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Motivators, decision factors, and
information sources influencing
those predisposed to medical
tourism
Jennifer N. Henson, Bonnie S. Guy and Michael J. Dotson
Correspondence to:
Jennifer N. Henson,
Appalachian State
University, Raley Hall,
Boone, NC 28608, USA
nevinsjl@appstate.edu
Abstract
This exploratory study, employing a national
sampling of persons in the USA, focused on a
group of respondents who self-identified as willing
to consider seeking medical care abroad, otherwise
known as medical tourism. To learn more about
how such individuals approach the decision of
whether to engage in medical tourism, they were
surveyed regarding their motivations to do so, the
decision factors they would consider important,
and the information sources they would consult.
In addition, the study sought to determine if these
responses differed across several variables, such as:
(a) the nature of the medical condition for which
treatment is sought (life threatening, serious but
not life threatening, medically optional or life
enhancing), (b) prior international travel experience
and prior receipt of care abroad, (c) confidence that
their health insurance was sufficient to cover current
and future medical needs, (d) risk aversion, and (e) a
number of basic demographic variables. The results
contribute to limited empirical research on the consumer decision-making process of those considering
medical tourism. Findings provide tentative guidance to countries and healthcare providers marketing their services to medical tourists, as well as to
domestic healthcare providers either competing
against or referring patients to medical tourism
options.
Keywords: Medical tourism, Medical decision
making, Sources of medical tourism information
of obtaining health services abroad, is a phenomenon and industry which is rapidly expanding and
undergoing dynamic change. However, many note
the lack of original and replicated empirical research
on who considers medical tourism as an option to
obtain needed or desired healthcare services,13
what conditions motivate them to do so,4 what
factors drive their decision making,3,5 and what
sources they consult to obtain information important to them.3,6,7
A much clearer understanding is needed about
how potential and/or actual medical tourists go
through the decision-making process about
(a) whether to participate in medical tourism,
(b) what destinations to consider and select, and
(c) what healthcare facilities and providers to consider and select. Concern has been expressed that
there are insufficient health communication efforts
to adequately inform potential medical tourists
about the options, benefits, and risks,8,9 and suggestions that patients should obtain information from
multiple sources including the internet, others
with similar experiences, family members, primary
care physicians, and foreign provider facilities. In
addition, a limited space in promotional materials
necessitates valid knowledge of the motivations
and considerations people find important.5
There have been some conceptual pieces outlining
proposed decision models for medical tourists.
Smith and Forgione10 present a two-stage model,
proposing that those who decide to become
medical tourists first determine a country or location
for their care, after which they make decisions about
what facility and doctors they will choose. This
model does not address what goes into the original
decision to seek or reject the option of receiving care
outside ones domestic borders. Other conceptual
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Henson et al. Motivators, decision factors, and information sources influencing medical tourism
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Henson et al. Motivators, decision factors, and information sources influencing medical tourism
Risk aversion
Perceived risk is the function of uncertainty and
potential consequences inherent in the product,
in the pace and mode of purchase, within the subjectivity of tourists themselves it is individual and
situational, shaped by past experiences, lifestyle,
demos, culture.20 It seems likely that a higher importance on various decision factors would be found
among those who are more risk averse than
among those who are more risk tolerant.
Demographics
Various studies provide conflicting results regarding differences in medical tourism motives and
decision making based on age, gender, education,
marital status, children, income, etc. Therefore, this
study seeks further clarification on how demographics correlate with medical tourism motivations,
decision
factors
considered,
and
information sources utilized.
