Investigating the effective indicators on the sustainable development of tourism in choosing a health tourism destination (case study: Yazd province)

Introduction

Health tourism, as one of the dynamic sub-sectors of the tourism industry, has experienced significant growth in recent decades. This growth is due to increased public awareness of health, advances in medical technology, and ease of access to affordable health services compared to developed countries. Yazd province, with its natural attractions, well-equipped medical centers, and skilled physicians, has high potential to become a prominent health tourism destination at the national and international levels. However, the sustainable development of this industry requires the identification and management of key indicators that simultaneously cover economic, social, and environmental dimensions. The aim of this study is to examine the indicators affecting the sustainable development of health tourism in Yazd province and to provide operational solutions to strengthen this industry. This study, focusing on the role of quality of health services, infrastructure capacity building, and strategic planning, seeks to reduce negative consequences and increase the competitiveness of the health tourism destination of Yazd.

Methodology

This research was descriptive-survey and conducted with a mixed approach (qualitative-quantitative). The statistical population consisted of two groups: 15 academic experts and active in the field of health tourism who were selected purposefully, and 78 health tourists who were sampled non-randomly from those visiting health centers in Yazd province. Data were collected through semi-structured interviews with experts and questionnaires designed based on indicators extracted from the research literature. Fuzzy cognitive mapping (FCM) technique and social network analysis using FCMapper and UCINET6 software were used to analyze the data. In the analysis process, 16 final indicators including quality of health services, cost of services, access to advanced equipment, physician skills, compliance with health standards, destination carrying capacity, and strategic policymaking were identified and causal relationships between them were drawn. Scenario building was also conducted to examine the effect of removing or strengthening key indicators.

Results and discussion

The findings showed that three indicators of quality of health services (with a centrality of 18.3), increasing the carrying capacity of the destination (centrality of 15.9), and strategic policy and planning (centrality of 15.5) have the greatest impact on the sustainable development of health tourism in Yazd province. The quality of health services was identified as the main driving factor, including access to modern medical equipment, expertise of medical staff, and compliance with global standards. This finding is in line with similar studies in South Korea and Turkey that consider quality of services as the axis of attracting health tourists. The destination carrying capacity index also plays a key role in the long-term sustainability of the industry, emphasizing the development of accommodation, transportation, and medical center infrastructure. Previous research in Thailand and India has shown that the limited capacity to accept health tourists is a major challenge in the competitiveness of destinations. The strategic policy factor was also identified as the basis for sustainable development by creating coordination between government and private institutions, developing transparent laws, and targeted investment. The scenario-building conducted in this study showed that neglecting any of these three indicators, even when other factors are strengthened, leads to a decrease in the overall performance of the system and threatens the sustainability of the industry. For example, ignoring the carrying capacity of the destination, despite improving the quality of services, increases the pressure on existing resources and reduces tourist satisfaction.

Conclusion

The results of this study show that the sustainable development of health tourism in Yazd province requires simultaneous attention to three key components: quality of medical services, infrastructure capacity building, and strategic planning. To achieve this goal, operational suggestions have been presented in four main areas, each of which plays a significant role in promoting Yazd as a top destination for health tourism. In the area of improving the quality of medical services, attracting and training specialized personnel, equipping medical centers with advanced technologies, and obtaining international certifications, along with continuous monitoring of health standards and patients' rights, are considered essential measures. These measures not only increase the satisfaction of medical tourists, but also strengthen the international reputation of the province. On the other hand, increasing the capacity of infrastructure requires the development of appropriate hospital hotels and accommodation centers, improving the urban and intercity transportation system, and proper management of medical waste. These provide easy access to medical services and minimize negative environmental impacts. In addition to these, developing an integrated strategic plan by forming a High Council for Health Tourism, attracting domestic and foreign investments, and targeted international marketing can consolidate Yazd's competitive position in this field. In addition, educating and raising awareness among the local community and designing effective advertising campaigns play a key role in constructive interaction with tourists and introducing the province's capacities. Finally, the coordinated implementation of these proposals, along with benefiting from successful global experiences, can transform Yazd into a health tourism hub in the region and make a significant contribution to Iran's economic and social development