Contribute for the selection, to evaluate the impacts of the factors which affects medical tourism business and finally to recommend new strategies to develop a destination as a medical tourism destination.

Contribute for the selection, to evaluate the impacts of the factors which affects medical tourism business and finally to recommend new strategies to develop a destination as a medical tourism destination.
Chapter 1 Literature Review
• Medical tourism Background
As per views of Lunt, Mannion, and Exworthy (2013), medical tourism is a type of travelling done by people which have as a purpose to keep them or their family healthy, while Hanefeld et al. (2013) defines the need of medical tourism occurred after high technology medical care was starting to sell in developed countries. In the last few years , medical tourism travellers number have increased , therefore medical tourism successfully set a benchmark for every country. People used to travel often to utilize better healthcare services to different countries , from long distances. In earlier times, patients used to travel from less developing countries to developed countries for medical purpose. However, in this time, is noted that patients travel in both directions for healthcare : patient travel from less developing countries to developed countries as well as patients travel from developed countries to less developed countries for the same purpose. To support this, Hanefeld et al. ( 2013) state that the interest for medical tourism have increased and it has created new business opportunities in many countries, and technology is the key of a successful business in medical tourism.
• Explore the factors which affects medical tourism in UK
Moreover (2013) found and defines a series of factors that contribute to the success of medical tourism. These factors are : service quality showed by assurance, responsiveness, empathy, reliability, tangibility , but also the cost and destination competitiveness in attitude of tourists . In some circumstances, medical tourists are interested also for climate, fauna, or surroundings, elements that come under the comparative advantage for a country or other, which can relate to attractions, heritage, events, health, government policy, along with quality and good skills of workers. According to Yu and Ko ( 2012), medical tourism business in each destination it can be affected by infrastructure factors , because tourists are checking the availability of different services and facilities before they choose a destination. Tourists are looking for a range of quality accommodations to satisfy their level of comfort , available well positioned : close to facilities and to the place where they get the medical care.
In addition, Crush and Chikanda (2015) , agree that risk and reward are very important factors that influence patients decision before they engage in medical travel. Consumers usually compare destinations by the reputation of the hospitals, clinics or doctors to evaluate the risk attached to the outcomes , for example, the degree of success or failure of a surgical operation need by a patient with an advanced disease. The expertise degree is differentiate by the particular field of study . For e.g. Nose surgery ( Rhinoplasties) have a good reputation in Brazil. Moreover, the future patients compare safety grade also in terms of hospital infection rates or pre and post-operative complication rates, between domestic markets
• Evaluate the impact of the factors that affects the medical tourism .
According to Hall (2013) , there are three categories of impacts that push medical tourists to travel from their home country to another country to get medical care in terms of costs. This are uninsured category ( those people who agree that the costs of insurances are to high, so they cannot choose any health insurance policies), uninsurable category ( is addressed for the people which suffer illnesses that cannot be covered by health insurance policy in the home country ) and underinsurance category ( some policies sometimes not cover the expenses that they should actually incur ) .
As per views of Runnels and Carrera ( 2012), what push people to choose UK as a medical tourism destination is the level of satisfaction regarding to the quality of treatments and services, especially on surgical and organ transplants segment, where UK gained a good reputation in the last few years. Lee, Han and Lockyer (2012), agree that UK have a good reputation for quality services and treatments, but there are only available for high class people, because the costs are high. The tourists that can afford treatments in the UK come from well developed countries and only in emergencies cases, tourists from developing countries come to UK for transplants or surgeries. In addition Henefeld et al. (2015) says that most of the tourists that travel for medical purpose in the UK need surgeries and transplants, which have a high risk involved and to minimise that they choose UK, which have a good reputation in low-risk transplants.
