Volume 19, Issue 1 (1-2022)
J Res Dev Nurs Midw 2022, 19(1): 42-45 |
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Amanjan A, Saeidi P, Azma F, Nasiri M. Health Tourism: Entrepreneurial Strategy of Nursing and Medical Sciences. J Res Dev Nurs Midw 2022; 19 (1) :42-45
URL: http://nmj.goums.ac.ir/article-1-1275-en.html
URL: http://nmj.goums.ac.ir/article-1-1275-en.html
1- Department of Entrepreneurship , Aliabad Katoul Branch , Islamic Azad University , Aliabad Katoul, Iran.
2- Department of Management, Aliabad Katoul Branch ,Islamic Azad University , Aliabad Katoul, Iran.
3- Department of Entrepreneurship , Aliabad Katoul Branch , Islamic Azad University , Aliabad Katoul, Iran.
4- Department of Economy , Aliabad Katoul Branch ,Islamic Azad University , Aliabad Katoul, Iran. ,Mnasiri64@yahoo.com
2- Department of Management, Aliabad Katoul Branch ,Islamic Azad University , Aliabad Katoul, Iran.
3- Department of Entrepreneurship , Aliabad Katoul Branch , Islamic Azad University , Aliabad Katoul, Iran.
4- Department of Economy , Aliabad Katoul Branch ,Islamic Azad University , Aliabad Katoul, Iran. ,
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Highlights:
What is current knowledge?
According to the existing literature, no study on entrepreneurship in the field of health tourism in Golestan province has been reviewed.
What is new here?
This study shows that the capacities of medical sciences and tourist attractions of the province can be considered as important factors for improving the health tourism situation of Golestan province.
Introduction
Medical tourism has emerged as an emerging industry due to the promotion of health technologies, reduction of travel costs, and innovation in the information technology (1). The number of medical tourists in the world was estimated to be 14 to 16 million in 2017 (2). In the next 10 years, it is estimated that 3-4% of the world's population travel internationally for health tourism and medical services (3). "Health tourism" is a planned trip from place of residence to another place in order to recover from illness, maintain health, or to assess physical and mental health (4). As a medical and rehabilitation force, travel is one of the most important goals of health tourism, and recreational activities in addition to receiving medical services are included based on the patient's health status (5, 6).
Entrepreneurship in the field of health can be considered as a great opportunity to develop competitive advantages. Moreover, entrepreneurship is a way to improve patients' health and increase the level of innovation and efficiency of health service providers (7). One of the significant benefits of health entrepreneurship is the activation of innovative capabilities and potentials of employees (8). Having an entrepreneurial desire is critical for promoting individual skills (9, 10). However, it should be noted that the entrepreneurial perspective cannot be applied in the same way in every sector, but this perspective is subject to different conditions (11, 12). Despite the undeniable importance of entrepreneurial perspective in the health sector, few studies have been conducted in this field (13).
In medical tourism, nurses are amongst the main components of the medical and treatment sector of this industry. It has been reported that factors such as the nurses' attitude, coordination with the treatment team, timely nursing care, explanation of actions, respect for patient privacy, and the ability to perform specialized tasks contribute greatly to the growth of medical tourism (14, 15).
Iran is one of the top ten countries in the world in terms of tourist attractions but ranked 53rd in terms of medical tourism, which accounts for only 0.35% of medical tourism revenue in the world (16-17). According to the Iran’s national vision document of 2026, it is expected that 1.4 million medical tourists will visit Iran for treatment (18, 19).
Today, Iran is faced with an increase in travels aimed at medical treatment or care, which can be a good platform for entrepreneurship in health tourism (20, 21). With its special capacities such as hot springs and salt mountains, the country can witness the development of health tourism as much as possible (22). In this regard, due to proximity to countries that are inferior to Iran in terms of treatment and medicine, the Golestan Province can be a suitable destination for medical tourists (23). Therefore, this qualitative study was conducted with the aim of identifying entrepreneurial categories in the field of health. The choice of a qualitative method for this research is due to the complexity and multi-factor nature of health entrepreneurship.
