Past themes and future trends in medical tourism research: A co-word analysis
Introduction
Health and medical tourism is a rising global phenomenon in the 21th century (Chew & Darmasaputra, 2015, p. 119) and since its emergence, it has attracted interest in both the academic and professional communities. It is the product of globalization in healthcare and neoliberal policies (Hopkins et al., 2010, Meghani, 2011) resulting from factors such as continuing search for lower costs, better quality care and shorter waiting lists (Ngamvichaikit & Beise-Zee, 2014).
Medical tourism (MT) specifically involves travel across international borders with the intention of receiving medical care. This care “is typically paid for ‘out-of-pocket’ and is motivated by an interest in cost savings and/or avoiding waiting times for care in the patient's home country” (Snyder, Crooks, & Turner, 2011, p. 3). Despite the rapid growth and increase of interest among scholars and practitioners on this question, there is currently no precise characterization of its conceptual contours and studies on its evolution are scarce. Most existing works evaluate MT research only over a period of time limited to the last 10–15 years and offer neither a complete nor a truly objective overview of the current state of research, but rather attempt to connect the existing literature with other issues such as the magnitude of the trade, patient experience or its impact on health. Additionally, the stream of publications on MT history suggests that the lack of consensus regarding its defining concepts is a major barrier for its theoretical understanding and future development.
This paper intends to address this problem and respond to the calls for greater theoretical clarification made by numerous researchers, tourism authorities and organizations. It provides a more objective quantitative approach which will supplement previous attempts to portrait its thematic evolution. The findings will enable researchers to better understand its current state, prevailing topics and to employ future lines of research as a guide. This will ultimately enhance theoretical development and clarify the conceptual background of this research field. The originality of the study is related to the methodology and time frame used. Methodologically, we used a co-word analysis, which, although is a technique applied in tourism in general, has so far not been so in respect of MT. It helped us detect central themes, uncover several direct and indirect links between them and reveal current research interests, knowledge gaps and the internal knowledge structure of MT field. Thus, the time-framed used helped us analyze changes, fluctuation of interest and linkages between keywords since the first published works providing a broader picture than those used in previous qualitative analysis.
In particular, the aims of this study are: a) to review a large number of publications on medical tourism ranging from 1931 to 2016 and indexed in the WoS and Scopus through co-word analysis; b) to examine the state of this domain of research through the most relevant contributions; and c) to suggest future lines of research. The paper is structured into four sections. Following the introduction, section one presents the theoretical background to medical tourism, section two describes the focus of the paper and methodology, whilst section three presents the preliminary data analyses, main outcomes, including the most prolific authors, journals and themes, as well as the relationships between the themes identified and future trends of research. Finally, section four provides the main conclusions, identifies some limitations and indicates future lines of research.
There is consensus among different authors to consider medical tourism (MT) as a subset of health tourism (Pocock & Phua, 2011, p. 2) (see Fig. 1) that, according to Lunt et al. (2011, p. 11) contains the following range of treatments:
“Cosmetic surgery (breast, face, liposuction); dentistry (cosmetic and reconstruction); cardiology/cardiac surgery (by-pass, valve replacement); orthopedic surgery (hip replacement, resurfacing, knee replacement, joint surgery); bariatric surgery (gastric by-pass, gastric banding); fertility/reproductive system (IVF, gender reassignment); organ, cell and tissue transplantation (organ transplantation; stem cell); eye surgery and diagnostics and check-ups”.
The typical themes in the research agenda for the academic community related to medical tourism include the analysis of destinations, risks and opportunities in a specific country (e.g. Sharma, 2013) or group of countries (e.g. Ramírez de Arellano, 2011); the cost saving potential, quality and continuity of care (Meghani, 2011, p. 19); the behavior and experience and common motivations of medical tourists (e.g. Gan and Frederick, 2013, Ye et al., 2011); and the decision-making models of potential medical tourists (e.g. Sung & Ozuem, 2014). Furthermore, there is also a continuous intense debate on the ethical implications and impact on the host country (Ramírez de Arellano, 2011, Snyder et al., 2011) along with an increasing interest from practitioners and governments in researching medical tourism. In recent years, the ministries of tourism in several countries and entities such as the World Health Organization (WHO), the American Medical Association (AMA), the Indian Institute of Tourism and Travel Management (IITTM) and consultancy firms such as Deloitte have conducted studies indicating awareness of the economic implications for the national economies (IITTM, 2011).