In opinion of Chen and Wilson (2013) , what push tourists to travel to UK for healthcare is the low prices of treatments compared to the quality of services and treatments offered to its customers. In contradiction with this, Connel and Fara ( 2013) specify that the low price reflect exactly the quality of treatment and increases the chance of failure in case of critical disease condition. The cost for medical tourism is not only the cost of treatment, but is a total cost of travel, treatment, insurance and accommodation , so UK is not a cheap country to travel for medical purpose. Also in case of far destinations , the cost o treatment is offset by the high cost of flights, etc. The term of low cost is only to attract more patients, but after counting all the services and facilities , the total cost it might be high if patient want to get high quality care. What makes a good destination for medical tourism is the possession of high technology equipment which is reducing the risk of failure. This equipment values lot of many, so obviously to get a special care, tourists have to pay more. Connel and Fara (2013), also conducted a study to see how future patients search for the best destination . It has been found two category of search : internal and external . Internal search It means the first visit to the destination , only for informative purpose. Secondary, external search is the advice that people get from different sources. There is four types of external search : word of mouth, destination manuals , marketing communication and travel professionals. In the UK, usually tourists travel from word of mouth search : other peoples experiences, doctors or insurance companies advice. On the other side, Noree, Hanefeld and Smith (2014), the destination reputation can set the perception of the future tourists. For example, UK have a good reputation for surgeries and transplants , so people interested in that would first give priority to this country without asking for advice from other sources. In the opinion of Vick (2012) , the climate and environment is an important element for tourists, and rather they will choose a destination as UK because it have nice surroundings and an acceptable climate to can help the tourist to relax and reduce stress and pain. Contradicting with this, Cohen (2012) assets that environment is used as a marketing scheme, made by different tourist proffesionals in form of offers e.g. spa and treatment , only to attract more patients, but distracting them from the real purposed of the travel.
• Recommend strategies to improve services and demand of medical tourism in UK
Freire (2014) says that UK have a good reputation for medical care, but needs some improvements. As a strategy to earn good profitability from this tourism segment, the Government of UK should establish economic hospitals for tourists that arrive from lower income countries. Many tourists from developing countries have no access to medical tourism in UK because of their income and high prices. In the views of Botteril, Pennings and Mainil ( 2013), creating new policies for health system, will encourage investors for all over the world to create new businesses in the country which will bring more patients from behind the borders . In addition, Snyder, Crooks and Johnston ( 2012), says that what makes a business profitable in the medical tourism segment is high standards technologic equipment at an attractive price. For that, the government should invest in new equipments to treat different diseases , and open new hospitals in areas less developed, in order to improve medical tourism and attract more demand. Kingsbury et al. (2012) stated that to grow this business segment it needs work on development of the product. For that each business should focus only on a few products and train their staff to make the best in order to create a brand reputation
References
Botterill D. Pennings, G. and Mainil T. eds. (2013)Medical tourism and transnational health care. Springer:USA
Chen, L.H. and Wilson, M.E . (2013) The globalization of healthcare: implications of medical tourism for the infectious disease clinician. Clinical infectious diseases, 5 7(12), pp.1753-1760.
Cohen , LG., (2012) How to regulate medical tourism (and why it matters for bioethics). Developing world bioethics, pp.9-20.
Connell, J. and Fara, X., (2013) Medical tourism in the Caribbean islands: a cure for economies in crisis . lsland Stud J, pp.115-30.
Crooks , V.A., Turner , L., Cohen , LG., Bristeir , J., Snyder, J ., Casey , V. and Whitmore, R., (2013) Ethical and legal implications of the risks of medical tourism for patient5: a qualitative study of Canadian health and safety representatives’ perspectives . BMJ open,.
Crush , J. and Chikanda , A., (2015) South- South medical tourism and the quest for health in Southern Africa. Social Science & Medicine, 124, pp.313-320.
Freire N.A. (2012) The emergent medical tourism: Advantages and disadvantages of the medical treatments abroad . International Business Research , p.41.
Hall C.M. (2013 ) Medical tourism: The Ethics, Regulation, and Marketing of Health Mobility (Vo l. 33). Routledge : UK
Hanefeld, J., Lunt N., Smith, R. and Horsfall, D., (2015) Why do medical tourists travel to where they do? The role of networks in determining medical travel. Social Science & Medicine, 124, pp. 56-36 .
Hanefeld , J., Horsfall, D., Lunt, N . and Smith, R. (2013) Medical tourism: a cost or benefit to the NHS?. PLoS One, 8(10)
Lee M. Han H. and Lockyer, T. (2012) Medical tourism- attracting Japanese tourists for medical tourism experience. Journal of Travel & Tourism Marketing, 29(1), pp.69-86.
Lunt, N.T. Mannion , R. and Exworthy , M., (2013) A framework for exploring the policy implications of UK medical tourism and international patient Social Policy & Administration, 47(1) pp. 1- 25.
Noree, T. Hanefeld J. and Smith , R., (2014) UK medical tourists in Thailand : they are not who you think they are. Globalization and health , p. 1
Runnel s , V. and Carrera, P.M., (2012) Why do patient s engage in medical tourism?. Maturitas 73(4), pp.300-304.
Vick, L., (2012) The perils of cosmetic surgery medical tourism . Clinical Risk, p. I 06.
Yu, J Y. and Ko, T.G. (2012) A cross-cultural study of perceptions of medical tourism among Chinese Japanese and Korean tourists in Korea. Tourism: Management, pp.80- 88.