A Study of Medical Tourism in Taiwan-A COmparative Perspective

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(1)College of Management I-Shou University. Master Thesis. A Study of Medical Tourism in Taiwan-A Comparative Perspective . . Advisor: Yeh, Shang-Pao Graduate Student: Sung, Tzu-Ying .

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(3) . Acknowledgments. The thesis is not only issued by the achievement on the study, but also that I want to forward the new milestone at the same time. Reviewing the graduate student for two years, I desire to thank my professor, Yeh, Shang-Pao who offered me guidance and encouragement of thesis. Besides guiding the thesis writing, he lead me to greet and challenge several lives with the positive attitude. On the other hand, I also thank for committee Professor who provided for my suggestion on the day of oral examination with different aspects and make this thesis more intact.. In addition, I will express gratitude to my parents; they foster me and devote time and money of them to enter the research institute arduously. My school classmate also help me while in the school, we study each other in thesis writing and remind the thesis progress each other. This is a progress with long hardships, but I am much honored guidance of study with my classmates and professor in with supreme compliments.. Sung tzu-ying. Jul.3, 2011. i .

(4) . Table of Contents Chapter 1 INTRODUCTION ................................................................................... 1 1.1 Research Background ...................................................................................... 1 1.2 Research Motivation ....................................................................................... 3 1.3 Research Purpose ............................................................................................ 4 Chapter 2 LITERATURE REVIEW ........................................................................ 4 2.1 Definition ........................................................................................................ 5 2.2 Increasing Global Activity .............................................................................. 6 2.3 Thailand ........................................................................................................... 9 2.4 India ............................................................................................................... 13 2.5 Singapore ....................................................................................................... 17 2.6 The status of medical tourism in Taiwan ....................................................... 17 Chapter 3 METHODOLOGY .................................................................................. 20 3.1 Research Design ............................................................................................ 20 3.1.1 Qualitative Research…………………………………………….…………………………...21 3.1.2 Semi-structured Interviews .................................................................. 22 3.1.3 Major bebefits of semi-structured Interviews ...................................... 23 3.1.4 Using the tool ....................................................................................... 23 3.2 Sampling Method .......................................................................................... 24 3.3 Research Process ........................................................................................... 26 Chapter 4 DATA ANALYSIS AND DISCUSSION 4.1 Data analysis ................................................................................................. 27 4.2 Interviews ...................................................................................................... 34 4.2.1 Professional Medical Practitioner ........................................................ 34 4.2.2 Travel Agent ......................................................................................... 36 4.2.3 Insurance Agent .................................................................................... 37 4.2.4 Government Officer ............................................................................. 38 4.3 Summary of results ...................................................................................... 39 Chapter 5 CONCLUSION AND RECOMMENDATION 5.1 Conclusion ..................................................................................................... 40 5.2 Suggestion ..................................................................................................... 42 Reference .................................................................................................................... 45 . ii .

(5) . List of Figures Figure1 International travellers reporting health treatment in 1996-2006……….…...7 Figure2 Origin of inbound medical travellers to the U.S.,2006…………….................8 . iii .

(6) . List of Tables Table 1 The compare table....……………………………………………..…………………………..…..19 Table 2 Fundamental data of interviewers…………………….………………..……...............25. iv .

(7) . Abstract The medical tourism industry is globally recognized as one of the fastest growing market sectors today. Medical tourism combines lower-cost medical procedures with the patient’s desire to enjoy tourism in the locale providing such health care services.. This study. focuses on a comparison of relative data in three countries: Thailand, India and Singapore. This comparison is made in order to estimate how Taiwan may similarly improve the development of its own medical tourism industry. Through a literature review of the related industries in Asian countries, an analysis of factors leading to full exploitation of medical tourism’s potential in the respective three countries is made. At the same time, tables are made use of and an in-depth interview is used in a case study approach to explore the different aspects observed. Finally, the study uses quantitative research to analyze the collected data, include descriptive analyses. We can found that Taiwan tend to focus on medical service in medical tourism industry from the research outcome, our government should make relevant strategy between medical service and tourism industry in order to improve the international competitive.. Keywords: Medical Tourism, Descriptive Analyses, Qualitative Research.. v .

(8) . Chapter 1. INTRODUCTION. Medical services, technology and sustainable energy represent three of the major core growth areas in global industry today. The scope of this paper will concentrate on the first area of medical services and how they may be exploited economically through locality-based tourism. The scale of global health care market has reached 2 to 3 trillion U.S. dollars in 2005, with Singapore, South Korea, India, Thailand and other Asian countries in direct competition for the overall market. (The Economist Intelligence, 2005). Many experts consider that medical tourism will continue to remain a fast growing industry as patients travel from one country to another for high quality healthcare, providing many reasonable, cost-saving, or even prohibited alternatives. In 2009, according to The Medical Letter of the CDC & FDA, it was mentioned that the reputable accounting firm Deloitte & Touche provided an estimate stating that as many as 3 million Americans could possibly travel abroad, spending $4.4 billion, and possibly reaching 23.5 million Americans spending $79.5 billion U.S. Dollars by 2017. (Renee-Marie Stephano - Medical Tourism Association President). 1.1 Research Background The global market in medical tourism will be worth $100bn in or before 2012, up from around $60bn in 2006 and $40bn in 2004. This analysis, compiled by global researcher Grail Research LLC, suggests that increasing medical tourism has been driven, at least in part, by emerging countries investing large sums of limited financial resources in their bid to capture a slice of this lucrative niche market. (Zarocostas, 2009). With consequent social and economic development, medical tourism has increased the 1 .

(9) . number and variety of travel patterns that reflect a wider demand for tourism. Medical tourism is a fast growing industry that combines elements of both medical and tourism. Over the past few years, vigorous development has taken place in many countries because of the economic importance attached to this service sector. International competition has driven medical tourism to become one of the fastest growing industries, as well as becoming a major new trend worldwide. People are now going overseas to seek medical treatments such as organ and marrow transplants, joint replacement surgery, cosmetic surgery, etc. A combination of many factors have driven the popularity of medical tourism, especially the high costs of health care in the United Stated, long waits for facility access, and the increased consistency in worldwide standards of healthcare, technological advancements, and equipment quality. (Tompkins, 2010). Recently, a trend towards medical tourism has emerged whereby people in developed countries choose to forego the medical care offered in their own communities. These people decide to travel to under-developed areas of the world in order to receive comparable medical services at lower costs. Medical tourism has been becoming increasingly popular, and it is projected that as many as 750,000 Americans sought offshore medical care in 2007 alone. (Michael, 2007). The medical tourism industry in Asia currently generates US $1.3 billion in revenue for certain national economies, and it is expected to grow to as much as US $4.4 billion by 2012, growing at a CAGR of 19%. Currently, the major countries competing for medical tourists in Asia are Thailand, Singapore, India and Malaysia. (Ivy, 2007) Among them, the Thai International Hospital in Bangkok, Thailand has been a leading advocate of medical service quality as a major form of national diplomacy. However, Thailand is not alone in using the lure of low-cost, high value health services to attract both economic and 2 .

