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Table of contents
Abstract………………………………………………………………………………………………………….. 3
Chapter 1.0 Introduction…………………………………………………………………………………… 4
1.1 Background of the research…………………………………………………………………… 4
1.2 Overview and Significant of Medical Tourism…………………………………………. 6
1.3 Middle class Chinese seek medical care abroad………………………………………… 6
2.0 Review of the Literature……………………………………………………………………………… 7
2.1Definition of medical tourism…………………………………………………………………. 7
2.3Medical Tourism Destinations and Treatments………………………………………… 12
2.4Top Reasons Why Medical Tourism is Popular………………………………………… 13
2.4.1Price………………………………………………………………………………………….. 14
2.4.2Access to the latest medical technology………………………………………… 14
2.4.3Long waiting lists……………………………………………………………………….. 14
2.4.4Travel Opportunity……………………………………………………………………… 15
2.5 Medical Tourism in UK……………………………………………………………………….. 15
2.6THEORY OF MOTIVATION………………………………………………………………. 16
2.6.1Push and Pull Motivation Factors…………………………………………………. 16
2.6.2Motivations of prospective medical tourists…………………………………… 18
2.7Elements of the Marketing Mix…………………………………………………………….. 21
2.7.1Product……………………………………………………………………………………… 22
2.7.2Place…………………………………………………………………………………………. 23
2.7.3Price………………………………………………………………………………………….. 23
2.7.4Promotion………………………………………………………………………………….. 24
2.8Consumer Satisfaction…………………………………………………………………………. 24
2.9Chapter Summary………………………………………………………………………………… 25
Chapter 3.0 Methodology……………………………………………………………………………….. 26
3.1 Introduction………………………………………………………………………………………. 26
3.2 Research design………………………………………………………………………………….. 26
3.2.1 Secondary research…………………………………………………………………….. 26
3.3Research Framework……………………………………………………………………………. 29
3.3.1Primary research…………………………………………………………………………. 29
3.3.2Induction and deduction……………………………………………………………… 30
3.3.3Questionnaire design…………………………………………………………………… 31
3.3.4Relevant Data Description…………………………………………………………… 33
3.3.5Sample and sample size……………………………………………………………….. 33
3.3.6Data Collection and Gathering Procedure……………………………………… 34
3.3.7Investigation ethics…………………………………………………………………….. 34
3.4Chapter Summary………………………………………………………………………………… 34
Chapter 4.0 Data findings and analysis…………………………………………………………….. 35
4.1Introduction……………………………………………………………………………………….. 35
4.2DemographicFactors……………………………………………………………………………. 35
4.3Findings……………………………………………………………………………………………… 39
5.0Conclusions and Recommendations…………………………………………………………….. 39
Reference:…………………………………………………………………………………………………….. 43
APPENDIX………………………………………………………………………………………………….. 51

The objective of this dissertation is to analyze the influencing factors that lead Shanghai medical tourists to choose UK as medical tourism destination. There are 70 copies of questionnaire were distributed, a total of 70 questionnaires were returned. Data was collected online. These factors will be ranked according to significance in order to assist in determining which point the hospital should concentrate on.
Chapter 1.0 Introduction
1.1 Background of the research
Medical tourism market has been raised as one of the competitive industries and income-earning on earth and is considered to be an innovative field of modern tourism in recent years. Tourism is the largest and most extensively developing world industry presently, as stated by globe Bank evaluations. International tourists arrivals grew by 4.4% in 2015, reaching to a total of 1,184 million in 2015, As stated by the latest UNWTO World Tourism Barometer. International tourism reached the sector’s firm execution for new heights in 2015, is contributing to job creation and economic rise in many sections of the earth. It is thus critical for countries to promote policies fostering tourism’s continued growth (UNWTO,2015). A few main source markets have driven tourism expenditure in 2015 that was backed up by a strong currency and economy. Among leading source of the world markets, China, with double-digit rise in expenditure every year since 2004, continues to lead global outbound trip, benefitting to Asian destinations such as Thailand and Japan, as well as the United States and diverse European destinations. As to reason for travel, half international vacationers go to foreign countries for vacations, 25% go to travel to relatives and companions, for medical treatment and for religious purposes, and 16% go on business journeys (Travel Exhibitions).  Medical tourism is one of the most dynamically growing industries nowadays. Thought about the direct effect of healthcare’s globalization, medical tourism exhibits strong growth potential certainly globally.
Ever since 2010 tourism has been the fastest growing part in the UK in employment sessions. It is forecast that Britain have a tourism industry worth more than £257 billion by 2025. The Deloitte Tourism: rise report and jobs found the marginal profit that was required to generate a job in UK tourism for that is estimated to be around £54,000. For every 1% growth in overall expenditure in UK tourism, it might be expected that full time equivalent employment will raise by 0.89%. Britain will have a tourism industry worth over £257 billion by 2025 – just under 10% of UK GDP and supporting almost 3.8 million jobs, which is around 11% of the total UK number.(Britain’s visitor economy facts,2016) Whereas medical tourism is a burgeoning industry. As stated by Hopkins et al. (2010), medical tourism is “a quickly emerging manifestation of worldwide commercialization of health care” Gupta (2008) writes that “medical tourism is a multi-billion dollar industry that is boosted by governments and the medical and tourism industries”. Although a few types of medical tourism might be hundreds of years old, medical tourism in the twenty-first century is unique in relation to any past portrayal. While UK has a high potential for this industry. To provide a basis for the further development of England as a medical tourism market, it is apparent that there is a need to understand the key customer behaviours of the medical tourists, especially with regard to destination choice, which are likely to be fundamentally different from those of leisure tourists. Because of this need, the present study concentrates on the destination choice of medical tourists, particularly as far as the impact of image on that decision. The study thus attempts to identify the factors that determine how medical tourists choose a destination for their offshore medical treatment.
Despite its recent popularity, medical tourism has existed for thousands years (Hancock, 2006). Greeks’ written records traveling to Tell Brak, Syria, for eye remedy date back 5000 years (Gahlinger, 2008). Throughout ancient times, mineral springs were frequented by people from afar owning to their purported curing nature. People had a trip for healing from ailments like skin conditions, arthritis, and muscular wounds. Medical tourism nowadays is much more diversified, both technologically and geographically. Medical tourists travel to distant locations around the globe for treatment. Over 50 countries have identified medical tourism as a national industry. In past decades, wealthy individuals from developing nations came to developed zones, for example, the U.S. and European nations for therapeutic treatment. Most of these patients came to the West to attain highly advanced medical treatments that were not available in their home countries.
