Ozan-Rafferty Margaret E, Johnson James A, Shah Gulzar H, Kursun Attila
Dignity Health, Nevada Market, St. Rose Dominican Hospitals, Henderson, NV, United States.
J Med Internet Res. 2014 Feb 6;16(2):e43. doi: 10.2196/jmir.2694.
Patients regularly travel to the West for advanced medical care, but now the trend is also shifting in the opposite direction. Many people from Western countries now seek care outside of their country. This phenomenon has been labeled medical tourism or health travel. Information regarding health travelers' actual outcomes, experiences, and perceptions is lacking or insufficient. However, advanced Internet technology and apps provide information on medical tourism and are a vehicle for patients to share their experiences. Turkey has a large number of internationally accredited hospitals, is a top tourism destination, and is positioning itself to attract international patients.
The objective of this research was to identify the important individual characteristics of health travelers, outline the push and pull factors for seeking health care in Turkey, identify satisfaction with the outcomes and the results of these individuals' treatments, and note positive and negative factors influencing their perceptions and overall experiences about patients' health travel.
This research uses qualitative data from Internet narratives of medical tourists to Turkey. Ethical considerations of using Internet narratives were reviewed. Narratives for analysis were obtained by using the Google search engine and using multiple search terms to obtain publicly posted blogs and discussion board postings of health travelers via purposeful sampling. Narratives were included if they were written in English, described travel to Turkey for health care, and were publicly accessible. Exclusion criteria included narratives that were on medical tourism facilitator or provider promotional websites, not in English, and did not describe an experience of a medical tourist. Medical tourists' written words were analyzed in an iterative analytic process using narrative analysis theory principles. Three stages of coding (open, axial, and selective) were conducted to identify characteristics and themes using qualitative analysis software.
The narrative posts of 36 individuals undergoing 47 procedures who traveled to Turkey for medical care between 2007 and 2012 were analyzed. The narratives came from 13 countries, not including the narratives for which patient origin could not be determined. Travelers were predominantly from Europe (16/36, 44%) and North America (10/36, 28%). Factors driving travelers away from their home country (push factors) were cost and lack of treatment options or insufficient insurance coverage in their home country. Leading factors attracting patients to destination (pull factors) were lower costs, physician's expertise and responsiveness, and familiarity or interest in Turkey. Health travelers to Turkey were generally satisfied with the outcomes of their procedures and care provided by their physicians, many noting intent to return. Communication challenges, food, transportation, and gaps in customer service emerged as key areas for improvement.
This analysis provides an understanding of the insights of medical tourists through the words of actual health travelers. This nonintrusive methodology provides candid insights of common themes of health travelers and may be applied to study other patient experiences. The findings of this research expands the body of knowledge in medical tourism and serves as a platform for further qualitative and quantitative research on health travelers' experiences.
患者经常前往西方接受先进的医疗服务，但现在这种趋势也在向相反方向转变。现在许多西方国家的人在国外寻求医疗服务。这种现象被称为医疗旅游或健康旅行。关于健康旅行者实际治疗结果、经历和看法的信息缺乏或不足。然而，先进的互联网技术和应用程序提供了有关医疗旅游的信息，并且是患者分享其经历的一种途径。土耳其有大量国际认可的医院，是顶级旅游目的地，并且正致力于吸引国际患者。
本研究的目的是确定健康旅行者的重要个人特征，概述在土耳其寻求医疗服务的推动因素和拉动因素，确定对这些人的治疗结果和治疗效果的满意度，并指出影响他们对患者健康旅行的看法和总体体验的积极和消极因素。
本研究使用来自前往土耳其的医疗游客互联网叙述的定性数据。审查了使用互联网叙述的伦理考量。通过使用谷歌搜索引擎并使用多个搜索词，通过目的抽样获取健康旅行者公开发布的博客和讨论板帖子，以获取用于分析的叙述。如果叙述是用英语撰写的、描述前往土耳其寻求医疗服务且可公开获取，则纳入研究。排除标准包括在医疗旅游促进者或提供者宣传网站上的叙述、非英语叙述以及未描述医疗游客经历的叙述。使用叙述分析理论原则，在一个迭代分析过程中分析医疗游客的书面文字。使用定性分析软件进行三个编码阶段（开放编码、轴心编码和选择编码）以识别特征和主题。
分析了2007年至2012年间前往土耳其接受医疗服务的36名接受47种手术的个人的叙述帖子。这些叙述来自13个国家，不包括无法确定患者来源的叙述。旅行者主要来自欧洲（16/36，44%）和北美（10/36，28%）。促使旅行者离开本国的因素（推动因素）是成本以及本国缺乏治疗选择或保险覆盖不足。吸引患者前往目的地的主要因素（拉动因素）是成本较低、医生的专业知识和响应能力，以及对土耳其的熟悉度或兴趣。前往土耳其的健康旅行者总体上对手术结果和医生提供的护理感到满意，许多人表示有再次前往的意愿。沟通挑战、食物、交通以及客户服务方面的差距成为需要改进的关键领域。
本分析通过实际健康旅行者的话语提供了对医疗游客见解的理解。这种非侵入性方法提供了关于健康旅行者共同主题的坦率见解，并且可应用于研究其他患者经历。本研究的结果扩展了医疗旅游方面的知识体系，并为进一步对健康旅行者经历进行定性和定量研究提供了一个平台。
