ANALYSIS OF BARRIERS IN MEDICAL TOURISM DURING THE COVID-19 PANDEMIC

Year 2021, Volume: 1 Issue: 1, 10 - 20, 28.02.2021

Saliha Karadayı Usta Şeyda Serdar Asan

Abstract

Medical tourism is emerging both as a business and as an academic research area that provides patients access to
medical institutions for treatment/rehabilitation outside their country of residence. Since the transnational
medical travels are interrupted due to the COVID-19 pandemic, the medical tourism, especially the mostly
requested elective low-risk treatments like dentistry, laser eye surgery, esthetics and hair transplantation are
almost come to a standstill. Therefore, this study aims to identify the barriers to the development and execution
of medical tourism during the COVID-19 Pandemic and to analyze the causal relationships between these barriers.
In order to that, text mining and Interpretive Structural Modeling (ISM) analysis were conducted. Text mining was
applied to the medical tourism related tweets in English from January to June 2020 via RapidMiner software and
the current barriers in medical tourism were identified. The relationships between these barriers were examined
via expert evaluations. Interpretive Structural Modeling (ISM) was applied to construct a structural model of the
barriers that presents how the barriers are related and the hierarchy between them. According to the hierarchical
structure the prominent obstacles were: restrictions on transportation, disruption of hospital operations,
increasing complexity of medical tourism services and unexpected fluctuations in exchange rates. The main
contributions of the study can be listed as: determining the barriers to medical tourism under pandemic conditions
by using text mining, and the analysis of the relationships between these barriers with interpretive structural
modeling and revealing the root barriers.

Keywords

Medical tourism, Barrier Analysis, Text mining, Interpretive Structural Modeling

PANDEMİ DÖNEMİNDE MEDİKAL TURİZM ENGELLERİ ANALİZİ

Abstract

Kişilerin ikamet ettikleri ülke dışında tedavi / rehabilitasyon görmek için tıbbi kurumlara erişimlerini sağlayan
medikal turizm, hem iş hem de araştırma alanı olarak son yıllarda gittikçe artan bir şekilde dikkat çekmektedir.
Uluslararası tıbbi seyahatlerin COVID-19 salgınına yönelik önlemler kapsamında kesintiye uğramasıyla, medikal
turizm kapsamındaki diş tedavisi, lazer göz ameliyatı, estetik ve saç ekimi gibi isteğe bağlı ve düşük risk taşıyan
tedavilere olan talep de duraklamıştır. Bu bağlamda bu çalışma, pandemi döneminde medikal turizm ile ilgili
engelleri tespit etmeyi ve bu engeller arasındaki nedensel ilişkileri analiz etmeyi amaçlamaktadır. Çalışmada
yöntem olarak metin madenciliği ve Yorumlayıcı Yapısal Modelleme analizlerine başvurulmuştur. RapidMiner
yazılımının kullanımıyla, medikal turizm ile ilgili Ocak-Haziran 2020 arasında atılan twitter metinleri incelenmiş ve
medikal turistler tarafından ifade edilen engel ve zorluklar belirlenmiştir. Engeller arasındaki yapısal etkileşim
uzman değerlendirmeleri aracılığıyla Yorumlayıcı Yapısal Modelleme ile değerlendirilmiş ve son olarak bu
engellerin birbirini nasıl etkilediği ve aralarındaki hiyerarşik ilişki ortaya konmuştur. Buna göre öne çıkan engeller
ulaşıma getirilen kısıtlamalar, hastanelerin işleyişinin aksaması, medikal turizm hizmetlerinin işleyişinin
karmaşıklaşması ve döviz kurlarında beklenmedik dalgalanmalar olmuştur: Çalışmanın ana katkıları metin
madenciliği kullanılarak Pandemi koşullarında medikal turizmin önündeki engellere dikkat çekilmesi ve engeller
arası ilişkilerin yorumlayıcı yapısal modelleme ile analizinin ardından kök engellerin ortaya konmasıdır.