1.2 Overview and Significant of Medical Tourism 
Chanda (2002) discovered four modes of worldwide trade in trade’s health services (1) crossborder delivery, ( 2) consumption of health services overseas, ( 3) commercial presence , and (4) health personnel’s movement. Mode 2, the consumption of health services overseas, refers to consumers’ movement especially to the country that provides treatment services and diagnosis. This mode indicates contemporary medical tourism’s beginning. Medical tourism is an economic movement entailing trade in services and symbolizes the splicing of at least two parts: tourism and medicine (Bookman & Bookman, 2007). The term “medical tourism” can be broadly defined as patients travelling to other countries with the collaboration purpose of obtaining medical, dental, surgical or other forms of specialization treatment and tourism (El Taguri, 2007; Ramirez de Arellan, 2007). Numerous countries have benefited from medical tourism considerably. Nations promoting medical tourism actively do so for self-serving reasons. Investing in the medical industry is a method to increase the gross internal product, improve services, generate foreign exchange and generate a more favorable balance-of-trade situation, and promote tourism.
Patients and suppliers have been attracted by medical services’ growing commerce sector, with some borderline towns that have a number of expertise in specific kinds of services and drawing from a broad catchment region (Ramirez de Arellano, 2007). As “dental oases” that attracted chartered flights loaded full of patients from Minnesota and California in look for cheaper dental care, an article in Times magazine describes the towns of Nuevo Progresso and Los Algodones in Northern Mexico (Kher, 2006). The market drivers for medical tourism are cost savings, comparable or better standard care, and shorter waiting durations, thus faster access to health the care (Keckley, 2008).
1.3 Middle class Chinese seek medical care abroad
Chinese are showing up overseas not just with shopping cameras and bags, but also in increasing numbers with their medical records. The easier visa rules and rising revenue make going abroad for medical procedures more approachable than ever for Chinese patients. Hospitals and clinics around the world are targeting this burgeoning market. Health care in China confronts various challenges. Because of the poor infrastructure and imbalanced designation of resources, it is difficult to provide effective, comfortable health services to 1.3 billion residences, which has prompted to the deterioration of doctor–patient connections. As a result, more wealthy Chinese travel abroad for better medical treatment. Quite many foreign medical institutes are opening Mandarin language service up to cater to Chinese patients’, although there is no accurate number on it take a year for how plenty of outbound medical trips Chinese needs. As the medical tourism destination for Chinese tourists, Britain has found great chances in outbound medical tourism of China. Shanghainese go to various nations for different medical practices. They go to Japan for standard health checkups, to South Korea for plastic surgery, to the U.S. for cancer treatment, to the UK for hip replacement, and to Switzerland for placenta injections. Investigation shows that, in general, Chinese patients with serious illnesses and deep pockets mostly go to countries such as the U.S., UK and Germany, whereas people with less severe diseases and more modest economic means they will intend to choose nearby countries including Japan, South Korea, India and Singapore. (Worldcrunch,2015)
2.0 Review of the Literature
2.1Definition of medical tourism
In medical tourism’s early stages, several studies including spa remedies and relax in medical tourism’s category by reason of the difficulty to differentiate between medical tourism and health (Bindu & Kanagaraj, 2013). Recent study discriminate medical tourism as tourism that contains specific medical intention. In a similar way, medical tourism refers to persons who living in one nation and go to another country in request to get medical, surgical and dental care while meanwhile getting equal to or higher standard care than they would have in their own country, and are going for medical care on account of affordability, better access to care or a more excellent quality of care (Medical Tourism Association, 2015). Connel (2006) defined medical tourism as “tourism related to direct medical intervention deliberately, and it is expected that results will be long and considerable term. ”On the other hand, Baukute (2012), medical tourism has two main models: surgical and therapeutic. Surgical tourism is a tourism containing surgeries, whereas therapeutic is tourism helps to curing treatments. Therapeutic tourism shares some resemblance with surgical tourism like diagnosis and medical checkups, but is distinguish in the actuality it is frequently a long visit or requires repeat visits. Today many authors such as Connell (2006) describe  medical  tourism as a well known mass culture “where individuals travel frequently-long distance to abroad destinations, to get restorative dental and surgical care while in the meantime being holidaymakers, in a more ordinary sense. In contrast, medical tourism can be can be generally characterized as provision of cost efficient private restorative care in collaboration with the tourism industry for patients needing surgical and other models of specialized treatment (Kazemi, 2008). Finally, medical tourism defined in several studies, as the act of traveling to other countries to get medical treatment, dental, and surgical care or where people travel to other countries to get medical care maybe contains complementary (alternative) and traditional medicine like (spa water or climate, black mud stone, sand.).
Hall(2003) , in seeking to make a definition, consistent with tourism’s official definitions, indicated that health tourism be defined as: a commercial phenomena of industrial society involving a person travelling overnight away from the usual internal environment for the express benefit of maintaining or upgrading health, and the supply and promotion of facilities and destinations seeking to provide such benefits (with Hall, 2003, p. 274). According to Hunter-Jones (2004), medical tourism is travel for recovery rather than travel for direct treatment.
Medical tourism is alike a contested session. (ESPCA, p1) in a report on medical tourism in the Asia‐Pacific area, defines “medical trip” as: individuals’ international phenomenon travelling, frequently great distances, to gain access to health care services that are otherwise not available due to high costs, long waiting restricted health care capacity or lists in origin’s nation, and medical tourism referring: For this study, the holistic and broad definition provided by his and Reddy co-authors (2010) will be adopted: “Medical tourism is the act of traveling abroad [past international boundaries] to obtain diverse sorts of wellness remedies and health” ( p. 510). These remedies may range from highly invasive heart operations, hip resurfacings, and plastic surgeries, to less invasive procedures like dental work, and even wellness treatments like massage remedies and spa. In this definition, health care may be the primary or secondary cause for journey. Advantages and disadvantages of Medical Tourism
Medical tourism has many advantages. First, it is advantageous to the supplier , medical tourism to the UK benefits the economy by hundreds of millions of pounds and is a substantial source of income for the NHS, researchers have found. Medical tourism is advantageous to not only the supplier, but also the clients. The relative affordability of medical tourism brings many clients facing prohibitive out-of-pocket expenses in their home country because either their insurance does not cover/pay the needed procedure or they are uninsured altogether. It is accounted for that about half of all insolvencies in the United States are because of medical reasons (Bies and Zacharia, 2007). Secondly, it is advantageous to the medical tourists, medical tourists from developing countries may access to latest technology. The technology and equipment used by the supplier country are the latest and the greatest. It is common to see surgeons working with billion dollar robotic machines in operating rooms.