Methods
The present qualitative study was conducted with the foundation data approach. In this study, subjective interpretation of the content of textual data was performed and raw data were summarized and categorized based on inference and interpretation. The meanings were interpreted objectively and systematically and the themes in the text were identified using a systematic classification process (24, 25). In the conventional content analysis, categories and their names are abstracted from the text of the data and the researcher immerses himself in the data to gain a new insight into the phenomenon (26). Data were collected via purposive sampling. In the present study, 19 faculty members and staff (with maximum diversity in terms of gender, age, work experience, etc.) of Department of Nursing at Golestan University of Medical Sciences were interviewed in 2020 (Table 1). The individual and semi-structured interviews were conducted and continued until data saturation was achieved. During the interviews, a general question was first asked: "Can you tell me about your experience in entrepreneurship in health tourism?". Then, exploratory and follow-up questions were asked in order to obtain more information and clarify the participants' statements. Each interview lasted approximately 45 minutes. The data analysis process was performed simultaneously and continuously with data collection. (27) Words, sentences and paragraphs from the participants' statements that contained important points related to the research topic were selected as the semantic units. Participants' semantic units were extracted in the form of initial codes. The codes were then categorized, transformed, and limited based on similarity, semantic, and conceptual differences to form themes. Themes and sub-themes was emerged by breaking down the data into separate sections and then carefully examining similarities and differences. Questions about phenomena were asked, thus conceptualizing the data. By coding and creating relationships between related sub-themes, the data were newly linked to each other. When a particular phenomenon was identified in the data, its implications were also identified. By reviewing the codes and the sub-themes, the main theme of the study was also identified (27).
The Lincoln and Guba criteria were used to ensure credibility of findings (28). Communicating with participants helped build their trust and understanding of the researcher's experiences. Good communication and allocation of appropriate and sufficient time based on the opinion of the participants to collect data would increase the acceptability and reliability of the data. The selection of participants with maximum diversity increased the validity of the data. In addition, the data credibility method was used by the participants to review the manuscripts in order to remove ambiguity in the codings. For this purpose, the researcher provided participants with parts of the interviews and codings to achieve the same concepts in relation to the statements of the participants.
The degree of homogeneity between the extracted themes was compared with the participants' experiences, and the correctness of the codes, the classification of similar codes and interpretations were ensured. The codes that did not express participants’ views were corrected. The ability to confirm conformability was also made possible by accurate recording and writing the research steps and processes. Dependability of findings was assessed by using the opinions of three colleagues who were familiar with the research topic. For transferability, the findings of the present study were shared with other health professionals, and the consistency of the findings with their experiences was questioned and reconciled. The study was approved by the ethics committee of Golestan University of Medical Sciences (ethical code: IR. GOUMS.REC.1399.275).
.PNG)
Results
Based on the results of data analysis, nine main categories were obtained (Table 2).
A. Tourism rules and standards
In this regard, the participants mentioned the following in their experiences:
"Implementation of the health tourism services quality evaluation plan, as a complement and in line with the accreditation plan, is an essential step towards improving the quality of health tourism services infrastructure and standardizing the health tourism industry in the country" (participant 9).
B. Health tourism beneficiaries
This category was addressed by a number of participants:
"If a patient receives unfavorable health services and is not satisfied with his/her travel, he/she will definitely ruin the credibility and image of the tourist destination or the center for providing these services for many years to come" (participant 8).
C. Developing entrepreneurial strategies
One of the participants in the study expressed this category as follows:
"In terms of entrepreneurial opportunities, findings of medical and tourism methods cannot be ignored; therefore, a wide range of medical tourism services is provided by private companies and organizations" (participant 10).
D. Facilitation of health tourism infrastructure
This category was expressed by one of the participants as follows:
"In my opinion, consider the followings: reform tariffs for medical expenses in accordance with international standards, coordinate the country's health insurance to facilitate the payment of international medical expenses, and support the establishment of international patient units and departments" (participant 14).
E. Quality of medical tourism services
This was addressed by most participants:
"The capabilities of medical professionals, state-of-the-art technologies, international standards, treatment economics, treatment costs, and domestic regulations are important factors in health tourism" (participant 14)
D. Tourist attractions of Iran
This was also expressed by a significant number of participants:
"Hot springs, salt lake, bright sun, medicinal mud bath, medical massage, herbal bath as well as beautiful, clean and calm environment to help skin, respiratory, rheumatology, and muscular patients to recover from treatment and surgery. Thanks to God; the diverse nature of Iran has provided all kinds of natural healing resources to human beings" (participant 3).
