Analysis of factors affecting the development of health tourism in the case study of Tehran

A B S T R A C T
Among the emerging sectors of tourism, health tourism has considerable potential for investment and income generation, thereby contributing to growth and development; moreover, it is recognized as one of the world’s most competitive and profitable industries. Health tourism has become a major industry in the past decade, and following the increase in activity in this sector, the decision-making process of consumers and the factors affecting the expansion of health tourism have become of great importance to scholars. In the contemporary lifestyle, the necessity of health tourism has increased due to the emergence of various physical and mental diseases. In this study, an attempt was made to analyze and investigate the factors affecting the expansion of health tourism in Tehran. The study is applied in terms of purpose and descriptive-analytical in terms of methodology. The statistical population of includes people who have referred to medical centers in Tehran for treatment. In order to determine the sample size, due to the lack of a statistical population, the Cochran formula was used for an unlimited population, and the sample size estimated to be 384 people. The validity of the research tool was calculated utilizing the confirmatory factor analysis model and its reliability calculated employing Cronbach's alpha. The data were analyzed using SPSS and LISREL software through descriptive statistical methods and structural equation modeling. The findings exhibited that marketing mix with a path coefficient of 0.45, health tourism destination reputation with a path coefficient of 0.35, and service quality with a path coefficient of 0.33 have a positive and significant effect on the expansion of health tourism. Among the identified factors, the marketing mix factor had the most effect.
Extended Abstract
Introduction
Health tourism refers to travel to a recreational area for health and medical purposes. It is a type of tourism that focuses on health and wellness and is classified in the patient market and not in the category of tourism that targets healthy people. Health tourism or medical tourism is a broad concept that encompasses high-quality health care services as well as some other facilities such as better accommodation, shopping, and sometimes recreational arrangements. In fact, health tourism is a form of tourism that includes all natural and cultural resources, rehabilitation and sports activities, facilities, and places with services related to the health and medical sector and the tourism sector to serve people who travel for physical and mental health reasons. Today, people travel for health as well as fitness, well-being and relaxation, and in response to this mounting demand, countries, healthcare providers and hospitality and tourism organizations are striving to offer a wider range of medical, health, and wellness tourism experiences. In health tourism, each segment meets different customer needs and is constantly evolving in line with societal and lifestyle changes. The growth of health tourism is also fueled by the changing demands of increasingly sophisticated travelers who are seeking not only new experiences but also meaningful experiences while traveling. Correspondingly, greater health awareness, acceptance of alternative treatments, and greater environmental and psychological awareness have all increased the demand for health-related tourism. Accordingly, many studies have pointed out a direct relationship among the components affecting health tourism. Researchers in the field of health tourism have provided various definitions of health tourism in numerous studies and described its advantages and disadvantages.
Attention to health tourism in Iran has grown significantly in recent years. The significance of focusing on the health tourism system is so great that it has been highlighted in various documents such as Article 87 of the Law of the Fourth Program of Socio-Economic and Cultural Development of the country. The Ministry of Health was obliged to provide the necessary facilities within the framework of strategic commercial policies regarding the introduction of capabilities, supply and marketing of health services, as well as medical education, and related areas. Accordingly, the main question of the research is: What are the factors affecting the expansion of health tourism in Tehran? In order to answer the research question, the hypotheses are presented as follows:

Marketing mix has a significant impact on the expansion of health tourism in Tehran.
Destination reputation has a substantial influence on the development and expansion of health tourism in Tehran.
Service quality has a noteworthy impact on the expansion of health tourism in Tehran.

 
Methodology
The present study is applied in terms of purpose and descriptive-analytical in terms of methodology. Library and field methods were used to collect data. The statistical population includes people who have referred to medical centers in Tehran for treatment. Due to the lack of accurate statistics on the number of people referring to hospitals and medical centers in Tehran from other provinces, the Cochran formula was employed for an unlimited population to determine the sample size, which estimated to be 384 people. Simple random sampling was used in this study. A questionnaire was used to collect field data. The reliability of the questionnaire was measured by calculating Cronbach's alpha and calculating the composite reliability coefficient (cr). The value of Cronbach's alpha and the composite reliability coefficient for each variable are between zero and one, and if the value obtained is higher than 0.7, the questionnaire has appropriate reliability. The results of the Cronbach's alpha and composite reliability of the questionnaire confirm the appropriate reliability of the questionnaire. The validity of the questionnaire was also confirmed in two stages: face validity and apparent validity through obtaining opinions from professors and experts, and divergent validity by calculating the average variance extracted (AVE) index. In this study, SPSS and LISREL software were used to analyze the research data.
 