While Potential follow-up care becomes a problem. If a complication should arise after a patient returns home, immediate medical attention is difficult to obtain. Having to travel such a long distance around the world not just for the foremost surgery but also follow-up care can become extremely tiresome and expensive, not just financially but also mentally and emotionally. Similarly, difficulties in transferring medical records between home and destination countries can make the follow-up care more complicated. (Burkett L,2007,p223) With the growth of the industry have also come concerns regarding the impacts it is having on destinations, An oft-rehashed problem is that it will worsen health inequities in both the destinations and home nation for medical visitors. (Crooks VA , Snyder J ,2010)In the destination country, if medical tourists drive demand for costly services, they may price out poorer citizens, or at least create a second tier of medical care in those countries Medical tourism may transfer services from preventive public health measures to less effective, and more expensive, clinical interventions.( De Arellano R,2007,p193-198) The development of private clinics serving foreigners may also encourage the movement of trained physicians from the public to private sphere
2.2Demand factors in medical tourism
Tour patterns generally are impacted through an interrelated and complex set of disentangling these drivers and variables, especially on a market by market basis, could be challenging. Disappointment with their own nation’s health system, inaccessibility or low standard of proper operator, and moderateness of medical care in the residential market are part of the biggest influencing factors for persons that go for medical care in other countries (Helble 2011). Hence, the international demand for UK as a medical tourism destination will be a reflection of a number of drivers. Which include: accessibility of services (or higher standard services), medications or operation techniques that are not accessible in their own countries; the reputation of British as a secure destination for medical tourism, and a destination for high standard health services; with relatively reasonable cost of medical services in UK; other factors including regulations and migration rules for conjoint leisure tourism possibilities, medical treatment visas, privacy and anonymity, and cultural affinity. Additionally, the expanded interest for cosmetic services in China and Western countries is not circumscribed to the elder generations; for example, Botox ‘injections have now gotten to be famous among young persons and youthful grown-ups (Healy, 2008). This greater demand for cosmetic surgery now pervades all age cohorts, but meeting such demand is usually outside the scope of government policies and insurance coverage. Planned medicinal sightseers along these lines decide to get offshore treatment (both compulsory and elective) on the grounds that such medications are inaccessible or hard to get to (or even illicit) in their nations of habitation (Jones and Keith, 2006). In summary, the demand for medical tourism is driven by economic factors (fees and insurance costs), and the limited availability and accessibility of many medical services in some countries.
In recent years, the impact of these demand-and-supply factors in medical tourism has been facilitated through considerable changes in the global commerce environment. These progressions include: expanding globalization and exchange progression, improved correspondence through technical innovations,  and a greater propensity for people to travel abroad(Awadzi and Panda, 2005,Fletcher and Brown, 2002) As the demand for overseas medical treatment has increased, prospective medical tourists no longer perceive difficulties in travelling abroad. The demand for medical tourism, together with international air travel’s increasing comfort, has been facilitated by lifestyle and demographic changes in developing economies.
Advanced innovation has additionally assumed a vital part in realizing real-time communication and dispersion of data. This has meant that prospective medical tourists are more knowledgeable about medical procedures and the availability of various services to address the health problems that they are facing (Awadzi and Panda,Mougomba, 2006, Fletcher and Brown, 2002). Besides, digital technology has made networking easy to access among both consumers and providers of health-care services throughout borders (Keith and Jones, 2006). Free trade liberalisation and deregulation has additionally encouraged the flow of production factors across borders—including individuals, restorative supplies, and therapeutic equipments (Bridges and Percivil, 2006) the importation of equipment and medical supplies has been facilitated through deregulation, and improved travelling logistics have made transportation of facilities and people quicker and more approachable (Brown,2002 and Fletcher, Lovelock et al., 2001).
In summary, the potentiality has been generated by significant movements in both supply and demand for a burgeoning health-care industry’s evolution in developed countries. This has been facilitated by free trade organization, advances in communication, and more efficient transaction arrangements.
2.3Medical Tourism Destinations and Treatments
More than fifty nations in the global actively encourage medical tourism, as announced by Gahlinger (2008). Most of them are in Asia and Latin America. A part of the prominent Asian countries are India, Jordan, Malaysia, China, Singapore and Thailand. European nations promoting medical tourism like Spain, Belgium, Croatia, Germany, Hungary and Poland . Thailand is one of the most popular destinations for medical tourists owning to several factors. Numerous specialists in Thailand who treat foreign patients are U.S. trained. Thailand also has numerous JCI accredited hospitals. Thailand is also a popular traveler destination where crime rates are low and Thai hospitality is second to none (Gahlinger, 2008). Thailand offers both propelled therapeutic procedures and more all encompassing medications. Some of the well-known procedures that medical tourists routinel undertake in Thailand are hip replacement, kidney transplant, dental care, cosmetic surgery, heart surgery, lip sculpture, plastic surgery, traditional Chinese medicine, and acupuncture. Thailand is also one of the few nations known for gender reassignment operation (Marsek & Sharpe, 2009).
A few Latin American nations are likewise known for medicinal tourism. For dental techniques, Mexico, Costa Rica, Argentina, and Brazil are famous destinations. (Marsek and Sharpe, 2009). For cosmetic surgery, Argentina, Brazil, Cuba, Panama, and Venezuela are popular destinations (Gahlinger, 2008). For plenty of American medical tourists, Mexico is the most popular destination for cosmetic surgery and dental care. A lot of specialists and surgeons have opened equipments right over the border in Mexico to make travel easy and fast for American patients. Around 40,000 U.S. patients go to Mexico every year looking for medicinal treatment (Schult, 2006). A greater part of them visit border towns rather than Mexico City or resort towns because of the nearness of health facilities specifically set up to treat the substantial number of American patients searching for affordable and efficient medicines. Some of the leading border towns in Mexico are Tijuana across from San Diego, California; Ciudad Juarez across from El Paso, Texas; and Nuevo Laredo across from Laredo, Texas. A large number of cosmetic surgeons and leading Mexican dentists have been attracted by these towns by reason of their 30 proximity to the U.S., which supplies a comparatively affluent and big customer base.
In Costa Rica, tourism is one of the top revenue generators US$7.6 trillion (10% of global GDP) and 277 million jobs (1 in 11 jobs) for the global economy in 2014. Costa Rica received 150,000 medical visitors in 2006, primarily for cosmetic surgeries and dental procedures (Understanding Medical Tourism, 2008). Costa Rica is known for ecotourism, and medical vacationers can recover whereas relaxing among nature. In Eastern Europe, both Hungary and the Czech Republic are well known countries for reasonable dental strategies. Numerous patients from Western Europe, especially Germany and Britain, visit these two nations for top quality but with reasonable price dental systems, for example, corrective oral surgeries, full mouth, rebuilding efforts, implants, cleaning, and checkups (Woodman, 2007). Sopron, a town of 20,000 citizens in Hungary, owns 200 optometrists and over 200 dentists. Sopron which is just an hour’s drive from Vienna, Austria, pander primarily to Western European medical vacationers (Herrick, 2007).