(10) . diplomatic acceptance internationally. Taiwan has made the effort recently to join the growing list of Asian health-care providers who wish to secure their portion of the medical tourism marketplace.. Taiwan is located as an important economic hub in Asia. Following the implementation of a national health insurance program, the on-going scheme for development of the proposed 2015 First-Term Plan for Economic Development in the New Century (Three-Year Plan for 2007~2009), the promotion of the medical services industry engaging international health tourism, and the extension of high-profile health tourism marketing to the international sector, have all served to promote medical tourists seeking diverse healthcare services in Taiwan. (ROC Executive Yuan, 2007) However, the current level of medical marketing has been insufficient for Taiwan’s desired growth level, and it has generally lacked a specific planning strategy of any sort.. Therefore, the development of medical tourism has been. limited to say the least, and it has been ill-accomplished to say the most.. 1.2 Research Motivation Medical tourism was originally introduced to Taiwan in 2005. It has provided potential recipients of this form of healthcare with such services as senior health checks, beauty SPA treatments and physical fitness resorts that mix a variety of medical practices (pulsating lights, electric wave pulls, traditional Chinese medical practices, etc.) with traditional tourism. Taiwan's medical tourism program allows those willing to pay with access to high-tech medical equipment. Taiwan's current level of medical care practice is said to be already sufficient enough to promote Taiwan's fledgling medical tourism industry internationally. (ROC Tourism Bureau, 2006) However, the most pressing issues for the development of medical tourism are the non-existent strategies that may be used to develop it overall, and the inattention to 3 .

(11) . increased international competitiveness and market potential.. The demand for medical tourism services remains unclear in Taiwan; therefore, the vision of promoting medical tourism should be broader and not solely confined to the concept of making the domestic marketplace a primary source for consumers. In the Asian region, the development of medical tourism in many Asian countries has shown excellent results. Participating countries have been able to exploit their own individual characteristics and develop brand identity. Taiwan should learn how to improve competitiveness and trumpet the relative advantages of its medical tourism industry in comparison with other Asian countries. This is the principal motivation for this research.. 1.3 Research Purpose The study focus on explore discernible factors concerning medical tourism development in Taiwan and to determine a viable strategy to meet growth projections at the present stage of expansion. Relative data is utilized to portray the current situation surrounding medical tourism development in Taiwan with that of other Asian countries. It is hoped that the research will serve to provide recommendations on the practical inclusion of relevant government departments in order to foster growth, potential sources of income, and raised awareness of a diplomatic profile for Taiwan. The research purpose as follows: 1. Evaluate the advantages in the development of medical tourism in Taiwan. 2. Provide recommendations to the government departments and relevant industries.. Chapter 2. LITERATURE REVIEW. This chapter will provide a working definition of medical tourism. It will also give a 4 .

(12) . review of literature concerned with the development of medical tourism in different countries worldwide.. 2.1 Definition of Medical Tourism The term “medical tourism” is a relatively recent term coming into the English language. Medical tourism is defined as “the practice of patients seeking lower cost health-care procedures abroad, often packaged with travel and sightseeing excursion”. (Smith, 2007). According to Wikipedia, the on-line free encyclopedia, “medical tourism” (also called medical travel, health tourism or global healthcare) was a term initially coined by some travel agencies and the mass media in order to describe the rapidly-growing practice of travelling across international borders to obtain cheaper health care. It also refers somewhat pejoratively to the overall practice of healthcare providers travelling internationally so that they may deliver healthcare in untapped or under-served markets. The word “medical” is used to mean a treatment of illness, disorder or injury. In general, “tourism” means to travel for one’s own pleasure or experience.. According to the World Tourism Organization (WTO), the word “tourism” compromises any number of “activities conducted by persons traveling to, and staying outside, their usual environment for leisure, business and other purposes.” Hence, medical tourism may be defined as “the set of activities in which a person travels’ often long distance or across the border, to avail themselves of medical services with either a direct or indirect engagement in leisure, business or other purposes.” (Jagyasi, 2008). Horowitz & Rosenberg refer to the notion of “medical tourism” as an activity in which people travel from a more-developed country to a less-developed country for purposes of 5 .

(13) . obtaining quality healthcare at a lower cost. In other cases, people from poorer countries will practice medical tourism by going to a richer country to get treatment that is not available, or even prohibited, in their home country.. 2.2 Increasing Global Activity Medical care will soon become one of the top three industries worldwide, along with information technology and sustainable energy. The market for health care alone will reach more than 2 billion dollars globally, of which the annual health tourism market, will have a foreseeable output of more than 7.7 billion dollars. (The Economist Intelligence Unit, 2000) Thus, the market demand for medical tourism will lead to increasingly large amounts of economic profit for Asian countries. The medical tourism market is estimated to provide roughly 3~5% to the overall tourism market and maintain a stable growth rate of 30% per year. (Morgan, 2003; Acharuyulu & Reddy, 2004). In 2003, approximately 350,000 patients departing from industrialized nations traveled to a variety of lesser-developed countries for their choice of health care providers. It is projected that 750,000 Americans went offshore to seek their medical care in 2007 alone, with this number having increased significantly to six million in 2010. (Horowitz & Rosensweig, 2007) Additionally, medical insurance programs underwritten by American Insurance carriers have encouraged their policy holders to travel to foreign countries for the sole purpose of seeking lower-cost, or alternative, treatments to defray costs. The current world financial downturn at the end of the last decade, by increasing patient waiting- list time and pressurizing personal finances with exorbitant fees, may further exacerbate this trend. (Leahy, 2008). 6 .

(14) . Fig.1 International Travelers Reporting Health Treatment as the Primary Purpose for their trip, 1996-2006. Source: U.S. Department of Commerce, Office of Travel and Tourism Industries, Survey of International Air Travelers, 1996-2005. Figure3 shows the number of inbound, non-U.S. resident travelers who openly reported that the main purpose of their trip to the U.S. was to seek health treatment, the number of outbound U.S.-resident travelers who openly reported that the main purpose of their trip overseas was to seek health-care treatment, and the number of non-U.S. residents traveling to the U.S. for health treatments as a proportion of total travelers. These numbers represent data from1996 to 2006 respectively. The overall number of travelers to the U.S. for purposes of seeking health-care dropped by 16% between the years 2000 and 2001. The number of outbound U.S. residents traveling overseas to seek medical care as a proportion of total overseas travelers has more than doubled since 2000.. 7 .

(15) . Fig. 2. Origin of inbound medical travellers to the U.S.,2006. . Fig. 2 shows the distribution of patients by home country taken from the same survey. One-third of inbound patients were reportedly originating from the Middle East, 17% coming from Canada, and 11% arriving from Mexico.. Health insurance providers such as Aetna, Blue Cross/ BlueShield of South California, Blue Shield of California, and United Group Programs are slowly beginning to reimburse some out-of-the-country treatments that are deemed non-controversial. Two state legislatures, those of Colorado and West Virginia, have introduced legislation in order to allow state employees to go overseas for non-elective surgery. In West Virginia, in 2006, Delegate Ray Canterbury introduced House Bill HB4359, and in Colorado, a similar bill, HB07-1143, was introduced by State Representative Spencer Swalm for just such a purpose. Within these propositions, patients were given incentives to choose the cheaper overseas care over that of the higher-priced domestic offerings. (Diane York, 2008). For example, more employers, like Blue Lake Casino & Hotel located in Northern California, are starting to introduce travel with medical purposes as part of their benefits 8 .