E. Gaining a competitive advantage
Providing special facilities and advantages that are very attractive to health tourists was another item mentioned by most participants:
"In my opinion, factors such as: attraction sights, bilingual physicians, holding international standards and qualifications, using US dollar as currency, and the need to exchange money are effective" (participant 4).
F. Modern technology and knowledge
The following was addressed by the majority of study participants:
"To attract health tourists, four basic items should always be considered in the field of medical tourism. The capabilities of medical professionals, modern technologies and international standards, treatment costs, and domestic regulations are important factors in health tourism" (participant 10).
G. Entrepreneurial management
In this regard, the following was expressed by a number of participants:
"However, the main challenge of medical tourism in Iran is the absence of integral management. Developing a comprehensive plan to resolve this issue can help policymakers attract medical tourists with a science- and local-based approach" (participant 3).
Discussion
Today, medical tourism has become a very important industry in the field of currency appreciation and increasing gross domestic product in many countries. Based on our results, Certification by international organizations and standards to health tourism service providers can guarantee the standardization of services for customers. In a study by Vaezi et al., the lack of international certificates was one of the codes extracted from their qualitative content analysis, which is consistent with the present study (17).
Facilitating health tourism infrastructure was another category mentioned by the majority of participants. In line with our findings, two previous studies also reported the facilitation of tourism infrastructure and implementation of modern knowledge technology as important factors for health tourism (29, 30).
According to the participants, the quality of health tourism services was another major category. Our findings are in line with the results of a study by Momeni et al. on identification of barriers to medical tourism (31). The results of a study in Malaysia also showed that technological and human factors such as language problems and the quality of services are obstacles to the development of medical tourism (32).
Iran’s tourist attractions were another category that was extracted from the interviews. Consistent with this finding, some previous studies also reported tourist attractions and health tourism beneficiaries as important factors in medical tourism (33, 34).
Given that the present study was performed using a qualitative method, it was impossible to eliminate observer bias, control the validity of the researcher's conclusion, and generalize the results.
Conclusion
Based on the results, implementation of an entrepreneurial approach can make use of nursing and medical capacities in the province in the field of health tourism. With increasing attention to entrepreneurial thinking and leadership and the existence of flexibility and adaptation in health tourism, which is the result of a proper entrepreneurial management, the model of strategic entrepreneurship in the field of health tourism will flourish.
Acknowledgements
This article has been derived from the results of a doctoral dissertation on entrepreneurship at the Islamic Azad University, Aliabad Branch, Iran. The authors would like to express their utmost appreciation to the participants in the study.
What is current knowledge?
According to the existing literature, no study on entrepreneurship in the field of health tourism in Golestan province has been reviewed.
What is new here?
This study shows that the capacities of medical sciences and tourist attractions of the province can be considered as important factors for improving the health tourism situation of Golestan province.
Introduction
Medical tourism has emerged as an emerging industry due to the promotion of health technologies, reduction of travel costs, and innovation in the information technology (1). The number of medical tourists in the world was estimated to be 14 to 16 million in 2017 (2). In the next 10 years, it is estimated that 3-4% of the world's population travel internationally for health tourism and medical services (3). "Health tourism" is a planned trip from place of residence to another place in order to recover from illness, maintain health, or to assess physical and mental health (4). As a medical and rehabilitation force, travel is one of the most important goals of health tourism, and recreational activities in addition to receiving medical services are included based on the patient's health status (5, 6).
Entrepreneurship in the field of health can be considered as a great opportunity to develop competitive advantages. Moreover, entrepreneurship is a way to improve patients' health and increase the level of innovation and efficiency of health service providers (7). One of the significant benefits of health entrepreneurship is the activation of innovative capabilities and potentials of employees (8). Having an entrepreneurial desire is critical for promoting individual skills (9, 10). However, it should be noted that the entrepreneurial perspective cannot be applied in the same way in every sector, but this perspective is subject to different conditions (11, 12). Despite the undeniable importance of entrepreneurial perspective in the health sector, few studies have been conducted in this field (13).
In medical tourism, nurses are amongst the main components of the medical and treatment sector of this industry. It has been reported that factors such as the nurses' attitude, coordination with the treatment team, timely nursing care, explanation of actions, respect for patient privacy, and the ability to perform specialized tasks contribute greatly to the growth of medical tourism (14, 15).