Despite the lack of a shared definition among all concerned researchers, medical tourism is fast becoming a worldwide, multibillion-dollar industry. It has the potentiality to increase even faster as medical care continues to be further privatized and considerable cost differentials remain. A lot of countries at economic development’s various levels have been trying to exploit this growing industry rapidly. Some nations, like Belarus, Costa Rica, Hungary, Latvia, and Mauritius don’t get countless inbound travelers; yet, these nations are occupied with expanding health tourism.
2.4Top Reasons Why Medical Tourism is Popular
Top Reasons that Medical Tourism is Popular. The medical tourism tendency has been made famous for the Americans, Canadians, British and other patients travelling overseas in search for low-priced high standard medical treatments. The following are the top reasons that medical tourists decide to take advantage of this growing industry.
Less expensive care cost is one of the key factors that patients travel abroad for medical treatment. As health care costs soar, patients in the developed world are searching abroad for medical treatment (Connell, 2006). Healthcare  services include a number of countries promising “first-class services at third-world prices” (Wolfe, 2006). For instance, a heart operation in a US hospital can cost more easily than $100,000. Hospitals in Thailand and India can provide comparable quality care for $25,000. This cost distinction can cover the journey expenses of the immediate family and patient easily and even allow for enormous savings (Baker, 2010). As indicated by Deloitte Development LLC Report 2008 (Consumers in Search of Value), the  following is the cost of medical procedures in the United States contrasted with the medical treatment cost in different emerging destinations in Asia, such as India, Thailand, Singapore and Malaysia.
2.4.2Access to the latest medical technology
The possible reasons that a citizen of one country might have a trip to another country are always the same: access and cost. Lack of access because the technology is not available, is prohibited or illegal, or the wait is too long in the domestic country, can result in medical tourism (Patsner, 2008). Stem cell-based  based treatments are the most well-known therapies that are not available to Americans, frequently  because of restrictive government regulations (Runckel, 2007).Therefore, medical vacationers also go to offshore  medical  destinations to have procedures that are not broadly accessible in their own particular nation of origin.
2.4.3Long waiting lists
With healthcare costs growing in increased willingness and the United States to search for private care in nations with government-run systems so as to to avoid waits, motivation for medical tourism isincreasing (Patsner, 2008). Another main reason in choosing to offshore health care to foreign lands is to circumvent delays that are associated with long waiting lists. In state-run health programs like those in Canada or the UK, waiting lists  can extend to over a year for essential surgery and past three for non-essential surgery(Runckel, 2007).Hence, patients look for medical treatments abroad for a quicker response to their medical needs.
2.4.4Travel Opportunity
medical  tourism  has  grown  in  a  number  of  countries  such  as  India, Singapore, and Thailand, many of which have deliberately linked medical care to tourism, and thus boost the attractions of nearby beaches (Connell, 2006). A quantity of popular sun-sea-sand tourism destinations have, in the last decades, tried to diversify into health tourism so as to to reach a more balanced, sustainable approach to tourism development (Syvertsen and Ariwa, 2010).The chance to travel to exotic destinations is an extra benefit for several medical tourists. For example, South Africa offers safari medical visitor packages, where a family visits for treatment took after by an wildlife safari (Runckel, 2007).In United Kingdom, medical travelers that experienced non-major surgeries can enjoy relaxing recovery in many beautiful towns.
2.5 Medical Tourism in UK
According  to  The  World  Health  Organization’s  (WHO),  United Kingdom’s  health care system  is  rated  18th in  the  world. UK became known as a destination for medical tourism because it specialized in hip replacements, knee replacements and other orthopaedic treatments. The famous Chinese sport star Xiangliu did his hip replacements many years ago in UK. UK private hospitals offer a high standard of clinical care and facilities, with experienced consultants and highly trained medical staff. UK healthcare costs in both UK private sector, and in NHS hospitals who offer private care, are surprisingly competitive. All National Health Service (NHS) hospitals and private healthcare providers must register with the Care Quality Commission, the body that is responsible for UK hospital accreditation and standards. This is compulsory. In the UK, there are no JCI accredited hospitals. Because the standards set by the UK’s Care Quality Commission either match or exceed those set by the US  domestic and international accrediatation bodies. In 2010, an estimated around 52,000 patients sought treatment in the UK. Major source countries for patients coming into the UK include Spain, Greece, Cyprus and the Middle East. The number of Greeks and Cypriots travelling into the UK to access treatment rose rapidly in 2009 and 2010( Johanna Hanefeld,2013). Unsurprisingly, the biggest numbers of inbound medical visitors were in the large hospitals which are internationally known for their specialism; foremost amongst these Great Ormond Street Hospital for Sick Kids which reported income of more than £20million from 656 patients.
Tourist motivation factors have concluded that factors that influence a travel decision can be categorized into two factors: “push factors” and “pull factors.”
2.6.1Push and Pull Motivation Factors
Visitors motivation that be based on the concepts of “push” and “pull” factors has been investigated through a number of researchers (Klennosky, 2002;Lam & Hsu, 2006; ; Kim & Lee, 2002). The literature came to the conclusion that “push factors” are linked to the internal socio-psychological motivation and cognitive process of the person to travel. Most “push variables” start from the  intangible or natural desires of people, including the longing for escape, curiosity seeking, adventure seeking, dream fulfillment, self-exploration, rest and unwinding, health and wellness, prestige, and socialization ( Lam and Hsu, 2006;). “Pull factors,” on the other hands, are the external forces emerging from the attributes that attract the people to a specific destination and establish the actual specific destination choice (Cha, McCleary & Uysal, 1995). “Pull factors” have been characterized in sessions of both intangible and tangible aspects such as historical and natural attractions, physical surroundings, infrastructure, recreation facilities and sport, provision, people and the marketed 26 the destination’s image (Kim, Crompton, & Botha, 2000; Klenosky, 2002;).