(16) . plan as a way to increase perception of their benefits package, while still reducing costs. Blue Lake Casino & Hotel chose to adopt a liberal medical travel program to achieve quality health care and to keep costs low. Further, the exemplary plan could realize 40 percent to 80 percent savings for the policy-holder, which for the individual means a reduced share of the costs in the co-pay and deductible amounts. (IOMA’s Report on Managing Benefits Plans, 2010) . 2.3 Thailand Medical tourism is becoming a strong selling point in Thailand’s tourism promotions strategy. This is because Thailand has maintained international standards of medical care and health services at a competitive price point in comparison with more expensive neighboring countries such as Singapore and Malaysia. As the rate of exchange in Thai baht against the U.S. dollar or to the euro remains relatively depressed, foreign health care seekers will be able to afford professional-level health care in Thailand. For example, the average costs for medical care visits were 5-20% less than those found in Singapore. Incentives are numerous and include overall cost savings, convenient family accommodations for those who accompany patients and modern hospital facilities located in most large urban areas. In addition to directly seeking professional health care while in Thailand, tourists may also visit the many tourist attractions that have made this country famous. The place of medical tourism is not only concentrated in Bangkok, but also in other popular areas frequented by foreign tourists, such as Phattaya, Hua Hin, Chiang Mai, Ko Samui and Phuket. (Zadok-Lempert, 2010) Milica & Karla states that Thailand receives approximately 400,000 foreign medical tourists every year, with 50,000 Americans going to the Bumrungrad hospital in Bangkok alone. Similarly, there have been approximately 50,000 medical tourists originating in Great 9 .

(17) . Britain who traveled to Thailand, South Africa, India, and Cuba to seek low-cost health care. Relatively speaking, invasive surgery in Thailand and South Africa costs about one-tenth of what it would cost in a U.S. or Western European operating theater. The cost savings can be a great incentive to go elsewhere. For example, heart valve replacement surgery might cost as much as $200,000 or more in the United States. By comparison, a knee replacement in Thailand, along with six days of physical therapy, costs about one-fifth of what it would in the United States.. Regarding quality, Joint Commission International (JCI), the chief international hospital accreditation organization now provides links to all the hospitals it has accredited. The site for the Bumrungrad Hospital in Bangkok describes the amenities offered as well as surgery prices. Currently leading the Asia-Pacific region, Thailand has six hospitals in Bangkok alone that cater for medical tourists. A full range of medical treatments is available along with cosmetic surgery, dentistry, and eye laser surgery (LASIK). The country is also a favorite destination for sex-change surgery. One of the pioneers of medical tourism in Asia is Bangkok’s Bumrungrad Hospital, which boasts a five-star hotel-like lobby, a Starbucks and over 200 surgeons who are board-certified in the US. (Llamas, 2006). According to the Thailand’s Ministry of Public Health and Thailand’s Bureau of Tourism statistics for 2003, medical tourism in Thailand may include up to 73 million foreign visitors so far. Furthermore, medical tourism has created the economic output value of $488 million in 2005 alone. As evidence that Thailand is a significant international health care destination, Bumrungrad International hospital was considered in the October 2006 of Newsweek magazine to be one of the top ten international hospitals providing medical care in 2005. It received 400,000 foreign patients. This is more than any one hospital in the entire world. 10 .

(18) . According to New York Times, Bumrungrad Hospital in Thailand has built a culturally compatible, patient-friendly wing for its Middle Eastern patients to make them feel more comfortable during their stays. The hospital took the additional steps of hiring qualified Arabic interpreters, built a new kitchen to offer religiously- acceptable (halal) food, and purchased high-quality Muslim prayer rugs for patients and their families to use during their stays. Patients visiting hospitals in Thailand do not have to worry about language difficulties. The International Medical Centre, located in Bangkok, provides Japanese patients with a special wing, paying particular attention to religious, cultural, and dietary restrictions of its discerning clients. In addition, there are ten “sales” offices located abroad that offer services directly to foreign customers. Some hospitals even maintain representative offices or agencies in other countries to act as middle-men in obtaining ever-increasing numbers of patients seeking lower-cost health care in a modern, clean, and politically stable environment. In addition to direct efforts, these institutions establish and maintain links to local hospitals, doctors, and insurance companies. They are also associated with embassies in order to facilitate visa issues for their clients. Singapore’s hospitals have long maintained offices associated with health care provision in the Middle East and Indonesia with great success.. In the late 1990s, a tourism promotional campaign called “Amazing Thailand” was launched by Thai authorities, and health care was touted as one of the principal niches available to foreign travelers. As part of this campaign, the government of Thailand succeeded in developing for the first time health-care centers located in tourist spots outside of Bangkok, such as those in Phuket and Chiang Mai. (Milica & Karla, 2007) Thailand is intent on developing their infrastructure because, as many development economists have already discovered, that the capital required for economic growth is not 11 .

(19) . just equipment and human capital, but also global access to public infrastructure. Infrastructure is defined as “the underlying amount of physical and financial capital embodied in roads, railways, waterways, airways, and other forms of transportation and communications, plus financial institutions, public utilities, and public services, such as health and education.” (Chilisa, 1994). In respect to private industry, Thailand has a market oriented health-care system that offers its population real choice in health care, as reported by International Trade in Health Services. But, it has not stopped there and plans to expand its business holdings beyond the borders of Thailand. As a primary example, the Bumrungrad, the largest hospital in Thailand, has already planned to invest in the off-shore Asian Hospital and Medical Center located in Manila, the Phillipines with a 40 percent stake in the hospital projected.. Medical tourists may wish to take advantage of sales promotion offered by the Bumrungrad Hospital in Bangkok which included a basic round-trip airfare, airport transfer, 24 hours-a-day personal assistance, and a Bangkok orientation tour. Patients can schedule private excursions, trips to beaches, shopping expeditions, and visits to ancient sites prior to or during recovery. All of these are scheduled around medical appointments made in advance. Most importantly, the sales promotions extend to airline fees and schedules. “Many Asian airlines offer additional frequent flyer miles to help patients return for follow-up visits.” (Becca, 2005) Significantly, it should be noted that, “The Bumrungrad is exploring ways of offering frequent flyer miles for their medical services.” (Milica & Karla, 2007) In order to promote medical tourism, the sales options available to international patients include room and board, and they are suited for all tastes, no matter how exacting. If international patients choose not to stay in the congested capital city of Bangkok, the resorts on the coast sell beach holidays coupled with visits to clinics offering low-cost 12 .