Methods
Healthcare coverage
In one study, 83% of respondents reported having
no domestic health coverage for medical treatments
sought.13 Those who are not insured or who have
inadequate insurance coverage should be more
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Henson et al. Motivators, decision factors, and information sources influencing medical tourism
Demographics
Gender
Male
Female
Age
2129
3039
4049
5059
60+
Education
High school or less
Some college
Associate/Bachelor degree
Graduate degree
Health insurance coverage
Yes
No
Frequency
Percent
98
96
50.5
49.5
2
31
41
59
61
1.0
16.0
21.1
30.4
31.4
20
45
62
67
10.3
23.2
32.0
34.5
180
15
92.3
7.7
Results
Medical tourists and non-tourists
Data were initially pooled across all three medical
treatment conditions to distinguish those likely to
consider healthcare treatment abroad from those
not likely to do so. The data were coded for segmentation using K-means cluster analysis, predicated on
responses to the question, I would consider seeking
medical treatment outside the U.S. if and included
eight different items assessing different motivations
for considering traveling abroad for medical services. Responses were measured on a 5-point
Table 2: Results of cluster analysis of willingness to consider medical treatment outside USA
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Cluster 1:
Non-tourists
Item mean
Cluster 2: Medical
tourists
Item mean
2.62
4.25
2.49
4.39
1.85
2.07
3.93
3.82
1.62
3.14
1.57
2.56
1.79
3.18
4.19
3.15
Henson et al. Motivators, decision factors, and information sources influencing medical tourism
Medical tourists
Cluster
Demographics
Gender
Male
Female
Age
2129
3039
4049
5059
60+
Marital status
Married
Unmarried
Children
Yes
No
Education
High school or less
Some college
Associate/Bachelor degree
Graduate degree
Income
<$40 000
$40 000$70 000
$70 001$100 000
$100 001$150 000
>$150 000
Frequency
Percent
74
56
53.2
40.3
2
16
31
40
41
1.4
11.5
22.3
28.8
29.5
91
39
65.5
28.1
91
40
65.5
28.8
10
29
44
48
7.2
20.9
31.7
34.5
25
40
22
30
13
18.0
28.8
15.8
21.6
9.4
Demographics
There were no significant demographic differences
in motivations to consider medical tourism treatment options in terms of education, gender, or
marital status. Only age provided a statistically significant difference in that 30- to 44-year olds
(mean3044 = 4.5) are more likely than other groups
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Henson et al. Motivators, decision factors, and information sources influencing medical tourism
Decision-making factors
Survey respondents were presented with a list of
factors they might consider when making such a
decision and were asked to rate each one on a 5point Likert scale as 1 = Very Unimportant to 5 =
Very Important. Principal components analysis
yielded four components with eigenvalues >1,
explaining 68.5% of the variation. Varimax rotation
revealed components that correspond to considerations regarding travel/logistics (Cronbachs =
0.90), medical confidence considerations ( = 0.86),
Medical condition
To understand whether the nature of the medical
condition influences the decision criteria employed,
univariate ANOVAs and post hoc analyses were run
for each of the decision-related factors (travel, cultural, medical confidence, and development/safety).
Medical condition was found to influence the
importance placed on cultural-related decision
making factors (F(2,131) = 3.3, P = 0.039). Specifically, medical tourists seeking elective treatments
rated the importance of cultural criteria (e.g. food,
Components
Variable
Travel Culture
Medical
confidence
Development and
Safety
0.762
0.835
0.798
0.554
0.547
0.713
0.751
0.811
0.834
0.755
0.631
0.708
2.80
14.7
55.4
0.85
1.37
7.2
62.6
0.86
1.11
5.9
68.5
0.78
Principal component analysis after varimax rotation. Only loadings >0.5 are included. Eigenvalues are from unrotated
solutions.
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Demographics
We found few criteria that differed across demographics, with the exception of the availability of
quality aftercare upon returning home among
older patients, females, and unmarried persons.
Seniors show greater concern with the availability
of quality aftercare than do younger patients
vs.
mean3044 years = 3.8,
(mean>60 years = 4.4,
(F2,127 = 3.1,
P = 0.049).