To examine the motivational idea of “push” and “force” factors, Yuan and McDonald analyzed the motivations of global voyagers going for a pleasure reason. Their review showed that explorers from the four nations (France, Japan, United Kingdom and West Germany) travelled to satisfy their neglected needs, for example, relaxation, renown, enhancement of connection relationship, escape, and novelty. Cha et. al. (1995) found the psychological intrinsic reason to travel by cluster motivations of Japanese who travel abroad. The outcomes namely emphasized three groups of tourists sports seekers, novelty seekers, and family/relaxation seekers. Further, Kim, Lee, & Klenosky (2003) also confirmed the impact of “push” and “pull” motivation factors through examining tourists reasons to visit Korean national parks. The review showed that tourists were “pushed” to manage a trip by their need to get away from their daily routine, appreciate natural resources and health, experience and build companionship, and family harmony and study. A few examinations of “pull factors” have been reported in travel and tourism literature. Yuan and McConald (1990) discovered pull motivations on vacations which include hunting, wilderness, facilities, cosmopolitan environment, culture and history, east of travel, and budget. To confirm the “pull” attributes of destinations, Fakeye and Crompton (1991) discovered six “pull factor” areas from 320 attribute items adopting a sample of visitors to a well-known winter destination in Texas. The “pull factors” identified attractions and included “social opportunities,” ” cultural amenities and natural, “” transportation and accommodations, “” infrastructure, foods, and friendly people, “” recreation activities and physical amenities, “and” bars and evening entertainment. ” In their review, the perceived importance of the trait areas varied among non-guests, first timers. Turnbull and Uysal (1995) discovered six “pull factors” including”heritage/culture,” “city enclave,” “comfort-relaxation,” “beach resort,” “outdoor resources,” and “rural and inexpensive.” They identified differences in the perceived importance of the “pull factors” examined among visitors from different nationalities. Kim, Crompton, and Botha (2000) reported four domains of destination attributes, like “entertainment,” ” infrastructure, “” physical environment, “and” high profile entertainment opportunities. ” Notwithstanding the general inspiration element of voyagers going for delight reason, which was already  mentioned, the motivation factors particularly to health or wellness visitors ought to also be incorporated into the review. Chen, Prebensen, and Huan (2008) find the hidden tourists’ travel motivation to a wellness destination. Their study revealed that relaxation, pursuing multiple activities, recreation, and enjoying nature are the primary motivations.
The “push-pull” framework provides an intuitive and simple method for explaining the motivations that underlie traveller behavior. The concept, however, has been characterized as being connected with two separate decisions that were made at two separate points in time in general — one concentrating on whether to go or not, the other on where to go (Klenosky, 2002). The motivation as a construct in tourism has been considered in a unidimensional way. In that capacity, it was viewed as being either a behavioral or cognitive construct (McCabe, 2000). it has also been mentioned that while the inner forces push people to travel, the external forces of the destination itself pull them simultaneously to select that particular destination (Kim, Lee & Klenosky., 2003). In contrast with the perspective of pull and explored push factors separately, researchers have indicated that push and pull factors should not be viewed as being completely independent of each other but rather as being as fundamentally relevant to each other (Kim, Lee & Klenosky, 2003;). Previous literature  proposes that the motivational factors (push and pull) have an impact on the choice whether to travel or not and the receive destination image of the tourism termini.
2.6.2Motivations of prospective medical tourists.
Medical travellers include a wide range of people travelling to receive medical therapy abroad. Aside from people from developed economies, medical visitors can also include the so-called from underdeveloped countries and foreign expatriates dwelling in neighbor nations (Ramirez de Arellano, 2007). Prospective medical visitors include: (1)the uninsured (people choosing not to ensure their health, normally because they cannot afford the insurance policies); (2) the underinsured (those whose insurance policies do not cover up the expenses really incurred while they receive medical therapy).
Companies are also one of the targets of medical tourism (Marlowe and Sullivan, 2007, Moody, 2007, Smith and Forgione, 2007). A considerable number of these organizations need to pay substantial medical expenses as a major aspect of the fringe benefits they supply to their emplyees. In many cases these involve complicated and costly medical procedures. It can be attractive for these companies to refer employees requiring elaborate procedures to offshore medical service providers. Retirees choosing to pass their lives as long-stay tourists in foreign nations can also be aimed as medical tourism’s potential clients (Norra, 2007, Pedersen, 2007, Connell, 2006, Business Line (The Hindu) , 2009). A few nations, for example, Japan and Singapore, really urge their folks to retire abroad, and these retirees usually require restorative care on a continuous basis (Connell, 2006).
The adoption of medical tourism by these various groups of people can be either “preventive behavior” or “protective behavior” (Carter and Kulbok, 2002). Persons engaging in such preventive or protective health conducts are motivated to do so through various kinds of environmental factors (Kulbok and Carter, 2002). These cover “health locus of control “, public support, income, education, and health status. Specifically, “health locus of control”— which alludes to an individual’s view of personal capacity to control his or her health condition (Wallston et al., 1994, Moshki et al., 2007)— is imperative with regards to medical tourism. On the off chance that a person trusts that he or she has a high level of control over their own wellbeing, that person is said to have a high level of “internal health locus of control”; such individuals are more motivated to take part in healthy behaviour (Wallston et al., 1994). Social support is also an important influence on an individual‘s motivation to engage in healthy behaviour; individuals who are satisfied with their social support are more likely to engage in health enhancing activities (Callaghan, 1998). As a whole, the literature indicates that people having an inner locus of control, good social backup, a high layer of education, and a large income are more likely to engage in healthful behaviours. A desire to achieve and keep good health, however, does not explicate the motivation fully for an individual to engage in medical tourism. As noted above, individuals look for treatment abroad for a scope of different reasons. These incorporate economic motivations, a longing to minimize the sitting tight time for treatment, and the accessibility (and legality) of certain treatments. Other motivations include a desire for anonymity and an agreeable recuperation environment (Business Line, 2009, MacReady, 2007, Deloitte, 2008, Anonymous, 2009, Connell, 2006). Of these, economic factors, availability, and waiting times seem to be the dominant factors in motivating people to accept medical tourism.
Marketing Mix also  referred  to  as  the  4P’s,  which  consists  of  product, price, place and promotion. Marketing Mix is one of the best known of all the marketing models. These four  factors  are  used  to  analyze  the  effects in customer  preferences  of  choosing  hospitals  in  UK for medical treatments.
Demographic Factors
The perception of clients or patients may vary contingent upon one’s demographic background. Demographic characteristics like age, salary, and gender are usually presumed to influence on one’s level of product knowledge, shopping experience, and general purchasing behavior in the most service or item categories, and are often  used as the basis  for  market segmentation (Estelami, 1998).
Gender –Research  and  writing  related  to  sex  and  gender   have   been expanding  at  a  rapid  pace  since  the  late  1960’s  (Unger,  2001). Consumer perceptions  are  affected  by  materialism,  gender  and  nationality  (Kamineni, 2005).