(20) . cosmetic surgery. Tourists can fly directly to Phuket and check in at the Phuket International Hospital that advertises “Bright sun, blue sea, and the best cosmetic surgery anywhere!”. 2.4 India In 2004, 1.18 million patients from all over world traveled to India to receive health care, while Thailand cared for approximately 1.1 million medical tourists from a diverse number of countries in Asia, Europe and North America. Medical tourism in India produces an annual revenue stream of $300 million, with projected growth of up to $2 billion reported by the Union of India industry consulting with McKinsey & Co. for 2012. (Horowitz & Rosensweig, 2007). It is estimated that India could earn as much as $2.2 billion per year from revenues related to medical tourism by the year 2012. Medical tourism would do for India’s economic growth in the 2000s, ten to twenty times what information technology did for India’s economy in the 1990s, according to Mr. Narsinha Reddy, Manager of Marketing for Bombay Hospital, Bombay, India.. Health tourism is often hailed as a sector in which developing countries, such as India, have a huge potential for growth due to unique comparative advantages. These advantages are primarily based on their ability to provide world-class health care treatment at lower prices, combined with exotic domestic resorts for purposes of convalescence. According to the Federation of India Chambers of Commerce and Industry, the health-care market, which includes health insurance, is expected to expand by 2012 from US$ 22.2 billion, or 5.2% of gross domestic product (GDP), to between US$ 50 billion and US$ 69 billion, or 6.2% and 8.5% of GDP. (Chinai & Goswani, 2007). 13 .

(21) . Medical tourism is an example of how India is profiting from the process of globalization and the localized consequences of outsourcing. It is also a new form of consumer diplomacy for India, whereby foreigners who receive medical services in India help the country to promote itself (word-of-mouth) as a business and tourism destination to be reckoned with. India hosts medical tourists from almost all of the western industrialized countries, especially the United Kingdom and the United States. They also welcome medical tourists from neighboring Bangladesh, China and Pakistan. India currently faces intense regional competition in this sector, particularly from Malaysia, Singapore and Thailand. (Chinai & Goswani, 2007). In terms of cost, India can offer medical services estimated at around one-fifth to one-tenth the cost of those health care services provided by industrial countries. For example, the cost of coronary bypass surgery is about five percent of what it is when conducted in developed countries, while the cost of a liver transplant is one-tenth of what it is in the United States. Again, ample reason for medical tourists to travel and save. However, this may not be entirely necessary in the near future. “India’s Rockland Hospital is planning to open a hospital in London, England; where, in addition to regular services, follow-up care would be offered to European patients.”(Shardul & Sapna, 2005) This has yet to occur and the obstacles surrounding such an endeavor are considerable.. According to Financial Times of India, India’s 2002 national health policy specified a role for medical tourism. A year later, finance minister Jaswant Singh called for India to become a global health destination, marking the beginning of the Indian government’s direct policy to merge the nation’s medical expertise along with tourism. In addition, Indian authorities have continuously provided benefits and incentives to potential medical tourism providers, such as lowered import duties on equipment required for medical tourism to take place. 14 .

(22) . They also increased the rate of depreciation for life-saving medical equipment to further this cause. In India, given its highly decentralized political structure, cooperation between federal and state levels is crucial. Moreover, authorities have started involving the national airline in medical tourism strategies. (Milica & Karla, 2007). In regards to the availability of health care providers with professional skills, “In India, the authorities continue to encourage medical tourism by having helped to train over 20,000 new doctors per year since 2003. Altogether, India produces some 20,000-30,000 doctors and nurses every year.” (Milica & Karla, 2007) While roughly 3 percent of Indian doctors emigrated in the 1980s, the proportion of the graduates from the all India Institute for Medical Sciences, the best in the country, was 56 percent during 1956-80 and 49 percent during the 1990s. In 2004, India received the highest number of American visas for temporary skilled workers; more than double that of the next ranking country reported by New York Times.. It may be noted that both India and the Philippines seem to have relative advantages over other countries since English remains as one of their official languages, and the one most outside its borders. Language is also important to another aspect of trade in medical services: outsourcing. Fluency in English, coupled with a large number of highly educated people skilled in IT, engineering, and bio-medical technology has enabled India to develop a comparative advantage in the outsourcing of trained medical professionals. It has been predicted that soon India will begin outsourcing its labor to the former British colonies in Africa where English is spoken and labor is cheap. (Cetron, 2010). India provides centers for open-heart surgery, pediatric heart surgery, hip and knee replacement, cosmetic surgery, dentistry, bone marrow transplants and cancer therapy. A joint 15 .

(23) . study by McKinsey and the Confederation of Indian Industry has estimated that medical tourism could be worth US$2 billion to the country by 2012. Indian pharmaceutical companies also meet the requirements of the US Food and Drug Administration. Promoting India as a “holistic” healing center offering spiritual and mental healing as well as physical has been seen as one potential competitive edge, given the strong base of therapies such as yoga and naturopathy. (Llamas, 2006). 2.5 Singapore In 2000, Singapore’s healthcare system was ranked the best in Asia and sixth best in the world by the World Health Organization; however, the U.S. was ranked thirty-sixth from Health &Medicine Week. Singapore drew over 410,000 international patients to its domestic hospitals and treatment centers in 2006, and the country now boasts eleven JCI-accredited hospitals.. Singapore has become quite devoted to the development of a medical tourism industry in recent years. The Singapore Tourism Board has sought to promote the country‘s world-renowned, anti-aging beauty treatment regimens, and awareness of its inexpensive health check system. Due to geographic proximity, Singapore in 2005 received 400,000 foreign patients. It was estimated that in 2007 that Singapore realized nearly 15 billion U.S. dollars in related medical tourism. It is said that in 2012 , Singapore will achieve revenues even reaching 3 billion U.S. dollars.. The authors, Milica and Karla mentioned that Singapore has a recent per capita income that ranks it among the highest in the globe, with medical tourism having made a sizeable contribution to date However, its medical tourism industry, while long standing, has now priced itself out of the mass market as the rates of its services are comparable to those found 16 .

(24) . in Western states.. 2.6 The Status of Medical Tourism in Taiwan Medical tourism has surged worldwide in recent years. Throughout this phenomenal growth period, Taiwan’s nationalized healthcare system has long been praised as one of the most efficient in the world. The Taiwanese government is finally introducing its own medical tourism promotion plan that will merge health care industry and travel industry objectives in order to provide global awareness of a high-quality, internationally recognized medical tourism environment providing reasonable cost medical treatment. Taiwan maintains one of the top five liver transplant centers and one of the top three bone marrow donors database centers located in Asia. In fact, many international service centers and diagnosis enquiry hotlines are now operated by major hospitals in Taiwan. They provide established, professional coaching platforms to assist foreign clients in need. National Taiwan University Hospital presently holds a quality brand image and ultimate medical clinic service reputation through its cross-national partnerships and medical diplomacy strategy implementation.. In terms of specialization of surgery techniques, Mackay Memorial Hospital in Tamsui has developed numerous specific treatment fields such as Assisted Reproductive Technologies, Cosmetic Surgery, Cardiac Procedure and Neurological & Spinal Surgery. The hospital also offers long-distance healthcare services, health examinations, and nutrition coaching & management programs to consistently provide crucial, innovative and fully-covered medical health care services. Wan-Fang Hospital in Taipei is also the only award winner of subsidiary hospital operated under Medical University accredited by Joint Commission International, JCI. The hospital further ranks as the best hospital in Taiwan that meets 17 .

