Evaluation of Perceived Service Quality and Loyalty of Medical Tourists to India

Abstract

Medical tourism, a growing phenomenon in the world today, possesses a worthwhile potential for the economic development of any country. Globalization, development of information and communications technology (ICT) and adherence to international quality standards potentially result in a significant increase in the movement of patients and healthcare professionals across national boundaries. The emerging manifestation of healthcare is known as medical tourism or health tourism or medical travel. Patients in developed countries such as United States of America (USA), Canada, Western Europe, Australia and United Kingdom (UK) prefer cross-border healthcare for such specific reasons as low cost, avoidance of long waiting time, low insurance premium, affordability of international air travel, favorable economic exchange rates, customized services, Joint commission international (JCI) accredited hospitals, and an opportunity to combine vacation with treatment while maintaining privacy and confidentiality. The demand for medical tourism in India is experiencing a tremendous growth. A study conducted by Confederation of Indian industry (CII) reveals that India has the potential to attract one million medical tourists per annum contributing huge amount of revenue to the Indian economy. However, the Indian medical tourism sector faces various challenges such as an image of poverty and poor hygienic conditions, safety and security issues of the patients, xenophobia reflecting cultural as well as psychological barriers, inadequate health care standardization, Government restrictions and so on.
Since India attempts to position itself as one of the preferred global medical tourism hubs, a thorough understanding of means to attract, satisfy and retain medical tourists is extremely important. In such context, the medical tourist‟s perception of service quality is critical to healthcare organization‟s overall success. The perception of service quality is useful for the healthcare providers to identify various dimensions that lead to patient satisfaction. This research is primarily concerned with the study of service quality issues in the context of medical tourism. This may also be useful for the purpose of policy formulation on improving medical tourism service quality in India.
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A study on medical tourism service quality and loyalty has been conducted at seven Indian hospitals providing healthcare services to medical tourists. Fifty two items of service quality and thirteen items of service loyalty are included in the questionnaire through review of related literature and discussion with a focus group. Five hundred and thirty four (534) useful responses were tested to examine the validity and reliability of the scale to ensure a quantitative and statistically proven identification of the responses. The test for quantitative variables was conducted by factor analysis on responses using the principal component method followed by varimax rotation to ensure that the variables are important and suitable for the model using SPSS 19.0. The exploratory factor analysis (EFA) is used to identify the underlying dimensions of medical tourism service quality (MTSQ) and medical tourism service loyalty (MTSL) for medical tourism in India. Next, confirmatory factor analysis (CFA) was used to confirm the factor structure of the constructs and validate EFA results. Finally, structural equation modeling (SEM) is employed to examine the hypothesized relationships.
A comparative evaluation on medical tourism challenges (enablers) has been made. Interpretive structural modeling (ISM) approach has been used to establish interrelationship among the system design requirements and is portrayed in a hierarchical diagraph. However, the enablers having strong direct impact in the direct relationship matrix can suppress hidden factors that may substantially influence the model under consideration. Therefore, Fuzzy matrix cross-reference multiplication applied to a classification (FMICMAC) is introduced to check the sensitivity between the enablers and finally the key-enabler is identified. Quality function deployment (QFD) is used to develop the system design requirements considering the service quality dimensions as voice of customers. In order to transfer best practices among medical tourism service providers, a benchmarking study is carried out using data envelopment analysis (DEA). Since the decision making units (DMUs) have the liberty of choosing the weights, they generally choose higher weight on the parameters in which they are doing well and neglect the parameters in which they do not perform well. In this process the efficient DMUs may be considered as inefficient DMUs. However, all the parameters are equally vital in case of medical tourism. To restrict this uncertainty, assurance region approach is employed by imposing additional constraints on the weights. The
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study finally provides some useful guidelines for the decision makers and managers for improving service quality in Indian medical tourism settings.