Age –Gender and age significantly influence the perceived picture of traveler destinations (Baloglu and McCleary, 1999).
Residence’s nation — a study by Kozak (2002) captured a straightforward approach in testing differences in vacationer motivations between nationalities and between destinations. An exploratory method to the study of the value of nationality with respect to tourist behaviour was taken by Sussman and Pizam (1995).
Occupation –The different social classes demonstrate distinct preferences for a  variety  of  products  including  leisure  activities  (Kotler  and  Armstrong, 1995).occupation is one indicator of a person’s financial status.
Income –Travelers at lower salary levels may be expected  to take part in more searches to balance their relatively better  perceived  risk .  Higher  income  levels,  on  the  other  hand,  have  been  found  to  be positively  associated  with  greater  levels  of  information  search  including  the use of destination specific resources.
2.7Elements of the Marketing Mix
At the present time, it is recognized that not only adequate just to adopt the marketing mix, but it also needs to be adapted each time a change in consumer demand, which requires them (Froelich, 2012). Each enterprise has focused on clients requires discovering appropriate marketing mix of each other but rather as being related to each other as fundamentally (Kim, Lee & Klenosky, 2003; Klenosky, 2002). The marketing mix consists of four main elements: product, price, promotion and place. The showcasing blend comprises of four primary components: item, value, advancement and place. This 4Ps are the four noteworthy decision territories that marketers need to oversee it with the goal that they meet or surpass the demand of clients superior to the competition (Kazemi, 2008). The marketing mix is a set of controlled variables that organizations use to influence the target market. Four Ps have long been the marketing strategy’s base in most industries and is progressively regarded by health care associations (Vasiliki, 2012). Eventually, marketing mix is one of the most important of all marketing model. These four factors are utilized to research the effect of visitors decision to pick the hospitals in UK for medical treatment. Below follows the implementation of the 4 Ps to health services.
Product is a significant aspect of developing a competitive offer within the medical tourism market. It is important to recognize that consumers above all are demanding the benefits of not the products and the products offer or features of the products (Smith & Puczko, 2009). What is more, the customer look for needs’ satisfaction, and these needs are pretty varied. Likewise, an item as defined by Kotler et al. (2006) is anything that can be offered to a market for attention, acquisition, utilize, or uconsumption that may fulfill a need or want. Lee (2006) found that the product is the center of the marketing mix strategy where retailers can offer unique attributes  that distinguish their product from their rivals. In contrast, in the medical sector, the product represents goods, services, or ideas provided by a healthcare organization (Spasojeric & Susic, 2010). The product is difficult to exactly be defined in healthcare, making a challenge for healthcare marketers. While, on the other hand, it is more hard to quantify services and clients differently assess them from more tangible products. Medical services have changed and nowadays it is unnecessary the customer searching from medical treatment but it can be the other way around (Burkett, 2007). Finally, product in this research defines to the medical treatment and services offered by the hospitals in UK. In addition, it alludes to the globally authorize hospitals in UK that provide fast services, eminent hospital facilities, high technology restorative equipment, first class specialists and medical attendants and incredible patient care services.
Place contains decisions regarding the distribution channels to be applied and their management, the locations of channels, ways of transportation and inventory levels to be held (Ariwa & Syvertsen, 2010). Moreover, the purpose is to make certain that services and products can be obtained in the right qualities, at the place and proper time (Birschel, 2009). Distribution ways contain corporations such as retailers or wholesalers through which products pass on their way to consumers (Bookman & Bookman, 2007). On the other hand, Place in the medicinal division can describe to the area or the hours a therapeutic service can be accessed. As in earlier years a doctor could setup an office a location which is appropriate for him, today the customers progressively directs the role of place in the marketing mix. Finally, in medical tourism industry in UK, the place describes, to the hospital’s location near tourist attraction and shopping centers, accessibility to local transportation, situated in a famous city, sited in a safe and secured environment, and role in a calm location.
Price generally is a main factor of the marketing mix for the reason that it stands for a foundation what the enterprise receives for the product or service being marketed. What is more, Kotler et al. (2009) , define price is the sum of money pays for service or a product, or the total values that consumers exchange for the profits of having or using the service or product. Additionally, because of the impalpable nature of services, price becomes an important quality pointer where other information is lacking or absent (Zeithaml, 1988). Also, price is viewed as the most critical measurement of repurchase intentions (Saiprasert, 2012; Vasiliki, 2012). Furthermore, the price of a product or service must reflect the customer’s willingness to pay (Hall & Janes, 2011). In medical tourism sector, the price especially refers to the various medical process’ affordability in Britain compared to home nation of a patient. This contains the cost of an added benefit of a vacation tour in an interesting destination after a medical therapy.
Another component that impacts on attracting in medical tourism is promotion. This factor is regarded in marketing literature as an important element fundamental for the creation, building and success of medical tourism industry in UK. Promotion is one of the key elements of 4Ps in the marketing mix (Dibb et al., 1994) and obviously plays a fundamental role in building successful attracting medical tourism. Importantly, promotion plays a competitive advantage in destination marketing for appealing to medical tourism (Vasiliki, 2012). Regarding to medical tourism services in Jordan, promotion is an approach that is adopted to communicate the benefit and features of service or a product to the consumers. A marketer may utilize different strategies to develop product or service awareness to the picked target markets. Moreover, promotion is the effort to illuminate and persuade potential buyers to accomplish the sale of the product, services, or ideas (Mugomba and Danell, 2007). Also, promotion includes all this activities such as advertising, personal selling, public relations, publicity that are intended to stimulate customer demand and develop the marketing performance of sellers’(Al Azzam, 2012; Kumar & Komaraian, 2014). Finally, in this study, the promotion referred to the additional services such as visa extensions and airport service, special rates for insurance project coverage, claims and hotel accommodation, special price on diverse medical treatment package deals, and special rates for trip tours after medical treatment.
2.8Consumer Satisfaction
Consumer satisfaction is straightforwardly related to client retention since satisfaction is the significant antecedent of customer loyalty (Oliver, 1997).Excellence in quality is a method for consumer satisdaction. In order for consumers of medical tourism in UK to experience consumer satisfaction, the productthat they should receive must  surpass their expectations. Patients typically characterize satisfaction when the hospital gives high quality of services that are similar in the United States or in other western nations. What is more, medical tourists search for convenient accessibility in terms of hospital position and flight arrangements. Inexpensive health care cost and safety are also essential aspect of international medical tourists’ general client satisfaction.
