When elders choose: Which factors could influence the decision-making among elderly in the selection of health tourism services?
Introduction
The field of health tourism and associated medical services (interventions), have emerged as an important topics in any healthcare discussion worldwide. They nowadays represent the integral ingredients in a modern, globalized society [1]. Medical tourism, commonly identified with health tourism, has become prominent in the modern world market [2], [3]. However, it is essential to distinguish these two terms. Services obtained within medical tourism presume high expectations by their users. These services inherently assume significant improvements in respect to desired health outcomes [4], [5], [6], [7]. On the other hand, health tourism is oriented towards the promotion of a healthy lifestyles, recreational opportunities and general wellness. Thus, it encompasses the diversified palette of available natural remedies, resources, and climate advantages.
Different age groups will, naturally, require and seek different modalities of health services. In respect to elderly, medical tourism is regarded as a “healing of the ill” while the health tourism is primarily focused on the preservation and improvement of functional ability and wellbeing of “healthy” elderly [4], [5], [6], [7]. When health is the most important motive for the travel, some authors are still generally using the term “health tourism” in order to encompass, in a broad sense, all the forms of health-related tourism. This includes health tourism and wellness, general medical services, dental tourism, etc. [1], [4]. A number of health tourism programs that are provided through authoritative medical supervision use the advantage of available natural remedies [2], [3], [8], [9], [10]. Natural remedies and attractions in maritime health tourism setting differ from those in continental tourism. One offers Mediterranean climate, sea, cuisine and nutrition while the other provides thermal water and healing mud/medicinal clay treatments – this is also known as “fangotherapy” [2], [8], [9], [10]. For example, balneotherapy is mostly utilized in continental setting due to higher availability of spas and natural vapor resources [9]. On the other hand, thalassotherapy – medical use of seawater, as a form of therapy is readily available in maritime tourism [4], [8], [10], [11]. Thalassotherapy also includes use of shore climate, and sea products which are classified as natural remedies at the coast [11], [12].
Functional classification of tourism motives and activities is one of the bases for evaluation of tourism attraction [12]. For the sake of the argument, we will exemplify Croatia to demonstrate fundamental “take-home” concepts that we wish to demonstrate in our hypothesis. Geographical location in Southeast Europe and in the Mediterranean basin has a potential to greatly contribute to the economic orientation of Croatia. These rich natural resources, along with the reputable tradition of Croatian spas and sanatoriums make a versatile health tourism product. Health tourism programs often include components of physical rehabilitation medicine and the main goal of these treatments is to improve the health-related quality of life. Recent studies showed that warm climate conditions could exert beneficial effects on the rehabilitation program outcomes and these conditions suggest greater patient satisfaction [13], [14]. Croatian special rehabilitation hospitals (11 in total, as of 2009), both located at seaside and inland, are used for stationary inpatient medical rehabilitation [15], [16], [17]. In order to create an attractive health tourism product, it is of a pivotal importance to identify target groups of beneficiaries (health tourism service users) with a special emphasis on demographic, socioeconomic and geographical characteristics. Providers of such services should be aware of subjective and individual preferences of each particular beneficiary [18], [19].
The phase that precedes any decision is marked by the development of the awareness about the problem ahead. This awareness then creates necessities. Next phase is characterized by the retrieval and filtering of information and the creation of the so-called, “scale of preferences”. The scale of preferences plays a key role in the decision-making process [19]. User’s preferences are shaped based on the available information about particular health tourism destination and the characteristics of available services, bearing in mind the individual user’s perceptions. These perceptions are of subjective nature and they enable the user to maximize his/hers own satisfaction and benefit, with potential risks [4], [19].
In this paper, we focused on elderly citizens as our targeted group. People in older age group demonstrate a number of distinctions in terms of health tourism market distribution. Multimorbidities and functional disabilities are regularly more present among elderly than some younger age groups [20], [21]. Consequently, the growing population of elderly becomes increasingly prevalent in health tourism in general. Besides individual preferences, other factors could influence the decision-making process towards health tourism services among elderly. Suggestions from family members, and formal or informal recommendations received from various healthcare professionals (including primary-care or family physicians, nursing staff) can affect decision-making among elderly. In addition, feedback received from their referent social groups and friends, staff and other beneficiaries at public or private healthcare facilities should be accounted. Marketing aspects – public media advocates, TV, radio, Internet and newspaper advertisements contribute to a certain degree. Cultural determinants should not be overlooked – a typical user could contemplate his final decision based on intrinsic cultural and ethnic values that he/she might be expecting to receive in a certain health tourism milieu [19].