Keywords

Medikal turizm, Engel Analizi, Metin madenciliği, Yorumlayıcı Yapısal Modelleme

References

• Aiwerioghene, E.M., Singh, M., & Ajmera, P. (2019). Modelling the factors affecting Nigerian medical tourism sector using an interpretive structural modelling approach, International Journal of Healthcare Management, DOI: 10.1080/20479700.2019.1677036
• Akbar, F.H., Rivai, F., Abdullah, A.Z., Awang, A.H., & Maretta, Y.A. (2020). Dental tourism: New strategies for the health care in Indonesia, International Journal of Scientific and Technology Research, 9(2), 1432-1433.
• Alghizzawi, M., Habes, M., & Salloum, S.A. (2020). The Relationship Between Digital Media and Marketing Medical Tourism Destinations in Jordan: Facebook Perspective, Advances in Intelligent Systems and Computing, 1058, 438-448.
• Aljumah, A., Nuseir, M.T., & Islam, A. (2020). Impacts of service quality, satisfaction and trust on the loyalty of foreign patients in Malaysian medical tourism, International Journal of Innovation, Creativity and Change, 11(2), 451-467.
• Andreou, K., Ioannou, P., Konstantakopoulou, O., Kaitelidou, D., Galanis, P., & Charalambous, G. (2020). The attitudes of specialists towards medical tourism and in vitro fertilization medical tourism services in Cyprus, Archives of Hellenic Medicine. 37(2), 191-199.
• Asher, C.M., Fleet, M., Jivraj, B., & Bystrzonowski, N. (2020). Cosmetic Tourism: a Costly Filler Within the National Health Service Budget or a Missed Financial Opportunity? A Local Cost Analysis and Examination of the Literature, Aesthetic Plastic Surgery, 44(2), 586-594.
• Boguszewicz-Kreft, M., Kuczamer-Kłopotowska, S., Kozłowski, A., Ayci, A., & Abuhashesh, M. (2020). The theory of planned behaviour in medical tourism: International comparison in the young consumer segment, International Journal of Environmental Research and Public Health, 17(5),1626.
• Brown, J., Johnson, J., Ozan-Rafferty, M.E., Sharma, M., & Barbera, S. (2020). Internet Narratives Focused on Health Travelers' Experiences in India: Qualitative Analysis, Journal of medical Internet research, 22(5).
• Bunescu, R. C. & Mooney, R.J. (2007). Extracting Relations from Text: From Word Sequences to Dependency Paths, In book: Natural Language Processing and Text Mining, Bellevue, USA.
• Camargo-Plazas, P., Silva e Silva, V., Duhn, L., & Tregunno, D. (2020). Teaching about globalization for nursing practice: Medical tourism as an exemplar, Nurse Education Today, 89.
• Cham, T.-H., Lim, Y.-M., Sia, B.-C., Cheah, J.-H., & Ting, H. (2020). Medical Tourism Destination Image and its Relationship with the Intention to Revisit: A Study of Chinese Medical Tourists in Malaysia, Journal of China Tourism Research, (Article in press).
• Connell, J. (2006). Medical tourism: Sea, sun, sand and surgery, Tourism Management, 27, 1093–1100.
• Dalstrom, M., Chung, R., & Castronovo, L. (2020). Impacting Health through Cross-Border Pharmaceutical Purchases, Medical Anthropology: Cross Cultural Studies in Health and Illness, 39(2), 182-195.
• Dwivedi, G., Srivastava, S.K., & Srivastava, R.K. (2017). Analysis of barriers to implement additive manufacturing technology in the Indian automotive sector. Int. J. Phys. Distrib. Logistics Manage. 47(10), 972–991.
• Ferrer, M. & Medhekar, A. (2012). The factors impacting on the management of global medical tourism service supply chain, Journal of GSTF Business Review, 2(2), 206-211.
• Foster, S.C. (2020). Practitioner Application: Exploring Internal Benefits of Medical Tourism Facilitators' Satisfaction: Customer Orientation, Job Satisfaction, and Work Performance, Journal of healthcare management / American College of Healthcare Executives, 65(2), 105-106.
• Gan L. L. & Frederick J. R. (2015). Medical Tourism: Consumers’ Concerns Over Risk and Social Challenges, Journal of Travel & Tourism Marketing, 32(5), 503-517.
