The main paths of eTourism: trends of managing tourism through Internet

Drawing from the tourism and hospitality literature, this paper highlights the main research trajectories and themes in the context of eTourism. We use main path analysis to investigate the development trend of the synergistic relationship between innovative tourism applications and the new technologies. Further, the literature is classified into six groups through discovering the coherence structure in a citation network. The analyses show that research on websites, blogs, and social media on tourism is experiencing accelerated growth, which hints that there is a pendulum shift whereby the information and negotiation power asymmetry between the supply and demand sides are moving from provider-centric to consumer-centric. This study also elucidates the associated market disintermediation phenomenon and long tail effects on the distribution of destinations.     

Barriers to business relations between medical tourism facilitators and medical professionals

This paper examines facets of the developing business relations between two important actors in the supply-chain of transnational healthcare: medical tourism facilitators and medical doctors (MDs) practicing privately and internationalising their services. The empirical focus is Greece, an emerging destination for medical care. Drawing on the sociology of the professions as an analytical framework, rich qualitative data reveals a conflictual aspect in the relation between the two actors, and informs the literature on transnational healthcare of barriers to market development. Particularly, MDs practicing privately often resist what is perceived to be medical tourism facilitators' pressures to control the 'rules of the game' in the submarket which inhibits their collaboration. The paper contributes, thus, to the sociology of the professions by bringing to light a new challenge for MDs engaged in the transnational business arena, represented here by the facilitators; and encourages tourism practitioners to consider MDs' self-understanding, attitudes, and expectations.     

The medical tourism index: Scale development and validation

Medical tourism is an estimated $100 billion dollar industry. Despite the increasing number of people, companies and countries involved in medical tourism, we know very little about the key drivers and how countries are perceived as medical tourism destinations. The purpose of this paper is to present the Medical Tourism Index, a new type of country-based performance measure to assess the attractiveness of a country as a medical tourist destination. We followed a rigorous multi-steps scale development procedure by using four empirical studies based on 4995 respondents. The MTI is a multidimensional construct with 4 dimensions (country, tourism, medical costs, medical facility and services) with 34 underlying items. Our results show the MTI allows to measure meaningful differences between countries, not only on an aggregated level but also on each sub-indexes. It provides a useful tool for the various stakeholders to measure and manage their medical tourism destination brand.     

Connecting with prospective medical tourists online: A cross-sectional analysis of private hospital websites promoting medical tourism in India,Malaysia and Thailand

Websites of private hospitals promoting medical tourism are important marketing channels for showcasing and promoting destinations' medical facilities and their array of staff expertise, services, treatments and equipment to domestic and foreign patient-consumers alike. This study examines the websites of private hospitals promoting medical tourism in three competing Asian countries (India, Malaysia and Thailand) in order to look at how these hospitals present themselves online and seek to appeal to the perceived needs of (prospective) medical tourists. The content and format of 51 hospitals are analyzed across five dimensions: hospital information and facilities, admission and medical services, interactive online services, external activities, and technical items. Results show differences between Indian, Malaysian and Thai hospital websites, pointing to the need for hospital managers to improve their hospitals’ online presence and interactivity.     

Barriers to the development of medical tourism in East Azerbaijan province,Iran: A qualitative study

The purpose of the present study was to determine factors impeding the development of medical tourism in East Azerbaijan province, Iran. The data were derived from interviews with 16 key informants. Data analysis of the study was conducted through employing the software MAXQDA-12. The results show that marketing, international issues, culture, transfer, brokerage, management, and policy problems are the main barriers to the development of medical tourism. It seems that East Azerbaijan province should provide necessary context for the participation and investment of private sector in the field of medical tourism. Further, it should design and implement long and short-term strategies in proportion to the problems raised.     

Competitiveness attributes of a medical tourism destination: The case of South Korea with importance-performance analysis

This study aims to explore the importance and performance of medical tourism destination competitiveness (TDC). The aims were achieved by collecting empirical data on the perceptions of stakeholders in the medical tourism industry in South Korea. Results from the importance–performance analysis (IPA) revealed that medical TDC is primarily influenced by medical treatments and services, destination attributes, and tourism-specific factors. This study not only enhances tourism literature, but also contributes significantly to the existing literature on competitiveness. The study provides useful marketing insights for medical tourism suppliers in South Korea and countries in similar situations with the relevant industry.     