Findings and Discussion
The present study was designed to investigate the factors affecting the expansion of health tourism in Tehran. The findings indicate that the marketing mix with a path coefficient of 0.45 has a significant effect on the expansion of health tourism. In explaining the results of this hypothesis, it can be stated that the factor that affects the expansion of health tourism and causes behavioral control of tourists is the elements of the marketing mix such as medical services (product), treatment cost (price), location, and promotion. For example, factors such as diverse medical services, provision of all medical services in one center, quality of medical services, experienced specialists, well-equipped hospitals, relative cost of treatment, easy access to medical centers, provision of special services to patients and their companions, existence of health villages, favorable climate, hot mineral waters, mud volcanoes, salt lakes, and healing natural resources affect the level of learning and consequently the involvement of tourists. Then, the relative advantage of these factors creates value for the tourists, and they feel that their needs are met and realized that this trip has more benefits than other methods or trips to other tourism destinations, because it eliminates operational costs and provides timely and accurate information.
Another finding was the positive effect of the reputation of a health tourism destination with a path coefficient of 0.35 on the expansion of health tourism. The results of this hypothesis may be interpreted to indicate that reputation, understood as the belief, image, and public perception associated with a health tourism destination, constitutes its most important intangible asset and most powerful marketing tool. In the highly sensitive health tourism industry, where decisions revolve around the health and lives of individuals, a positive reputation is not only a competitive advantage, but also a fundamental prerequisite for survival and tourist attraction. Because health tourists value certainty, quality, and safety, a good reputation functions as a dependable signal of these characteristics. Deciding to travel for treatment or major surgery is associated with very high financial, medical, and emotional risks. Patients are choosing among different options around the world. A strong and positive reputation significantly reduces this perceived risk. When the name of a destination (such as Tehran for bone marrow transplants, Bangkok for cosmetic surgery, India for heart surgery, or Turkey for hair transplants) is associated with success, expertise, and safety, patients choose it with greater confidence. This trust is the cornerstone of their decision-making.
Furthermore, the findings from the research hypothesis test showed that service quality had a significant impact on health tourism in Tehran with a path coefficient of 0.33. Medical tourism is actually a different tourism market with its specialized features. It may include everything from basic health care services to other infrastructure facilities and other items such as recreation, entertainment, and shopping. Accordingly, to become a very successful health tourism destination, there is a need for different types and levels of skilled people along with high-quality products and services. In addition to all these factors, even the country's climate and the individual attitude of the customer can affect the success of this industry. On the other hand, the main feature of this industry is a variety of uncontrollable elements that cannot be changed. But there is still an opportunity to cope with them to continue to live and shine in this large tourism sector for urban destinations such as Tehran by improving the quality of health tourism services.
 
Conclusion
For centuries, the pursuit of health and medical care has been one of the main reasons why people travel. Today, people travel even more than before to achieve treatment, health, peace, and wellness. Health tourism, as a subset of the tourism industry, has become a global and expanding phenomenon and is considered one of the attractive markets in the tourism industry. On the one hand, rising public awareness and concern about health, particularly following the COVID-19 pandemic, together with the growing desire to enhance quality of life through improved life satisfaction, happiness, and social welfare, have played an important role, on the other hand, the high cost of medical treatment in the country of origin, the lack of adequate insurance, long waiting lines, the low quality of medical services provided, and the development of technology and international transportation, which has facilitated many processes, are among the factors that encourage people to travel to other places for treatment and have caused an increasing demand for health tourism services. Therefore, the present study was designed to analyze the factors affecting the expansion of health tourism in the city of Tehran. The results indicated that the marketing mix has a significant effect on the expansion of health tourism, and the path coefficient obtained was equal to 0.45, and it can be said that the marketing mix explains 20% of the variance of the dependent variable, namely the expansion of health tourism.
Given the positive value of the path coefficient, it can be concluded that the more active the health tourism destinations are in the field of marketing mix, the more opportunities are provided for the development of health tourism. Another result is the positive effect of the reputation of the health tourism destination on the expansion and growth of health tourism. Considering the path coefficient obtained, which was equal to 0.35, it can be stated that the reputation of the destination is able to explain 12.2 percent of the variance of the dependent variable. Another finding of this study is the positive impact of the quality of health tourism services on the expansion of health tourism. Considering the path coefficient obtained, which was equal to 0.33, this variable is able to explain 10.8 percent of the variance of the dependent variable, namely the expansion of health tourism. In accordance with the aforementioned findings, the following suggestions are presented to strengthen health tourism in Tehran:
- It is recommended that, in addition to establishing appropriate and rigorous standards for Tehran’s health tourism services, efforts should be made to raise public awareness in this industry and increase quality by forming non-governmental organizations.
- It is suggested that through establishing strong partnerships with leading hospitals and healthcare institutions, and investing in technology and precision medicine, efforts be made to develop advanced medical infrastructure and to expand training and expertise in specialized medical fields.
- It is advised that in addition to the quality of services, attention be paid to providing transparent and affordable price packages, and hospitals and health tourism service centers post their price packages online.
- Government support can also help encourage health tourism. For example, government airlines can help increase the influx of international patients to health tourism destinations by offering discounts to health tourists.
- The international medical department of a hospital is the easiest way to reach target customers. It is recommended to provide valuable information to potential health tourists about the services offered and to alleviate communication barriers by utilizing trained staff who speak multiple languages for easy communication with patients.
- Founding specialized clinics for high-demand treatments (such as dentistry, cosmetic surgery, heart, infertility).
- Providing telemedicine services to follow up on the patient's condition after returning to their country.
- Offer a “Complete Health Checkup” service as an attractive, low-risk product to attract new customers.
- Value-based pricing: Emphasize the quality of service and expertise of doctors rather than offering the cheapest price. The price should reflect the quality and outcome.
- Installment payment plans: Partner with financial companies to offer installment payment options for expensive treatments.
 
Funding
There is no funding support.
 
Authors’ Contribution
All of the authors approved thecontent of the manuscript and agreed on all aspects of the work.
 
Conflict of Interest
Authors declared no conflict of interest.
 
Acknowledgments
We are grateful to all the scientific consultants of this paper.