• Glinos, I.A., Baeten, R. & Boffin, N. (2006). Cross-border contracted care in Belgium hospitals. In Rossenmöller M, McKee M, Baeten R (Eds.). Patient mobility in the European Union: learning from experience. Copenhagen, Denmark: European Observatory on Health Systems and Policies, 97–118.
• Hindi, Z., Congly, S., Tang, E., Skaro, A., & Brahmania, M. (2020). Liver Transplant Tourism Liver Transplantation, 26(2), 276-282.
• Hong, J.-W., & Moon, J.-Y. (2017). Category effect of keywords on healthcare industry by text mining in web, Journal of Theoretical and Applied Information Technology, 95(21), 5924-5931.
• Jackson, C., Snyder, J., Crooks, V.A., & Lavergne, M.R. (2019). Exploring isolation, self-directed care and extensive follow-up: factors heightening the health and safety risks of bariatric surgery abroad among Canadian medical tourists, International Journal of Qualitative Studies on Health and Well- being, 14(1).
• Jain, V., & Ajmera, P. (2018). Modelling the factors affecting Indian medical tourism sector using interpretive structural modeling, Benchmarking, 25(5), 1461-1479.
• Kao, A. & Poteet, S.R. (2007). Natural Language Processing and Text Mining, Bellevue, USA.
• Karadayi-Usta, S., & Serdarasan, S. (2020a). A conceptual model of medical tourism service supply chain, Journal of Industrial Engineering and Management, 13(2), 246-265.
• Karadayi-Usta, S., & Serdarasan, S. (2020b). Uyarlamalı seçime-dayalı konjoint analizi ile medikal turizm hizmeti tasarımı, Hacettepe Sağlık İdaresi Dergisi, 23(2), 317-332.
• Khan, M.J., Khan, F., Amin, S., & Chelliah, S. (2020). Perceived risks, travel constraints, and destination perception: A study on sub-saharan African medical travellers, Sustainability (Switzerland), 12(7), 2807, 1-16.
• Kim, S., & Lee, W.S. (2019). Network text analysis of medical tourism in newspapers using text mining: The South Korea case, Tourism Management Perspectives, 31, 332-339. Kim, Y.-J., & Choi, H.-Y. (2019). A study on the risk recognition and motivation of medical tourists- comparison among Japan, Russia and China, Asia Life Sciences Supplement, 20(1), 35-46.
• Ko, S.-H. (2020). The effect of medical tourism motivation and psychological distance on perceived risk and revisit intention-focusing on Chinese medical tourists, International Journal of Advanced Science and Technology, 29(4), 277-284.
• Kumar, S., Breuing, R. & Chahal, R. (2012). Globalization of Health Care Delivery in the United States through Medical Tourism Globalization of Health Care Delivery in the United States through Medical Tourism. Journal of Health Communication, 17(2), 177–198.
• Lee, H.K. & Fernando, Y. (2015). The ancecedents and outcomes of the medical tourism supply chain, Tourism Management, 46, 148-157.
• Lee, J.C., Morrison, K.A., Maeng, M.M., Ascherman, J.A., & Rohde, C.H. (2018). Financial Implications of Atypical Mycobacterial Infections after Cosmetic Tourism: Is It Worth the Risk?, Annals of Plastic Surgery, 81(3), 269-273.
• Leto Barone, A.A., Grzelak, M.J., Frost, C., Ngaage, L.M., Ge, S., Kolegraff, K., Chopra, K., Tornheim, J.A., Caffrey, J., Lifchez, S.D., & Rasko, Y. (2020). Atypical Mycobacterial Infections After Plastic Surgery Procedures Abroad: A Multidisciplinary Algorithm for Diagnosis and Treatment, Annals of plastic surgery, 84(3), 257-262.
• Liman, H., Makusidi, M., & Sakajiki, A. (2020). Kidney transplant-related medical tourism in patients with end-stage renal disease: A report from a renal center in a developing nation, Sahel Medical Journal, 23(1), 7-11.
• Lumenta, D.B. (2020). Commentary on: Breast implant prevalence in the Dutch female population assessed by chest radiographs, Aesthetic Surgery Journal, 40(2), 165-166.
• Mason, A. & Wright, K.B. (2011). Framing Medical Tourism: An Examination of Appeal, Risk, Convalescence, Accreditation, and Interactivity in Medical Tourism Web Sites, Journal of Health Communication, 16, 163–177.
• Mathijsen, A., & Mathijsen, F.P. (2020). Diasporic medical tourism: A scoping review of quantitative and qualitative evidence, Globalization and Health, 16(1), 27.