As stated before, due to this growing interest, several studies that in one way or another can be seen as ‘reviews’ or ‘overviews” have appeared in recent years (See Table 1). The common conclusions gleaned from these reviews are that despite the recent flow of publications, there remains a lack of formal literature. Most earlier studies are exploratory with a tendency to describe in general terms the global development of this industry, explore the MT market (Woo & Schwartz, 2014), indicate how it should be developed (Chew & Darmasaputra, 2015), increase knowledge on the terminology and determine, in general, the size and flow of the trade (Carrera & Bridges, 2006). Hence several authors agree that there is an urgent need for more empirical studies collecting primary data and where “anecdotes, brokerage claims, and theoretical conjectures should be substitute for more deliberative study” (Hopkins et al., 2010, p. 194) and where theoretically and empirically driven approaches from a variety of disciplines should be developed (Snyder et al., 2011). Thus, the debate is ongoing, as many scholars are still calling for a theoretical clarification of this emerging industry and its subsequent domains.
Section snippets
Co-word analysis
The existing literature in a field is the starting point for researchers to build new frameworks and test hypotheses and relationships. The relations among the building blocks of literature can also be examined in what is called the “science of science” (Goldsmith & Mackay, 1964) reverting to bibliometrics to reveal the structure of knowledge in a specific field (Samiee & Chabowski, 2012).
Bibliometrics are defined as “the quantitative study of physical published units, or of bibliographic
Evolution of the documents and journals
Fig. 2 illustrates the evolution of the documents published on the topic per year from 1931 to the year prior to our study (2016). The slight increase of publications on medical tourism from 2004 reflects an increasing trend (except for 2012) suggesting that this subject is progressively gaining popularity in academia. It also clearly shows that the interest among editors in medical and health tourism has steadily grown since 2004, as the number of journals publishing articles on both topics
Conclusions, limitations and future research
On the basis of the papers included in the WoS and Scopus database services, we can assert that research on MT has broadened its focus since 1987 with the seminal publication by Goodrich and Goodrich. During this period, MT research saw an upward trend by the appearance of numerous papers and journals contributing to the dissemination and development of knowledge on this topic and forming a sound scientific corpus for future research. This increase of publications on MT since 2010 reflects a
Acknowledgments
This study was conducted with the financial support received from the Spanish Ministry of Economy and Competitiveness (Research Project ECO2012-39576) and the Andalusian Regional Government (Research Project SEJ-1980).
Full name: Andrea de la Hoz-Correa
Affiliation: Department of Marketing and Market Research at University of Granada
Brief professional biography: Ms. Andrea de la Hoz is an International Negotiator with a Master degree in Marketing and Consumer Behavior from the University of Granada (Spain). She is a professor and researcher in topics such as tourism, medical tourism, consumer behavior and online environments and currently a PhD candidate in Economics and Business at the University of Granada.
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Full name: Andrea de la Hoz-Correa
Affiliation: Department of Marketing and Market Research at University of Granada
Brief professional biography: Ms. Andrea de la Hoz is an International Negotiator with a Master degree in Marketing and Consumer Behavior from the University of Granada (Spain). She is a professor and researcher in topics such as tourism, medical tourism, consumer behavior and online environments and currently a PhD candidate in Economics and Business at the University of Granada.
Full name: Francisco Muñoz-Leiva
Affiliation: He is an associate professor at the department of Marketing and Market Research at University of Granada
Brief professional biography: Dr. Muñoz-Leiva holds a PhD in Business Sciences from the University of Granada (Spain). His main fields of research are Internet consumer behavior and neuromaketing. His recent works have been published in journals such as Current Issues in Tourism, Online Information Review, International Journal of Advertising, The Service Industries Journal, Quality & Quantity among others, as well as in national and international conferences (EMAC, AEMARK, Hispanic-Lusitanian Congress in Scientific Management, AEDEM, IADIS, Global Management, etc.).
Full name: Márta Bakucz
Affiliation: She is an associate professor at the Faculty of Business & Economics at the University of Pécs
Brief professional biography: Dr. Márta Bakucz is an acknowledged expert in Hungarian tourism research, the author of several related publications and the leader or participant of numerous tourism research projects such as the “Analysis of the Competitiveness Factors of Spas and Health Resorts in Hungary and Central European Regions” (2012–2016).