Assisting the poor in China through tourism development: A review of research

The role of Pro-Poor Tourism has been increasingly studied in China since the 1990s. The research has addressed a broad range of key issues such as the implication of “fu pin lv you” (or TAP to use an English acronym arising from the translation ‘Tourism-Assisting the Poor’), governmental roles, local participation and the contribution of rural, natural and cultural resources to TAP. However, there has been a lack of research in some areas such as in the micro-economics of TAP targeting local poor people, quantitative research, case studies and anthropological analysis. This paper reviews Chinese academic literature on pro-poor tourism to provide a clearer picture of current practice and progress in TAP policies and research in China.     

The evolution of coastal tourism destinations: a path plasticity perspective on tourism urbanisation

Evolutionary and relational approaches to economic development are gaining ground in geography as a discipline, although in the subfield of tourism geography, their potential is only just becoming recognised. This article focuses on the evolution of mature tourism destinations, taking the path dependency concept forward from the notion of path creation into the new domain of path plasticity. Drawing on the notion of cultural political economy, we examine how tourism destinations can break with path dependency routines incrementally and move steadily towards different future paths, which may recast tourism in a different light in the overall “urban” context of the destination. Using a case study of a Mediterranean coastal destination on Catalonia's Costa Daurada, we explore the inter-tangled tourism and urban development processes in relation to the socio-spatial dimensions of urban change. The article argues for a wider range of social and cultural criteria in the analysis of tourism evolution – advocating the use of path plasticity and a cultural political economy approach – to offer an alternative perspective on shifting tourism situations, reflecting the inherently “urbanising” nature of tourism development in the traditional coastal resort context. It adds to the growing literature on governance and strategy-making in sustainable tourism.     

冰雪旅游生态化发展范畴、问题与路径

冰雪旅游的生态化发展,是国家绿色、低碳、循环经济体系建设的重要环节,对于三北区域开发与振兴、美丽中国建设、保障冬奥会圆满举办具有重大战略意义。本研究基于规范分析与实证分析相结合的研究范式,分析了冰雪旅游生态化发展范畴及其生态环境依赖性,评估了冰雪旅游区域生态足迹以及生态环境影响机制。研究显示：中国冰雪旅游发展迅速且生态化趋势明显,但仍存在突出问题;冰雪旅游开发总体上表现为生态盈余,但部分重点地区处于生态赤字状态,超过了冰雪旅游接纳能力上限;部分重点冰雪旅游区域仍处于经济-环境曲线拐点左侧,生态环境压力可能将呈现高发态势。本文还探索提出了冰雪旅游生态化发展路径,强调亟待展开冰雪旅游的国土空间管控和生态化创新系统建构。     

Perceived impacts of medical tourism development on community wellbeing

Community leaders and tourism authorities in Las Vegas have suggested the promotion and development of medical tourism to improve the economy and quality of life for residents. The present study uses social exchange theory with spillover theory as the conceptual framework to examine factors of economic performance of medical tourism, overall community satisfaction, health care satisfaction and attitudes toward medical tourism; these factors influence on residents' perceptions of medical tourism's impact on community wellbeing, which in turn affects willingness to pay higher taxes and support for medical tourism development. The findings revealed that the greater the economic performance of medical tourism, the more positive the impact of medical tourism to community wellbeing was perceived. Similarly, attitudes toward medical tourism and overall community satisfaction positively influenced the perceived impact of medical tourism on community wellbeing. Finally, community wellbeing positively influenced residents' willingness to pay higher taxes and support medical tourism development.     

Asian medical marketing,a review of factors affecting Asian medical tourism development

Recently, medical tourism has been considered as a profitable economic sector in developing countries. In this study, we have reviewed articles from 2000 to 2017 on medical tourism marketing in Asian countries. We have found that perceived service quality and satisfaction are the most important factors to attract medical tourists. Moreover, a lack of factors like coordination among medical market stakeholders, medical services quality, insurance coverage, and effective laws are the major barriers to medical travel cited in studies. The results suggest that more specific models should be presented for Asian medical marketing, especially in niche markets of this industry.     