• Mi, C., Chen, Y., Cheng, C.-S., Uwanyirigira, J.L., & Lin, C.-T. (2019). Exploring the determinants of hot spring tourism customer satisfaction: Causal relationships analysis using ISM, Sustainability (Switzerland), 11(9), 2613.
• Moon, J.-Y., & Hong, J.-W. (2018). The differential effects of online content on healthcare adoption: Hierarchical modelling, Journal of Theoretical and Applied Information Technology, 96(6), 1722-1731.
• Murray, L., & Khan, N. (2020). The im/mobilities of ‘sometimes-migrating’ for abortion: Ireland to Great Britain, Mobilities, 15(2), 161-172.
• Nishikawa, M., Niiya, K., & Okayasu, M. (2014). Addressing practical issues related to nursing care for international visitors to Hiroshima, Revista da Escola de Enfermagem, 48(2), 299-307.
• Onuncu Kalkınma Planı 2014 - 2018 (2013). Kalkınma Bakanlığı, Ankara.
• Park, J.-K., Ahn, J., Han, S.-L., Back, K.-J., & An, M. (2020). Exploring Internal Benefits of Medical Tourism Facilitators' Satisfaction: Customer Orientation, Job Satisfaction, and Work Performance, Journal of healthcare management / American College of Healthcare Executives, 65(2), 90-105.
• Popescu, A.-M. & Etzioni, O. (2007). Extracting Product Features and Opinions from Reviews, In book: Natural Language Processing and Text Mining, Bellevue, USA
• Raggio, B.S., Brody-Camp, S.A., Jawad, B.A., Winters, R.D., & Aslam, R. (2020). Complications Associated with Medical Tourism for Facial Rejuvenation: A Systematic Review, Aesthetic Plastic Surgery, 44(3), 1058-1065.
• Rodriguez, C. (2018). Chinese maternity tourists and their “anchor babies”? Disdain and racialized conditional acceptance of non-citizen reproduction, Advances in Gender Research, 25, 91-106.
• Sadeh, E., & Garkaz, M. (2019). Interpretive structural modeling of quality factors in both medical and hospitality services in the medical tourism industry, Journal of Travel and Tourism Marketing, 36(2), 253-267.
• Sage, A.P. (1977). Systems Methodology and Planning: Methodology for Large Scale Systems. McGraw-Hill, New York.
• Sağlık Turizmini Geliştirme Konseyi (2012). Medikal turizmde asistan firmalar, 6/11/2018. http://www.saturk.gov.tr/images/pdf/tyst/08.pdf
• Sharma, A., Prasai, N., Ajmera, P., Yadav, S., & Madan, S. (2020). Challenges faced by medical tourists in India and its growth prospects (A descriptive study), International Journal of Scientific and Technology Research, 9(2), 5005-5011.
• Sunanta, S. (2020). Globalising the Thai ‘high-touch’ industry: exports of care and body work and gendered mobilities to and from Thailand, Journal of Ethnic and Migration Studies 46(8), 1543-1561
• Uluslararası Sağlık Turizmi ve Turistin Sağlığı Hakkında Yönetmelik (17/06/2020). https://saglikturizmi.saglik.gov.tr/TR,25259/uluslararasi-saglik-turizmi-ve-turistin-sagligi-hakkinda- yonetmelik.html
• Uner, M.M., Cetin, B., & Cavusgil, S.T. (2020). On the internationalization of Turkish hospital chains: A dynamic capabilities perspective, International Business Review, 29(3).
• Unsworth, D.J., Mathias, J.L., Dorstyn, D.S., & Koblar, S.A. (2020). Stroke survivor attitudes toward, and motivations for, considering experimental stem cell treatments, Disability and Rehabilitation, 42(8), 1122-1130.
• Yang, I.-C.M. (2020). A journey of hope: an institutional perspective of Japanese outbound reproductive tourism, Current Issues in Tourism, 23(1), 52-67.
• Yenradee, P., & Dangton, R. (2000). Implementation sequence of engineering and management techniques for enhancing the effectiveness of production and inventory control system. Int. J. Prod. Res. 38(12), 2689–2707.
• Yudatama, U.K.Y., Hidayanto, A.N., & Nazief, B.A.A. (2018). Approach using interpretive structural model (ISM) to determine key sub-factors at factors: Benefits, risk reductions, opportunities and obstacles in awareness IT Governance. J. Theor. Appl. Inf. Technol. 96(16), 5537–5549.