(25) . international standards of regulation. In particular, the development of medical tourism has advantages in promoting international level medical techniques, high-end facilities, reasonable medical treatment costs and outstanding public health environment to the Taiwanese medical community.. According to a review of literature related to the development of medical tourism in three countries, the following table is given in order to compare the holistic development of medical tourism in Taiwan.. Table 1. The compare table. Country. India. Thailand. Singapore. Taiwan. Price. Competitive price. Competitive price. Attractive price. Competitive price/attractive price. Cost. Cost effectiveness/ affordability. Affordability/low cost. Affordable. Affordable. Affordable Cardio and orthopedic care. Cosmetic surgery/dentistry/ medical check. Renown for Cardiology/ gynecology/ oncology and neurosurgery. Health check/beauty/ obesity/ liver disease diagnosis. Advanced healthcare. Advanced healthcare. Highest quality. High quality. JCAHO-certifie d hospital (Joint Commission International). JCAHO-certified hospital (Joint Commission International). JCAHO-certified hospital (Joint Commission International). Number of JCI ratio insufficient. Service-oriented. Personalized level of provision. Consumer-driven service. people-oriented service (Service excellence). Need improvement. Governmentsupported. Support from government. Support from government. Support from government. Support from government. Category. Specialty. Quality Accreditation system (international standard). 18 .

(26) . Modern facilities. Modern facilities. Technology. Innovative technology. Innovative technology. Location. Lucrative destination. Facilities. India. Environment. Modern facilities. Medical-driven Advanced technology. Leading medical hub in Asia. Center of Chinese region. Thailand. Singapore. Taiwan. Relaxing environment. Safety and stable environment. Safety and stable environment. Language ability. English spoken. English spoken. Chinese. Levels of Professionalism. Professional personnel. Reputable specialist and nurses. Good standing. Healthcare experience. Dependable healthcare experience. Waiting time. Decrease waiting time. Living standard Process. Transparency. Others. Herbal and holistic healing technique. Dependable reduced waiting time. Unknown. Low-cost of living. Fair. Friendly culture. British colony/doctors are UK or US-trained. Rich alternative medicine. Chapter 3 METHODOLOGY This chapter is based on those ideas in the previously described, limited literature review and upon qualitative research produced through semi-structured interviews with the relevant industry professionals. Data were collated and analyzed to provide comparative perspective related to the development of medical tourism in Taiwan.. 19 .

(27) . 3.1 Research Design This study focuses on a comparison of relative data in three regional countries (Thailand, India and Singapore) in order to assess how Taiwan might improve the development of its own medical tourism industry. Through a literature review of the related medical / health care industries in these respective Asian countries, successful factors leading to development may be determined. At the same time, it is possible to make use of tables and in-depth interview for a case study approach that may lead to exploratory research seen in the different aspects of data provided.. 3.1.1 Qualitative Research Shank (2002) defines qualitative research as “a form of systematic empirical inquiry into meaning”. By systematic this definition means “planned, ordered and public”, following rules agreed upon by members of the qualitative research community. By empirical, it means that this type of inquiry is grounded in the world of experience. Inquiry into meaning says that researchers try to understand how others make sense of their experience. Denzin and Lincoln (2000) claim that qualitative research involves an interpretive and naturalistic approach: This means that qualitative researchers study things in their natural settings, attempting to make sense of, or to interpret, phenomena in terms of the meanings people bring to them.. Denzin and Lincoln emphasizes qualitative research is a method of inquiry employed in many different academic disciplines, traditionally in the social sciences, but also in market research and further contexts. Qualitative researchers aim to gather an in-depth understanding of human behavior and the reasons that govern such behavior. The qualitative method investigates the why and how of decision making, not just what, where, when. Hence, smaller but focused samples are more often needed, rather than large samples. 20 .

(28) . Qualitative methods produce information only on the particular cases to be studied, and any more general conclusions are viewed as only propositions (informed assertions). Quantitative methods can be used to seek empirical support for such research hypotheses to be concluded.. The advantages of doing qualitative research on leadership may include the following (Conger, 1998, Bryman, 1988, Alvesson, 1996): 1.. Flexibility to follow unexpected ideas during research and explore. processes effectively; 2.. sensitivity to contextual factors;. 3.. ability to study symbolic dimensions and social meaning;. 4.. increased opportunities - to develop empirically-supported new ideas and. theories for in-depth and longitudinal explorations of leadership phenomena, and for more relevance and interest of practitioners.. 3.1.2 Semi-Structured Interviews Semi-structured interviews are conducted with a fairly open framework which allow for focused, conversational, two-way communication. They can be used both to give and receive information. Unlike the questionnaire framework, where detailed questions are formulating ahead of time, semi structured interviewing starts with more general questions or topics. Relevant topics (for example, as with cookstoves) are initially identified and the possible relationship between these topics and the issues such as availability, expense, effectiveness become the basis for more specific questions which do not need to be prepared in advance. (Tony Grove, 1990). Not all questions are designed and phrased ahead of time. The majority of questions are created during the interview, allowing both the interviewer and the person being 21 .

(29) . interviewed the flexibility to probe for details or discuss issues. Semi-structured interviewing is guided only in the sense that some form of interview guide, such as the matrix described below is prepared beforehand, and provides a framework for the interview. The purpose of the tool is to obtain specific quantitative and qualitative information from a representative sampling of the population. In addition, the purpose is also to obtain general information relevant to specific issues and to gain a range of insights on specific issues of interest to the researcher.. 3.1.3. Major Benefits of Semi-structured Interviews. Semi-structured interviews are less intrusive to those being interviewed since semi-structured interviews encourage two-way communication between interviewer and interviewed. Those being interviewed can ask questions of the interviewer. In this way it can also function as an extension tool.. Semi-structured interviews help to confirm what is already known but also provides the opportunity for learning. Often the information obtained from semi-structured interviews will provide not just answers, but the reasons for the answers. When individuals are interviewed they may more easily discuss sensitive issues. Help field staff become acquainted with community members. Outsiders may be better at interviewing because they are perceived as more objective. Using both individual and group interviews can optimize the strengths of both.. 3.1.4. Using the Tool. There are several considerations that a researcher should be aware of prior to utilizing semi-structured interviews as a tool. These are as follows, but not limited to:. 22 .