2.9Chapter Summary
Connell (2006) characterized medical tourism as a niche industry “where individuals frequently travel long distances to foreign countries to get medical, dental and surgical care while all the while being holidaymakers, in a more conventional sense. Because of the long waiting and costly medical care in a few developed nations, individuals look for quicker and less expensive medical services in other nations. One of the medical tourism trend’s most important barriers is quality of care. The number of website that were dedicated to medical tourism has burgeoned in recent years. Nowadays, information that regards quality of medical tourism abroad as well’s care as details on choices of health care destinations around the globe is readily available online. Therefore, the  safety  and quality  of  care  available  in many offshore settings is no longer an issue (Deloitte Development LLC, 2008). Previous  studies  regarding  the top reasons of the popularity of medical tourism marvel has been discussed. The difficulties and risks of medical tourism have additionally been discussed in this section. Choice and client preference depends on one’s demographic background. Based from Estelami (1998), demographic characteristics are the basis for market segmentation. As stated by Smith and Forgione (2008), there are four leading factors namely impacting the selection of an international health care facilit y: ( 1) Costs, ( 2) Hospital Accreditat ion, ( 3) Care’s quality, and (4) Physician practice. These key elements evolve into two critical factors playing a crucial role in selecting an international medical facility, which are the “Price” and the “Product”. In this  study,  the “Product”  is  the  main  factor  that  drives  patients  to  travel  abroad  for  medical purposes. The  following chapters  will  identify  the  influencing  factors  such  as  “Price”  or  “Product”  that drives Chinnese medical tourists to choose United Kingdom hospitals for medical care.
Chapter 3.0 Methodology
3.1 Introduction
This chapter’s primary objective is to clarify the procedures conducted in determining the essential factors that motives Shanghai patients to choose hospitals in UK as their medical tourism destination. A descriptive study has been performed to describe the relationship between factors that were involved and to explain why some factors are considered to be more significant than the others. The research methodology is important for investigators. It provides guidance to help analyze and explain a certain phenomenon. In this chapter, the investigation design, data collection and analysis that used in this investigation will be analyzed and evaluated. This chapter will be divided into eight sections, which are investigation design, the questionnaire design, the sample, the procedure and data analysis. Validity of the investigation will also be explained. In the end of this chapter, the investigation ethics and summary will be introduced.
3.2 Research design
3.2.1 Secondary research
According to literature review, the researcher found that there are some gaps in previous study. In the past research, there are less scholars research on the motivation for developing countries’ medical tourists go to developed country to have medical tourism. Most of them focus on the trend, thus, this is necessary to use primary research to collect large amounts of data to analyze impact of brand image. Key literature sources are as follows:
Table 1. Literature Matrix

Title of book/journals/articles
Research findings

Trade in health services.
Trade in health services
indicates contemporary medical tourism’s beginning
identify different modes of worldwide trade in health services industry

Medical Tourism and its Entrepreneurial Opportunities
A conceptual framework for entry into the industry
focus on the market or the customer and how to balance supply and  demand

Bindu, T
An Analysis of Push and Pull Travel Motivations of Domestic Tourists to Kerala
analyze push and pull factors of domestic tourists
a few reviews including spa medications and unwind in the class of medical tourism due to the trouble to separate amongst wellbeing and medical tourism

Bookman, M. Z
Medical Tourism in Developing Countries
Medical Tourism in Developing Countries
Distribution channels passing to clients

Mason, OH: Thompson South-Western.
Basic Marketing Research
Singular global medical vacationers were chosen since they were viewed as the most vital market section for the Jordanian medical tourism industry

Journal of Legal Medicine
Medical Tourism: Concerns, Benefits and the American Legal Perspective
Medical services have changed and nowadays it is not necessary the customer himself who searches from medical treatment but it can be the other way round

Froelich, N
Thesis published, Södertörn University.
Medical Tourism A study about motivational factors and the prerequisites for creating a competitive offer-with a Swedish perspective
It is perceived that not just adequate just to utilize the showcasing blend, however it likewise should be balanced every time an adjustment in customer request

For a full list of references please see reference section.
3.3Research Framework
This review used quantitative marketing research techniques to investigate the factors that lead medical traveler to pick hospitals in United Kingdom for their medical needs. Quantitative research techniques were initially developed in the normal sciences to study common phenomena (Hohmann, 2006). The quantitative study model adopts scales and questionnaires. As stated by Gall, Borg and Gall (1996) “the purpose of a survey is to use interviews or questionnaires to gather data from participants in a sample about their characteristics, experiences, and point of views in order to generalize the discoveries to a population that the sample is intended to represent” .  Questionnaires provide the opportunity to gather large  amounts  of  data  from  many  respondents  (Gall,  Borg  and  Gall,  1996; Krathwohl, 1998)
3.3.1Primary research
According to Harris (2011), primary research and secondary research are both valuable research to help investigator gather data. All in all, primary research is original research to help examiner gather data particularly for research current objective. Primary study explores the relationship between variables by field investigation. Secondary research refers to search that exists data that original data was gathered by some else. Investigators usually find these data from books, journals or libraries. In this investigation, there are many literatures about the pull and push factors and marketing mix. In the past research, most of the researchs are focus on consumer behavior and the drivers of medical tourism demand of medical tourism from developed countries choose developing countries as medical tourism destination, however, there are few researches in depth study another trend. The propose of this research is trying to identify influencing factors that would help marketers to set a suitable market mode to attract a large number of developing countries tourists come to developed countries like United Kingdom for medical treatment . Although use primary research will cause extra cost, like questionnaire paper and transportation cost (Anastasia, 2015), these costs are affordable for investigators and it is necessary for the study. In order to provide theoretical basis for this research, secondary research will also adopted. Mainly use previous materials about this research topic.
3.3.2Induction and deduction
According to social study method (2006), deductive and inductive approaches are two broad approaches of reasoning. Inductive refers to from specific observations to get some tentative hypotheses which can be explored, and eventually get theories or conclusions for some general. Deductive approach is opposite with inductive. Deductive is from general to specific. Deductive is from general to specific. It generally from a hypothesis about topic and afterward narrow it to more particular speculations that researcher can test. Investigator will proceed with narrow down after gather data. At that pointuse specific data to test hypotheses and whether confirmation original hypothesis or not. This research adopt deductive approach. As for the influencing factors that lead medical tourism choose medical tourism destination, there are many scholars have done in-depth researches and acquired theories. This research would base on these existing theories to investigate the influencing factors that lead medical tourists to choose medical tourism destination. The research method in this investigation thus is correspond to deductive approach. The research would also put forward hypothesis and test if the hypothesis is true through collecting and analyzing data. Primary research usually including questionnaire, interview and observation (BBC, 2014). This study will adopt questionnaire to gather quantitative data and qualitative data. The purpose behind choose questionnaire is on the grounds that, firstly, using survey can gather a lot of data from a substantial number of individuals in short period time (Routledge, 2004). In this way, study this examination by questionnaire could investigate  target that clients’ needs and motivations, and then to explore the motivations of Shanghai medical tourism choose UK as medical tourism destination.