A cross-cultural study of perceptions of medical tourism among Chinese, Japanese and Korean tourists in Korea

The purpose of this study is to observe factors related to perceptions of and possible participation in medical tourism by Chinese, Japanese, and Korean visitors to Jeju Island in Korea. It aims to identify cultural differences among them, and how those differences affect their pursuit of medical tourism in the future. The research results illustrate that significant differences exist in how Chinese, Japanese and Korean visitors view factors of choice, discomfort and preferred product items. The study establishes four factor groups regarding medical tourism with exploratory factor analysis. Based on these findings, differences of participation intention and behaviors among the three groups are explained. From this, the study describes distinct characteristics of medical tourism among the three cultural groups. The differences among Chinese, Japanese, and Korean tourists with regard to the selection of destination, inconveniences, and preferred products were found to be all significant. Korean tourists placed most significance on selection factors, followed by Chinese tourists, and, lastly, the Japanese. On the other hand, inconveniences related to medical and care services, stay and cost, and information and insurance elements were most strongly associated with Japanese tourists. This may be a reflection of a possible tendency of Japanese tourists to value safety and cost effectiveness. For Chinese tourists, the importance of stay and cost was equally high as those of their Japanese counterparts, which is indicative of Chinese tourists’ cost sensitivity. Light treatments (minor surgery) were preferred by Chinese tourists, while more significant treatments (major surgery) were preferred by Japanese tourists. In terms of aesthetic and healthcare services, Chinese tourists showed the most interest, while Japanese tourists placed emphasis on rehabilitation (lifestyle-related), which may reflect the Korean Wave’s influence in certain Chinese market segments, leading to an increased demand for cosmetic or plastic surgery.     

Medical travel facilitator websites: An exploratory study of web page contents and services offered to the prospective medical tourist

The growing trend of traveling outside of one's country for medical services, commonly known as “medical tourism” is expected to continue to grow exponentially in the next ten years (Keckley, 2008). With multiple destinations from which to select, and available information representing this type of travel being of variable reliability, many prospective medical travelers turn to the use of a “medical tourism facilitator”, who perform a variety of trip coordination responsibilities for the medical traveler. These medical tourism facilitators, themselves a new phenomenon to support travel to various global regions, may operate within the traveler's home country or the destination region. This study explores the services offered on medical tourism facilitators' websites to the prospective traveler. Through the application of correspondence analysis, it was discovered that differences in both website content and in services offered varied by the continent upon which the facilitator operated. With little yet known as to the motivations of a medical traveler in the selection of a specific destination, these discovered differences may be a first insight into regional differences that may play a role in such destination selection.     

Web users’ behavioural patterns of tourism information search: From online to offline

This paper presents a conceptual framework of Web users’ engagement in tourism information search for a comprehensive understanding of their integrated online and offline search behaviour. The information search experiences are characterised as a process constituting some common elements: prior knowledge and searching experiences, online searching strategies, processing and recording information, barriers to online searching, reasons for ending an online search, summarising information, exchanging information and searching for more information through other sources. Such behaviour goes beyond the scope of information searching and captures the other activities, including information processing, utilising and disseminating. The grounded theory research method is employed as an inductive investigative process in which the authors construct the framework by systematically collecting and analysing data. The aim of this research method is to build a theory. The data sets consist of both semi-structured in-depth interviews with subjects and their field observations based on online searching. A theoretical model incorporating 10 propositions is proposed for future testing.     

Korean and conventional medicine tourism industry trends as indicated in medical tourism advertisement images: qualitative research using data from medical Korea 2015

This study analyzed advertisement images targeting international audiences of South Korean medical facilities (traditional Korean and conventional medicine) participating in Medical Korea 2015 using thematic content analysis. The image categories most often used in conventional medicine were medical procedures, facilities, and staff photos, while those for traditional Korean medicine were medical procedures, staff photos, and images. Conventional medicine consistently presented high SERVQUAL tangibility scores, whereas Korean medicine displayed distinct associations between SERVQUAL categories and image size. Analyses suggested specialty preference by language. These findings may be used to recognize key messages in medical tourism and contribute to its systematic promotion.