Iran is one of the top ten countries in the world in terms of tourist attractions but ranked 53rd in terms of medical tourism, which accounts for only 0.35% of medical tourism revenue in the world (16-17). According to the Iran’s national vision document of 2026, it is expected that 1.4 million medical tourists will visit Iran for treatment (18, 19).
Today, Iran is faced with an increase in travels aimed at medical treatment or care, which can be a good platform for entrepreneurship in health tourism (20, 21). With its special capacities such as hot springs and salt mountains, the country can witness the development of health tourism as much as possible (22). In this regard, due to proximity to countries that are inferior to Iran in terms of treatment and medicine, the Golestan Province can be a suitable destination for medical tourists (23). Therefore, this qualitative study was conducted with the aim of identifying entrepreneurial categories in the field of health. The choice of a qualitative method for this research is due to the complexity and multi-factor nature of health entrepreneurship.
Methods
The present qualitative study was conducted with the foundation data approach. In this study, subjective interpretation of the content of textual data was performed and raw data were summarized and categorized based on inference and interpretation. The meanings were interpreted objectively and systematically and the themes in the text were identified using a systematic classification process (24, 25). In the conventional content analysis, categories and their names are abstracted from the text of the data and the researcher immerses himself in the data to gain a new insight into the phenomenon (26). Data were collected via purposive sampling. In the present study, 19 faculty members and staff (with maximum diversity in terms of gender, age, work experience, etc.) of Department of Nursing at Golestan University of Medical Sciences were interviewed in 2020 (Table 1). The individual and semi-structured interviews were conducted and continued until data saturation was achieved. During the interviews, a general question was first asked: "Can you tell me about your experience in entrepreneurship in health tourism?". Then, exploratory and follow-up questions were asked in order to obtain more information and clarify the participants' statements. Each interview lasted approximately 45 minutes. The data analysis process was performed simultaneously and continuously with data collection. (27) Words, sentences and paragraphs from the participants' statements that contained important points related to the research topic were selected as the semantic units. Participants' semantic units were extracted in the form of initial codes. The codes were then categorized, transformed, and limited based on similarity, semantic, and conceptual differences to form themes. Themes and sub-themes was emerged by breaking down the data into separate sections and then carefully examining similarities and differences. Questions about phenomena were asked, thus conceptualizing the data. By coding and creating relationships between related sub-themes, the data were newly linked to each other. When a particular phenomenon was identified in the data, its implications were also identified. By reviewing the codes and the sub-themes, the main theme of the study was also identified (27).
The Lincoln and Guba criteria were used to ensure credibility of findings (28). Communicating with participants helped build their trust and understanding of the researcher's experiences. Good communication and allocation of appropriate and sufficient time based on the opinion of the participants to collect data would increase the acceptability and reliability of the data. The selection of participants with maximum diversity increased the validity of the data. In addition, the data credibility method was used by the participants to review the manuscripts in order to remove ambiguity in the codings. For this purpose, the researcher provided participants with parts of the interviews and codings to achieve the same concepts in relation to the statements of the participants.
The degree of homogeneity between the extracted themes was compared with the participants' experiences, and the correctness of the codes, the classification of similar codes and interpretations were ensured. The codes that did not express participants’ views were corrected. The ability to confirm conformability was also made possible by accurate recording and writing the research steps and processes. Dependability of findings was assessed by using the opinions of three colleagues who were familiar with the research topic. For transferability, the findings of the present study were shared with other health professionals, and the consistency of the findings with their experiences was questioned and reconciled. The study was approved by the ethics committee of Golestan University of Medical Sciences (ethical code: IR. GOUMS.REC.1399.275).
Results
Based on the results of data analysis, nine main categories were obtained (Table 2).
A. Tourism rules and standards
In this regard, the participants mentioned the following in their experiences:
"Implementation of the health tourism services quality evaluation plan, as a complement and in line with the accreditation plan, is an essential step towards improving the quality of health tourism services infrastructure and standardizing the health tourism industry in the country" (participant 9).
B. Health tourism beneficiaries
This category was addressed by a number of participants:
"If a patient receives unfavorable health services and is not satisfied with his/her travel, he/she will definitely ruin the credibility and image of the tourist destination or the center for providing these services for many years to come" (participant 8).
C. Developing entrepreneurial strategies
One of the participants in the study expressed this category as follows:
"In terms of entrepreneurial opportunities, findings of medical and tourism methods cannot be ignored; therefore, a wide range of medical tourism services is provided by private companies and organizations" (participant 10).
