a study in a hospital is a form of social security that limits the ability to extend the results to the entire country.