Abbreviations: KHIDI: Korea health industry development institute; SERVQUAL: service quality     

Sustainability and nature-based mass tourism: lessons from China's approach to the Huangshan Scenic Park

With the rapid growth of tourism worldwide, the path towards sustainable mass tourism has become a critical issue for many destinations. Unlike most developed countries, China has its particular context and is testing a process of sustainable tourism development implemented through top-down institutional arrangements, using strict control systems to pursue both natural resource conservation and economic growth. Through a systematic analysis of the path towards sustainable development of a typical nature-based mass tourism destination, Huangshan Scenic Park, this research explores its successes and challenges. It finds that the Chinese government-dominated mass tourism nature-based development model has brought a dual structure with modern efficient management patterns at the core site and municipal scales, and a backward unsustainable situation at the community scale. It also reveals that this model risks running into a potential path-dependency trap, which creates barriers for an integrated resource- and community-based development. The study argues that while the government-dominated and learning-by-doing approaches toward sustainability are practical, the lack of integrated and systematic planning leading to transformation of the destination society as a whole may lead to a suboptimal situation, with problems exported out to surrounding inadequately managed villages and buffer zones. Parallels with other countries are discussed.     

The role of information sources and image on the intention to visit a medical tourism destination: a cross-cultural analysis

This paper intends to analyze: 1) how information sources, eWOM, and image influence the intention to visit a medical tourism destination;2) the moderating role of culture and 3) cross-cultural differences based on Hofstede’s individualism and uncertainty avoidance. A total of 534 responses were collected using a panel of internet users from six different countries and data were analyzed using structural equation modeling and a series of t-tests. The results show that information sources influence cognitive impressions and in conjunction with overall image and medical cognitive image influence the intention to visit a medical tourism destination. Furthermore, individualism and uncertainty avoidance have a moderating effect among these variables and cross-cultural differences exist in the degree of importance given to information sources, eWOM, image perceptions, and intention.     

边境旅游研究进展与启示——以SSCI论文为例

边境旅游是促进区域一体化发展和强化跨境旅游合作的主要手段,深入分析国际边境旅游研究脉络与研究热点,对促进富民兴边、睦邻安邦及对接国际国内旅游“双循环”具有重要借鉴意义。本文以1995—2021年发表的1 124篇SSCI英文文献为基础,对边境旅游研究领域的时间分布、关键词突现、聚类特征等进行可视化分析。研究发现,英文文献中对边境旅游的研究可分为起步阶段、发展阶段与创新阶段;主要研究议题包括边境旅游吸引物、边境旅游影响、边境旅游安全及跨境旅游合作;边境旅游研究趋势发生两大转变,一是研究视角从单一向多元转向,二是理论探索从功能说向效应说深入。建议国内对边境旅游的研究应结合国家战略拓展边境旅游研究议题,强调中国边境旅游特色的同时贡献“中国智慧”。     

传统与复建历史文化街区文旅融合特征与路径——基于符号学视角

历史文化街区既是城市文化的重要地标,也是旅游发展的重要资源,由此成为新时期文旅融合的重要实践载体。本研究基于符号学视角,选取黄山市屯溪区毗邻的屯溪老街和黎阳in巷分别作为传统与复建历史文化街区代表,基于扎根理论构建历史文化街区文旅融合的符号学理论框架。实证分析表明：传统与复建两类历史文化街区均形成了主题定位、文旅功能、空间布局、物质载体、业态产品、旅游服务六方面的文化和旅游符号,前者以传统文化符号居多,后者以现代旅游符号居多;两类街区文化和旅游符号融合的独特性、凸显性、融合性和适应性等特征差异明显,前者偏向地域文化的独特性,后者偏向旅游介入的适应性。据此提出传统历史文化街区“旅游趋向”和复建历史文化街区“文化趋向”的文旅融合路径,两类街区在文化传承与旅游发展中应加强文化资源符号化、资源功能多元化、符号空间整合化、文化符号全景化,促进文化产品价值化、旅游服务品质化,以实现历史文化街区可持续发展。     

Medical tourism development in Hong Kong: An assessment of the barriers

The aim of this study is to determine the factors influencing the development of medical tourism in Hong Kong. A qualitative research method was adopted to collect data from representatives of private and public hospitals, government bodies, and medical institutions. The results reveal that policies and regulations, government support, costs, capacity problems, and the healthcare needs of the local community are the main barriers to the development of such tourism. Several strategies for lifting these barriers are suggested, such as new promotional activity policies, government action to encourage investment in the medical tourism market, and cooperative efforts by the hospitality sector and medical institutions to develop medical tourism products.