Elderly beneficiaries worldwide are embracing concepts of healthy and active aging; they are progressively becoming self-involved and they take more responsibility about their health and functional ability preservation [22], [23], [24], [25], [26]. Principles of healthy aging, according to World Health Organization (WHO), include health and social care services, an adequate physical environment, along with various personal, social, economic and behavioral features. These recommendations emphasize gender (sex) and cultural features that significantly affect all other perspectives [27]. Therefore, it is of special importance to recognize that the health tourism is becoming an important pillar in the modern concept of healthy and active aging. Such theme has a potential to become employed internationally and hypotheses presented in this paper could be tested worldwide. What are the key factors that drive decision-making towards health tourism services among elderly? This information alone could be beneficial to countries, systems and organizations that have a health tourism potential, along with the attractive natural resources that require more efficient utilization.
Factors that are proposed in our model (Fig. 1) are presented to a higher detail in Table 1 and are elaborated in the text. We believe that these factors, when integrated, will carry a detrimental weight in the decision-making process. Therefore, each of these factors acts as a significant variable that could be used scientifically to predict behavioral and decision patterns among the elderly users of health services. An individual can have a different motivation to why he or she will choose a particular health tourism service. Improvement of the health is the primary motivation in most cases, however, leisure opportunities and exploration of a new environment, away from home, are important motivations as well [1], [3]. This is a decisive dynamic to observe since it directs user interests towards tourist resort setting—one that integrates health facilities, accommodation and leisure capacities. Every country has a different, albeit unique, legislative and regulatory mechanisms that supervise health tourism sector. These regulatory limitations can differ greatly and potentially act in respect to biosecurity risk (e.g. disease vector, drug resistant bacteria) [1]. Some countries, unfortunately, deal with various environmental and/or political difficulties and instabilities. Such circumstances make them less attractive in the eyes of a potential health tourism beneficiary.
If we could identify target groups within the elderly population and correlate their preferences with the health services that are available in a particular region, then we could optimize the management and allocation of available resources. We believe that hypotheses presented in this manuscript would improve following outcomes:
- (A)
Financial and market aspect—relevant institutions and entities would be able to direct their products, marketing, and advertising to the appropriate groups of potential beneficiaries. This would help to avoid bad marketing strategies and production of undesired financial and human resource burdens.
- (B)
Human resources aspect and more effective allocation of resources—this would be the consequence of the dynamics described under point A.
- (C)
Improvement of the quality of health service—if the targeted groups are correctly identified, relevant institutions and entities would be able to research and develop relevant aspects that are necessary to satisfy and serve those particular groups.
- (D)
Health-related quality of life outcomes—this is a summarizing and focal aspect. We assume that these qualities would improve as the each particular beneficiary in a certain group receives optimum of services, as a consequence of the dynamics described before (A through C).
Section snippets
Hypothesis
Elderly citizens are a heterogeneous group of people, commonly perceived in correlation to their chronological age (65+) while their characteristics such as functional ability and level of personal health are overlooked [20], [28], [29].
These characteristics can influence the demands for the different and specific services within health tourism. These services are different than those elected by younger beneficiaries, likewise, they vary within the group of elderly as well.
In our preliminary
Evaluation of the hypothesis
Our preliminary study showed that 45% of elderly beneficiaries (65+) in our sample (n = 200) were in state of full functional ability at the start of their stationary medical rehabilitation. These interventions were conducted at three specialized hospitals for medical rehabilitation, located on the Adriatic coast. Study results confirmed that diagnostic categories were associated with the class of functional independence [28]. Medical diagnoses were determined according to the International
Consequences of hypothesis and discussion
We hypothesize, based on our preliminary study, that the most significant influencing factor in decision-making towards health tourism services is the level of functional independence of beneficiaries. The functional independence is a medical variable that evaluates the level of (in)ability to perform everyday life activities [28], [29], [30], [31]. This variable particularly influences the organizational and economic aspects of health tourism. It dictates the required number and professional
Conflict of interest statement
All authors declare no conflict of interest. All authors declare that no competing interest exist.
Sources of support
Authors declare that no form of grant has been received for making of this article.
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