D. Facilitation of health tourism infrastructure
This category was expressed by one of the participants as follows:
"In my opinion, consider the followings: reform tariffs for medical expenses in accordance with international standards, coordinate the country's health insurance to facilitate the payment of international medical expenses, and support the establishment of international patient units and departments" (participant 14).
E. Quality of medical tourism services
This was addressed by most participants:
"The capabilities of medical professionals, state-of-the-art technologies, international standards, treatment economics, treatment costs, and domestic regulations are important factors in health tourism" (participant 14)
D. Tourist attractions of Iran
This was also expressed by a significant number of participants:
"Hot springs, salt lake, bright sun, medicinal mud bath, medical massage, herbal bath as well as beautiful, clean and calm environment to help skin, respiratory, rheumatology, and muscular patients to recover from treatment and surgery. Thanks to God; the diverse nature of Iran has provided all kinds of natural healing resources to human beings" (participant 3).
E. Gaining a competitive advantage
Providing special facilities and advantages that are very attractive to health tourists was another item mentioned by most participants:
"In my opinion, factors such as: attraction sights, bilingual physicians, holding international standards and qualifications, using US dollar as currency, and the need to exchange money are effective" (participant 4).
F. Modern technology and knowledge
The following was addressed by the majority of study participants:
"To attract health tourists, four basic items should always be considered in the field of medical tourism. The capabilities of medical professionals, modern technologies and international standards, treatment costs, and domestic regulations are important factors in health tourism" (participant 10).
G. Entrepreneurial management
In this regard, the following was expressed by a number of participants:
"However, the main challenge of medical tourism in Iran is the absence of integral management. Developing a comprehensive plan to resolve this issue can help policymakers attract medical tourists with a science- and local-based approach" (participant 3).
Discussion
Today, medical tourism has become a very important industry in the field of currency appreciation and increasing gross domestic product in many countries. Based on our results, Certification by international organizations and standards to health tourism service providers can guarantee the standardization of services for customers. In a study by Vaezi et al., the lack of international certificates was one of the codes extracted from their qualitative content analysis, which is consistent with the present study (17).
Facilitating health tourism infrastructure was another category mentioned by the majority of participants. In line with our findings, two previous studies also reported the facilitation of tourism infrastructure and implementation of modern knowledge technology as important factors for health tourism (29, 30).
According to the participants, the quality of health tourism services was another major category. Our findings are in line with the results of a study by Momeni et al. on identification of barriers to medical tourism (31). The results of a study in Malaysia also showed that technological and human factors such as language problems and the quality of services are obstacles to the development of medical tourism (32).
Iran’s tourist attractions were another category that was extracted from the interviews. Consistent with this finding, some previous studies also reported tourist attractions and health tourism beneficiaries as important factors in medical tourism (33, 34).
Given that the present study was performed using a qualitative method, it was impossible to eliminate observer bias, control the validity of the researcher's conclusion, and generalize the results.
Conclusion
Based on the results, implementation of an entrepreneurial approach can make use of nursing and medical capacities in the province in the field of health tourism. With increasing attention to entrepreneurial thinking and leadership and the existence of flexibility and adaptation in health tourism, which is the result of a proper entrepreneurial management, the model of strategic entrepreneurship in the field of health tourism will flourish.
Acknowledgements
This article has been derived from the results of a doctoral dissertation on entrepreneurship at the Islamic Azad University, Aliabad Branch, Iran. The authors would like to express their utmost appreciation to the participants in the study.
Funding source
The authors received no financial support for the research, authorship, and/or publication of this article.
Ethical statement
The study was approved by the ethics committee of Golestan University of Medical Sciences (ethical code: IR. GOUMS.REC.1399.275).
Conflict of interest
The authors declare that there is no conflict of interest regarding publication of this article.
Ethical statement
The study was approved by the ethics committee of Golestan University of Medical Sciences (ethical code: IR. GOUMS.REC.1399.275).
Conflict of interest
The authors declare that there is no conflict of interest regarding publication of this article.
Author contributions
Conceptualization: Majid Nasiri. Methodology, analysis, research review and editing: Majid Nasiri, Amanmohammad Amanjani, Parviz Saeidi, Fereidoun Azma. Writing: Majid Nasiri,Amanmohammad Amanjani. Supervision: Majid Nasiri
.PNG)
Type of Study: Original Article |
Subject:
Management and Health System
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