Explaining the Model of Customer Value Co-Creation Behavior in the Development of Medical Tourism Industry of Guilan Province

Extended Abstract
Introduction
The development of communication techniques and the transfer of medical knowledge has led to the emergence of a new form of tourism called medicine. Medical tourism includes any trip to promote health and, as one of the dimensions of tourism, contributes to the sustainable development and dynamism of the country's economy. Medical tourism is also a national strategy to increase the country's income and an arm of national security. Although there is no single definition of medical tourism, it can be defined as the extensive travel of people from their place of residence for health. Recovery is achieved through physical and mental health.
Gilan province, as one of the most important and touristic provinces of the country, can be the center of medical tourism in Iran, but the medical tourism industry in Gilan has not been able to attract more patients along with its therapeutic capacities due to the existence of regional competitors, which have actively occupied a significant share of the medical tourism market. Therefore, value creation is a new form of business strategy that emphasizes the continuous creation and recognition of common values of organizations and customers.
 
 Methodology
This research is part of the results of a combined study (qualitative and quantitative). This research has been done in two qualitative and quantitative stages. The statistical population of the research, in the qualitative phase, included managers and scientific and executive experts with more than five years of experience in the field of medical tourism and medical tourists, and in the quantitative phase included the heads of hospitals and medical tourists referring to hospitals in Guilan province. First, 16 experts and tourists were selected by purposive sampling method, and a semi-structured interview was conducted with them and then questionnaires containing information extracted from the research model among 50 heads and managers of hospitals. Gilan province was selected and distributed by census method, and 250 medical tourists from the same hospitals were selected and distributed by the non-probability method. In order to construct the model, first, semi-structured interviews and available documents and resources were used, and to determine the desired index, interviews and receiving the views of tourists and medical tourism experts were used. In order to evaluate the research measurement model, exploratory factor analysis, confirmatory factor analysis, convergent validity, divergent validity, and combined reliability and reliability by Cronbach's alpha method were applied and also, GOF criteria were exerted to fit the model. SPSS21 and PLS software programs were used to perform data analysis.
 
Results and discussion
The findings showed that in the categorical cluster, the causal conditions of the main categories of tourism capability and sub-categories, including culture building, service development capability, human resource management, and communication capability and in the categorical cluster, the underlying conditions of the main categories of medical tourism infrastructure, and in the cluster, the central phenomenon of the main category of organizational value co-creation and sub-categories of medical tourism product, medical tourism price, medical tourism location, and medical tourism advertisements and in the cluster of action strategies and interactions, the main category of customer value co-creation and sub-categories of tourist motivation, tourist resources, the interaction of tourists, and in the cluster of main category’s results of the co-creation behavior and sub-categories of loyalty and citizenship behavior were obtained. In this regard, 59 related concepts have been identified and examined. The first path reveals the impact of medical tourism capabilities on the co-creation of organizational value. In this analysis, the path coefficient value was calculated to be 0.21 and significant (3.16). Therefore, the first hypothesis of the research was confirmed. The path between medical tourism infrastructure and organizational value co-creation shows that this variable was considered an influential factor in organizational value co-creation. Therefore, the second hypothesis of the research was confirmed (t = 2.01 and the value of the path coefficient is 0.22). The third hypothesis reflects the relationship between organizational value co-creation and customer value co-creation. In this analysis, the path coefficient value was calculated to be 0.25 and significant (3.45). Therefore, the third hypothesis of the research was confirmed. The fourth hypothesis reflects the relationship between customer value co-creation and value co-creation behavior. In this analysis, the path coefficient value was calculated to be 0.24 and significant (2.77). Therefore, the fourth hypothesis of the research was confirmed.
 
Conclusion
Based on the paradigm model, strategies for creating organizational value, including the combination of medical tourism as the central phenomenon and medical tourism capabilities as the causal conditions that cause the creation and development of the phenomenon, were selected. Customer value co-creation, including resources, motivation and interaction of tourists, were considered strategies of action or confrontation that express purposeful behaviors and interactions adopted in response to the phenomenon and under the influence of the context. Medical tourism infrastructures were considered as factors that influence action or interaction strategies under certain conditions. Finally, loyalty and citizenship behavior were considered the consequences of adopting action or confrontation strategies (including customer value co-creation). The responsible organizations in the medical tourism industry of Guilan province, using the present model to form the customer value co-creation behavior, pave the way for citizenship behavior with a high level of tourist loyalty. This is important by planning and implementing it in order to create components such as instilling a sense of social responsibility, tolerating shortcomings and shortcomings, and sustained commitment to improving superior and innovative services. Also, to implement the customer value co-creation behavior, the present study recommends increasing the amount of information and knowledge of tourists.