(30) . 1.. Design (facilitator and/or interview team) an interview framework such as the matrix. example. Include topics or questions for discussion.. 2.. Establish the sample size and method of sampling.. 3.. Interviewers can conduct a number of practice interviews with each other and/or with a few community members, to become familiar with the questions, and get feedback on their two-way communication skills.. 4.. Record only brief notes during the interview and immediately following the interview elaborate upon the notes.. 5.. Analyze the information at the end of each day of interviewing. This can be done with the interview team or group.. 6.. Discuss the overall results of the analysis with community members so that they can challenge the perceptions of the interview team. This can make the process even more participatory.. 3.2 Sampling Method Researchers often try to use the method of semi-structured interviews, which means that the relevant question for the core of the problem and design the outline of the development-related issues is explored by understanding the existence of various related problems. In addition, because interviewers can be slightly in the control of nature and have open attitude in context of specific issues by joining the semi-structured interviews, so that the participants tell their real thoughts in order to obtain recognition of research issues, but not obscure the topic. We also understand potential problems to participants in the development of international medical tourism in Taiwan.. 23 .

(31) . In this research, participants who are interviewed are sourced mainly from the medical industry, the tourism industry and the insurance industry in this area of study. Interviewees are three professionals who work in local-area hospitals. Another two respondents working as licensed travel agents, one interviewed employee works as an insurance agent, and one respondent works in a Taiwanese government agency.. Table2. Fundamental Data of Interviewers Industry. Interviewer. Title. representative Hospitality. Year of experience. A1. Administrative. 4. Assistant A2. Nurse. 4. A3. Head Nurse. 3. B1. Executive. 4 . B2. Sales assistant. 3. Insurance. C1. Regional Manager. 5. Tourism Bureau/. D1. Officer. 7. Travel agent. government. The duration of the interview time period was from Sept. 20~Oct.19, 2010, and the time allocated for each interview was controlled within an hour with the cooperation of all participants. The interview location depended on the respondents’ needs, depending on who worked in the hospital, travel agency and insurance agency. Generally, interviewees were interviewed in their offices; the employee who worked in the government was interviewed in a public place. The interviews focused on the development of medical tourism in Taiwan and on the international medical tourism market in order to analyze the advantages and 24 .

(32) . disadvantages applicable to the Taiwanese marketplace. The questions were as follows: Q1 What do you think about the development of medical tourism in Taiwan? Q2 Which parts of service can be improved in the Taiwan hospital? Q3 Has Taiwan developed a customized service system that links medical sources with tourism?. 3.3. Research Process. This study focuses on realize the development of medical tourism in Taiwan by comparing the relative data in three countries such as Thailand, India and Singapore. We collect the relevant literature reviews from three countries and explore discernible factors concerning medical tourism development in Taiwan. The process of research analysis as follows: First, we make sure the research topic and it included the research background, research motivation and research purpose. Secondly, going a step further is draft the research scope and making the definition of proper noun. Thirdly, we collect the literature review for the development of medical tourism in different countries and introduce the development of medical tourism in Taiwan. Fourthly, we make sure research methods which included qualitative research and semi-structure interviews and implement it. Finally, we explore key factors by analyzing the outcome and provide recommendations to the government departments and relevant industry in order to improve international competitive.. 25 .

(33) . Chapter 4. DATA ANALYSIS AND DISCUSSION. With data taken from the table to compare the development of medical tourism in India, Thailand and Singapore, we may be able to analyze the differing aspects of medical factors in Taiwan.. 4.1.1. Price. The price of total knee replacement surgery at a JCI-accredited hospital in Taiwan, including all surgical costs, VIP accommodations, concierge service, transportation, and round-trip airfare, is generally less than $15,000 (U.S.), while the price in the United States is often upwards of $60,000. People want to undergo treatment abroad in India to obtain the most competitive fees for treatment, medical facilities and competent doctors. Since the average living standard is inexpensive and the medical treatment at private hospital reasonably comparable, Americans would seek to obtain higher quality health care and attractive price in Singapore,. 4.1.2. Cost. While high costs are the primary reason for American medical tourists to seek health care provider alternatives, the lure of travel to other countries will remain a good choice for tourists without medical interests. To illustrate the cost different, a heart bypass surgery in a U.S. hospital easily can run in excess of $100,000, whereas the same procedure is $32,000 in Singapore. The price is $24,000 in Thailand, and less than $12,000 in India. A hip replacement in the U.S. can be around $100,000 but $14,000 in Thailand and $9,000 in India. A $60,000 knee replacement in the U.S. would cost $9,000 in Taiwan. Cost savings are once again significantly apparent.. 26 .

(34) . 4.1.3. Specialty. Thailand’s medical tourism services are focused on treatment areas that are more popular to medical tourists, such as with cosmetic surgery, cosmetic dentistry, and general medical check-ups. Singapore is renowned for a broad range of specialist care such as with cardiology, gynecology, oncology and neurosurgery. A lot of Indian doctors who have practiced abroad will return home after they accept professional training in UK, so cardioand orthopedic segments of medical treatment are rather competitive. At the present stage in Taiwan, medical service is famous for liver disease diagnosis, beauty enhancement surgery, obesity treatment, and overall medical examination.. 4.1.4. Quality. India has long way to go to establish itself as a leading medical tourism brand that can offer high quality healthcare at affordable prices, with an additional pull factor being its attractive tourism activities. Taiwan’s own high quality of medical system is evident because many private hospitals have received national accreditation and are part of an international accreditation system in order to ensure the quality of medical service and attract medical tourists. Americans would seek to avail themselves of high quality health care in Singapore, more than 410,000 visitors traveled to Singapore for medical service in 2006. The Bumrungrad Hospital in Thailand was the first hospital in Asia to receive such international accreditation so it has subsequently attracted many international patients who seek advanced healthcare at lowered costs.. 4.1.5. JCI. In order to meet or exceed quality standards of U.S. hospitals, hospitals in a developing country often rely on stringent accreditation standards. Accreditation systems should be a vital factor whenever evaluating the quality of care issue for institutions and individuals 27 .

(35) . alike. The Bumrungrad Hospital in Thailand was the first hospital in Asia to receive accreditation. In India, accreditation dates for six regional hospitals ranging from August 2005 to October 2006. All Singaporean hospitals are accredited according to government-fixed standards of professional health care. In Taiwan, the number of JCI accreditation system ratio is insufficient for purposes of this study.. 4.1.6. Service-orientation. Singapore remains a chief health care destination to inbound international patients and has become associated with people-oriented service. India plays a significant role in the growth of medical tourism because of personalized level of provision and a dependable healthcare experience for medical tourists and locals alike. The demand for medical tourism is predominantly consumer-driven, including patients, employers who pay bill, and insurance companies seeking to identify low-cost provider networks in Thailand. To provide people-oriented service, we need to improve the overall service-orientation because the number of hospitals which provide this kind of service is insufficient at this time.. 4.1.7. Government Support. The Indian government actively supports the growth of healthcare corporations by offering incentives, creating institutional infrastructures, supporting an accreditation system. They promote the overseas sales and marketing of medical tourism through participation in trade missions, global medical tourism congresses and networking events. The government can also develop good regional medical tourism activities as well; the position of each individual Indian state in the medical tourism sector depends on the strategies they have utilized to promote their services.. The expansion of the health care / medical tourism industry in India, Singapore, and 28 .