mean4560 years = 4.05)
Females and unmarried persons also place greater
importance on quality aftercare than males and
married persons (meanFemale = 4.34, meanMale =
3.93; P = 0.016) (meanUnmarried = 4.36, meanMarried =
4.00; P = 0.050). Marital status influenced the
decision criteria to some degree. Unmarried persons
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Prior receipt
of foreign
healthcare
Significant
international
experience
No
Risk
Item
Yes
No
Yes
Averse
Tolerant
4.28
4.14
4.44
4.26
4.19
4.00
4.45
4.28
4.50
4.26
4.29
4.18
4.28
4.41
4.48
4.57
4.22
4.35
4.49
4.58
4.58
4.65
4.28*
4.42
3.51
3.38
4.00*
3.70
3.37
3.26
4.00***
3.71*
4.02
3.66
3.73*
3.55
4.14
3.55
4.46
4.22*
4.09
3.26
4.45
4.25***
4.55
4.22
4.20*
3.91
2.96
2.55
2.48
2.52
3.63**
2.90*
2.82
2.66
2.87
2.45
2.39
2.48
3.62*
2.91*
2.82
2.66
3.66
2.90
2.72
2.54
3.26*
2.69
2.69
2.65
2.48
2.91*
2.44
2.90*
2.99
2.58*
2.79
3.34*
2.70
3.33*
3.42
2.97
2.48
2.80
2.26
2.82*
2.85
2.54
3.86
4.13
3.70
4.15*
4.25
3.86
3.53
3.03
4.02*
3.61*
3.47
2.83
4.01**
3.62
4.17
3.77
3.66***
3.15***
3.69
3.21
4.21+
3.92**
3.61
3.22
4.20+
3.88*
4.43
4.03
3.75***
3.49**
3.93
4.33*
3.91
4.31
4.48
4.03
3.24
3.73*
3.35
3.68
3.91
3.35**
3.76
4.22+
3.70
4.21+
4.31
3.95*
consult, 5 = very likely to consult) and were provided a list of potential information sources.
Univariate ANOVAs and independent sample ttests were performed to determine significant
differences.
Medical condition
The severity of medical condition had only a marginal significance on the information sources consulted. Those with life-threatening conditions rated
personal physician input more highly as an information source (meanlife-threat = 4.6) than those with
medically optional conditions (meanoptional = 4.2),
P = 0.063.
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Henson et al. Motivators, decision factors, and information sources influencing medical tourism
Figure 1: Information sources used in medical tourism decision making. Percentage of respondents who indicated the
source as Likely or Very Likely to be consulted.
Conclusion
Risk aversion
Those who are more risk averse are more likely
to consult with friends and family than those
who are more risk tolerant (meanrisk averse = 4.2,
meanrisk tolerant = 3.8, P = 0.025). While both groups
rate personal physicians as being important information sources, risk averse patients rate their
personal physician much more highly than do
risk
tolerant
patients
(meanrisk averse = 4.6,
meanrisk tolerant = 4.2, P = 0.006)
VOL.
Healthcare coverage
Those who had low confidence that their insurance
coverage would meet current and future medical
needs were more likely to consult medical tourism
facilitators than were those with high confidence
in their insurance coverage (meanlow conf = 3.6,
meanhigh conf = 3.1, P = 0.03).
12
Demographics
Only age and gender showed any statistically significant influence in the use of information
sources. Older patients (>60) were less likely to
consult medical tourism agencies or facilitators
than were younger age segments (mean>60 = 2.9,
mean3044 = 3.5, mean4560 = 3.4; F(2,127) = 3.24, P =
0.042). Females were more likely to consult with
friends/family than were males (meanFemale = 4.3,
meanMale = 3.8, P = 0.008). There were no significant
differences between married/unmarried patients in
terms of the information sources consulted.
Figure 1 shows the likelihood that potential
medical tourists would use the identified resources
in their decision-making process.
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Medical condition
As for motives, those seeking a medically optional
treatment are more motivated to go abroad to
combine treatment with leisure and vacation activities. As such, they place much more importance on
cultural elements such as food, beauty, entertainment, and attractions when making decisions.
Those with life-threatening conditions are significantly more concerned with the economic development of a provider country, perhaps equating
advanced development with advanced technologies, quality of care, or safety. They are also far
more likely than others to consult their personal
Demographics
A few demographic differences exist in medical
tourism decision making. Those in the 3045 age
group are more likely to travel abroad for care
than respondents in other age ranges. Those who
are older, single, and female are most concerned
with availability of quality aftercare, and married
respondents place higher importance on medical
confidence, success rates, and economic development of the destination country. Older respondents
are less likely to utilize medical tourism agencies
and females are more likely to solicit inputs from
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Disclaimer statements
6.
7.
8.
9.
10.
11.
12.
13.
Funding None.
Conflicts of interest None.
14.
Ethics approval There were no ethical issues associated with this paper. The study survey was
reviewed by the Institutional Review Board at
Appalachian State University at determined to be
exempt from further IRB approvals.
15.
16.
References
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