(36) . Thailand, as well as in other Asian nations, is a key part of national economic development and health sector planning. National governments in these countries take an active role in promoting their nations as destinations for foreign patients. Government support for medical tourism includes sponsorship of trade shows and other promotional events held abroad that are designed to attract patients and market word class medical facilities.. In Taiwan, we have government support and our government promotes the internationalized flagship plan of medical care and takes the high-quality medical treatment into the world. Not only promote good image of medical treatment to the international community, but also drive the development of relevant industry and the growing of economy in domestic. However, the government lack of policies set by combination with medical service and tourism industry.. 4.1.8. Facilities. Since India’s economic liberalization 10 years ago, private hospitals are finding it easier to import equipment and other items. Medical technology used to be what differentiated the care available in developed countries from that on offer in India, this gap doesn’t exist anymore and with private Indian hospitals now at the same technological level as hospitals in Europe and America. Thailand are now promoting their modern facilities for more serious procedure, other destination include Singapore. In Taiwan, the pattern of facility is trend to medical-driven in hospital.. 4.1.9. Technology. Globalization of the healthcare industry has seemed to work wonders for India’s economy and quality of life. Not only has it brought the latest innovative technology to the country, it has also allowed health care providers to meet international standards of competency and 29 .

(37) . technological innovation. Significant investment has been made to install innovative technology, to achieve recognized quality certifications, and to attract highly-skilled doctors to keep India ahead of Thai competition in medical tourism.. 4.1.11 Location Singapore has long been the leading medical hub and health care destination of choice in Asia. North Americans have consistently sought high quality health care in Singapore. But, it should be noted that Taiwan boasts a geographic advantage. Taiwan is very close China after the government implemented open-door policies regarding trade, and it is also quite convenient when China people seek to medical services without a language barrier. India is often a favorite place travel and medical services destination for British people because of historical reasons and language. India is a very low-cost alternative destination for people wanting to undergo treatment abroad, and it possesses the most competitive charges for many common medical treatments.. 4.1.11 Environment Environment is another important factor for medical tourists to take into account; for example, there is a relaxing environment in much of Thailand. Singapore appeals to American travelers as one the cleanest and safest English-speaking countries in the world. In Taiwan, patients may expect to receive fully-covered treatment and careful health management service in comfortable surroundings.. 4.1.12 Language Ability Since Singapore had been a British colony for many years of its modern existence as a city-state, the general English ability is not a problem for most of its citizenry. Although Taiwan’s relative language advantage is Mandarin Chinese, the English ability of medical 30 .

(38) . staff and tour operators needs to improve so that Taiwan can face the competitive environment of globalized medical tourism.. 4.1.13 Professional Staffing India’s medical education system produces a large number of skilled professionals annually, For example, there are more than 35,000 specialist doctors of Indian origin in the U.S. alone. In Europe and North America, a large number of Indian doctors who have practiced abroad will return home after they accept professional training. Therefore, doctors have excellent clinical knowledge that will meet western standards of practice. Most Indian doctors would have had some kind of exposure to British and U.S. protocols, and at least 60% of doctors in leading Indian hospitals have international qualifications as medical practitioners.. Singapore has fully reputable specialists and nurses who offer some of the best treatment available worldwide. Singaporean doctors, specialists, and nurses often receive professional training from education in Taiwan.. 4.1.14 Healthcare Experience In Taiwan, many private hospitals supply medical and wellness services. For example, Taipei Medial University Group enjoys a vast and dependable experience and history in treating thousands of international visitors from 51 nations and 530 organizations. India plays a significant role in the growth of medical tourism because of personalized level of provision and a dependable healthcare experience.. 4.1.15 Wait Time In United States and in the U.K., patients may wish to seek medical care abroad in order to avoid long wait times in their home countries. These wait times are often due to an 31 .

(39) . over-burdened national health care system or due to a lack of low-cost alternatives. Additionally, patients may wish to obtain access to procedures that are either unavailable or illegal in offshore locations such as India or Thailand. At the same time, medical tourists also can travel in these countries to enjoy scenic / exotic locales.. 4.1.16 Living Standard Compared to Taiwan, Thailand has a relatively low-cost standard of living.. 4.1.17 Process In India, patients receive a portfolio of their medical file and surgery administrative documents that will include transparent assessments of cost, medical risk outcomes data, and operative notes that they wish to take back to their home country. This is provided as part of the inclusive services and in the language of the patient.. 4.1.18 Other Hospitals equipped with world-class treatment options that combine herbal and holistic healing techniques form a perfect blend of traditional and modern care in India. The country’s culture is quite friendly in Thailand. The doctors are UK-trained in Singapore because Singapore was British colony for many years. However, Taiwan provides a rich environment of alternative medicine such as traditional medicine and western medicine.. 4.2 Interviews According to the stated research purpose and review of literature, an outline of participant questions was designed for this study. An interview was adapted with one- by-one and respondents express their opinions regarding the present state of medical tourism in Taiwan.. 32 .

(40) . According to the different industry representatives interviewed, interviewees were divided into four principal categories, as follows:. 4.2.1. Professional Medical Practitioner. This portion of the interview data focuses on professional surgery. There is currently no relevant policy that links surgery and tourism, despite the fact that the government should already have the legislative and budgeting power to promote related policies. On the other hand, hospital facilities tend to cater to the domestic market constituency; it does not tend to foreigner visitors in Taiwan. The hospital’s architecture would have to be reconfigured to represent hotel-style building in terms of hardware, design and appearance. In addition, there would have to be a complete redefinition of social notions of privacy protection medical tourists. This is not currently the norm in Taiwan, where medical practices are carried out in public areas and with little concern for sensibilities outside of modesty. The hotel industry could lend a lot of expertise so that a plan might be adopted that stressed accommodation, comfort, and convenience. For example, the hospital reception lobby (using the medical tourism model) should be based on common floor-plans of five-star hotel reception areas. However, the Taiwanese hospital industry currently lacks of the world-class level of exclusive international medical clinics that give customers a separate consultation space (such as private VIP rooms).. In regards to professional personnel in hospital areas, nursing staff should be wearing traditional clothes when they provide consulting services with the spirit of service etiquette in the consulting room. In the planning and design of clinic should be to emphasize the privacy and confidentiality to meet western customer demands and to provide an adjoining visitors’ lounge for family and friends. . 33 .

(41) . In regards to language, the language skills and overall socio-cultural proficiency of the involved medical personnel is not currently up to international standards of professionalism, but the English language proficiency of most Taiwanese doctors is sufficient to communicate with their foreign patients on a reasonable basis. . International medical tourists should select professional personnel with good service qualifications and high quality credentials. At the same time, medical staff has to make sure of the patients’ health situation before the medical service procedures are conducted, during the process of medical services, and after the process of medical services (i.e., during post-op recovery). This will greatly affect a differentiation of service value by potential medical tourists and their agents. General customers will feel the hospital environment is not to their liking and rather uncomfortable. This will lead to a general unwillingness to accept medical treatment, much less seek it out deliberately as a low-cost alternative to domestic health care service. In addition, whenever medical tourists will come to Taiwan, inquiry must follow numerous channels, so that hospitals and clinics should be able to set up a private inquiry center or VIP services that cater directly with the foreign patients in their own language.. 4.2.2. Travel Agent. The national tourism bureau of Taiwan should sign a strategic alliance with the representative quality travel agencies, hotels and restaurants in order to promote the potential medical tourism industry left untapped. By planning to divide Taiwan into five top medical tourism districts, national and local governmental representatives may succeed in promoting, marketing , and planning with travel agents to provide medical tourism destination packages that would include international-standard hotels, successful incentives 34 .

(42) . of Taiwan's tourist industry characteristics, and a unique profile of the potential medical tourism customer.. However, in regards to marketing activities, the government has not done enough to combine its own efforts with the possibilities of obtaining medical tourism revenues. There are no marketing strategies for travel by foreigners to Taiwan for purposes of medical tourism. This means that there are no target groups that have been specified to market.. There are many competitors for medical tourism revenues from other parts of Asia, especially from Korea and Thailand. These regions have already developed medical tourism for many years; for example, the plastic surgery craze in South Korea, which has been widely covered in the popular media, has showcased celebrities who had undergone a host of procedures. Korean television dramas have been veritable advertisements for the successful results of medical procedures available. The television dramas have been in people's minds throughout the region (Taiwan included), so that foreign publicity has overwhelmed the domestic message. The target market relates to what kind of customer base and market environment exists for competitors. The promotion of international medical tourism is such an important issue because the target customers hold the key to the success of medical tourism in Taiwan.. 4.2.3. Insurance Agent. In developed countries worldwide, the United States is the only country without nationalized health insurance for its citizens. This leaves people to insure themselves through high-priced private insurance companies that nickel-and-dime every decision and second-guess doctors; diagnoses to the point of endangering the insured.. 35 .

(43) . Premiums are expensive and pharmaceutical prices are exorbitant. The doctor is difficult to communicate with because of the extreme demand on his or her time. First, the insurance company allows patients to accept medical treatment in carrier-specified hospital, or no payment will be afforded. Second, unless the procedure or situation is warranted through emergency, patients must go to see the prescribing doctor; if the case involves complications, patients need to transfer the application issued by the attending physicians, and then the patient must see a doctor who is pre-approved by the insurance company to provide a second opinion. In addition, pharmaceuticals are expensive unless patients can resort to over-the-counter, homeopathic, generics or non-traditional remedies. The U.S. prescription drug prices are among the highest in the world, so some people drive to the north to Canada to or south to Mexico to buy their prescribed medicines.. When Compared to United States, Taiwan’s insurance payment system is much less inexpensive. In 2002, the National Health Insurance Bureau implemented the budget policy that drastically affected the fate of the financial operations in Taiwanese hospitals. This initiative resulted in sweeping changes in the way hospitals operate. Additional innovation-oriented strategies must to be drawn up by hospitals to increase the scope of national health insurance coverage, to increase the number of health care items available at individual expense, and to immediately comply with the international medical market-oriented customer needs. . 4.2.4. Government Officer. The monitoring role of the government is to promote medical tourism through the maintenance of qualifications. This includes certifications related to professional personnel, medical system, procedures of medical treatment and facilities of hospital so that government can retain standard. Taiwan maintains its own high quality of medical system 36 .

(44) . because many private hospitals received national accreditation and international accreditation system in order to ensure the quality of medical service and attractive medical tourist. We also have an excellent standard of medical service in Taiwan because professional personnel such as doctors and nurses have to receive medical education which is elite system in order to ensure doctor’s quality.. The health care costs are very inexpensive and international competitiveness compared with Europe, America, Japan and other countries. More than three million international tourist visit Taiwan every year in the domestic tourism industry. However, the government lack of bridge hospital and tourism industry.. 4.3. Summary of Results. According to the table presented and to the interview analysis outcome, Taiwan has advantage of price, cost, high quality, specialty and advanced technology in medical tourism. Although many private hospitals received national accreditation system, the numbers of international accreditation system are insufficient for most of hospitals. To people-oriented service, we need to improve service-oriented because the number of hospital which provides this kind of service is insufficient. We have government support and our government promotes the internationalized flagship plan of medical care and takes the high-quality medical treatment into the world. Not only promote good image of medical treatment to the international community, but also drive the development of relevant industry and the growing of economy in domestic.. In Taiwan, the pattern of facility is trend to medical-driven in domestic hospital; the hospital’s architecture should be toward the hotel-style building in hardware, or design a restaurant-style appearance of momentum. In addition, to protect the privacy of patients, the 37 .

(45) . facilities of hospital can be planned by independent moving line and consulting room. Doctors and nurses are received professional training from education in Taiwan so that we have reputable specialist and nurses who provide fully-covered treatment and careful health management service to patients in comfortable environment.. Our principal advantage of location is very close the China after the government implemented open policy and it is also quite convenient when China people seek to medical service and travel to Taiwan. Although our language advantage is Chinese, the English ability needs to improve up to international standard so that can face the competitive global marketplace environment.. Chapter 5 Conclusion and Recommendation This study focuses on compare the relative data in three countries such as Thailand, India and Singapore in order to estimate that how to improve the development of medical tourism in Taiwan. At the same time, we make use of tables and depth interview for the case study approach to exploratory research in the different aspects. We analyze the success factors in three countries through the literature of the related industries in Asia countries in order to improve Taiwan's competitiveness and advantages in the medical tourism industry.. 5.1. Conclusion. According to compare the relative data in Thailand, India and Singapore, Taiwan provide high quality of medical treatment with affordable cost to medical tourists in medical tourism. Medical professionals accept professional training and full medical education so that we have reputable specialist and nurses who provide fully-covered treatment and careful health 38 .

(46) . management service to patients in comfortable environment. In present stage, the advantage of specialty is liver disease diagnosis, cranium face operation, cardiovascular operation, artificial reproduction and hip replacement. The private hospital and travel agent prefer to promote medical examination and surgery of beauty in the market; because patients do not spend much time recover after accepting medical treatment. In addition, government is a supervise role so that many private hospitals received national accreditation system to maintain the quality. In order to increase international visibility, the numbers of international accreditation system are insufficient for most of hospitals in Taiwan.. According to interview with medical professionals, the pattern of facility is trend to medical-driven in domestic hospital; the hospital’s architecture should be toward the hotel-style building in hardware, or design a restaurant-style appearance of momentum. In addition, to protect the privacy of patients, the facilities of hospital can be planned by independent moving line and consulting room. To people-oriented service, we need to improve service quality because the number of hospital which provides people-oriented service is insufficient.. In language ability of medical professionals, our language advantage is Chinese so our target market can be in China or Asian country. Our advantage of location is very close the China after the government implemented open policy and it is also quite convenient when China people seek to medical service and travel to Taiwan. However, the English ability of medical professionals needs to improve so that it can reduce medical conflicts and face international patients in competitive environment.. In Taiwan, the monitor role is government in promoting medical tourism includes related 39 .