3.3.3Questionnaire design
It is believed that quantitative information results is need gathered by high quality survey.  According to Trochim (2006), common questionnaire type typically consist of dichotomous questions, rank order questions, multiple choices (single answer) questions, multiple choices (multiple answers) questions, like reaction scale and open questions. In this questionnaire, agent for the most part adopted three questionnaire types: Firstly, to measure customers basic travel information, the dichotomous questions will be used. Dichotomous question often set two possible answers, customers will tick one box, for yes or no. For example, customers will be asked have they ever been to UK or not? The sum of respondents choice demonstrates their past experience. As stated by kowalczyk (2005), the advantage of dichotomous is the question is categorical and it is fast to respond. The first three questions are the common questions that can help research know the knowledge of potential medical tourists about the medical tourism destination. For rank order question, it will help researcher to analyze which is the most important factors that influence customers when they choosing a medical tourism destination. After ranking question, there has a question ask respondent that “after they select medical tourism destination, through whom will they organize their medical accommodation and travel”. This question would help medical tourism destination to know better about medical tourists in Shanghai. Finally at the end of questionnaire is personal information, single question will be used in this part. These questions are pretty simple, respondents just need to tick one box. It is easy for respondents to fill in. For the ranking questions and other types questions are as follows, see table 1. The questionnaire transcript will be put in Appendix 1.


Dichotomous questions
1.      Have you ever been to UK?
2.      Do you know anything about medical tourism?
3.      Would you consider travelling in UK for surgery if it is necessary?
4.      Do you think the strongest motivation for you to choose a medical tourism destination is cost-saving?

Multiple questions
1.      Which country do you think is the most common destination for Medical Tourism?
2.      Where do you get information about medical tourism destination?
3.      Normally ,only major surgery (significant treatments) will make you consider going abroad to have medical tourism
4.      Do you have any concern and worries about your medical trip in UK?

Please rank the following factors, which influence you to select the UK as your medical tourism destination.

3.3.4Relevant Data Description
Target Population
Relevant Data Description Target Population A population  is a complete collection of data that  includes all subjects of  interests  in which  properties  that  are  relevant  to  the  research  study  are  studied  and  analyzed. According to NHS(2010) UK welcomed an estimated 53000 patients from many countries for a wide variety of medical procedures in 2010. The target population of this research was the potential international tourists from Shanghai China.
3.3.5Sample and sample size
A sample is a part of the number of inhabitants of interest, a sub-collection chose from a population. Since the exact number of the aggregate populace is uncertain, samples of this research were chosen through the convenience  sampling  method. According to Roberts-Lombard (2002) convenience  sampling  is a non-probability examining technique where subjects are chosen because of their helpful accessibility and accessibility to the researcher. Under convenience sampling, the sample collection relies on personal judgement of the researcher. The sample size ought to depend on the importance and the target population capacity of the study. There, however, are general rules, thirty cases are adequate forstudies in which statistical analysis is to be done (Schindler and Cooper, 2006). Nevertheless, the  researcher  distributed  one  hundred   questionnaires. The  questionnaires  were  distributed  to potential international medical tourists from Shanghai Huashan Hospital . The research instrument utilised by the researcher was the questionnaire. The information for this research study was assembled through self-administered surveys. Self-administered questionnaire are research surveys personally conveyed to the respondent by the questioner but finished by a respondent with no interviewer involved (Chigamba and Fatoki, 2011). A questionnaire was developed to assess the significance of each influencing factor to the respondents.(解释问卷内容)
3.3.6Data Collection and Gathering Procedure
The secondary and primary data was adopted by the researcher in this study. The researcher used questionnaire to gather the primary information from the potential international medical tourists from Shanghai at Huashan Hospital . On the other hand, the secondary data that are used in this study by the researcher includes articles, journals and textbooks, dictionary and websites. The  questionnaires were distributed over a six day period during December 5 –10, 2016 at Shanghai Huashan Hospital. The distribution of the survey was not permitted to be conducted inside the clinics. Thusly, this research review was led outside premises of the hospitals. The respondents were given roughly 15 minutes to finish the survey. There were an aggregate of 70 finished questionnaire were gathered by means for convenient sampling.
3.3.7Investigation ethics
“Research ethics refer to the appropriateness of behavior of researchers in relation to the rights of those becoming your work’s topic and are affected through the work” ( Saunders et al., 2000, p142). There are a number of ethics issues will be considered in this investigation. For privacy, the researcher will secure respondents privacy, and will not exposure it. The researcher will not try to force respondents to answer questionnaire. When respondents consented to fill questionnaire, the researcher will keep the aim of the study, and to tell respondents the motivation behind this survey. Furthermore, when researcher sending survey through the internet, researcher will pay more attention to the netiquette. This study won’t hurt respondents health or safe. The collected data will be used in researcher dissertation only.
3.4Chapter Summary
The main purpose for this research study is to identify the affecting factors that lead medical tourists to pick UK hospitals as their medical tourism destination. This research adopted a quantitative research method and therefore  have used survey questionnaire so as to evaluate the motivational factors that lead client preference to pick hospitals in United Kingdom for health care services. The research study’s population scope was the Chinese potential visitors to UK. The questionnaires were distributed at the premises of Shanghai Huashan Hospital . There were 70 finished questionnaires were collected by the researcher.
Chapter 4.0 Data findings and analysis
In this chapter, data results and findings gathered through questionnaire will be presented. These data will be also analyzed by investigator. The results present the discussion about the influencing factors leading Shanghai medical sightseers to choose UK as medical tourism destination. According to information mentioned before in methodology chapter, there are 70 questionnaires were complete. The interviewees have different age groups, from 18 to 45 years old above. Female respondents accounts for 47.14% and male respondents account for 52.86%. The majority interviewees are recent graduates from university, most of them are company employee now. 18-24 years old respondents account for 62.86% and 26-35 years old account for 34.29%. The specific feedback will cited in this section. Statistical data will be shown by the table.
The demographic information was included in the questionnaire’s first part. The intended respondents, international medical visitors, were asked to identify their demographic categories which consists of: ( 1) Gender, ( 2) Age, ( 3) Residence’s country, ( 4) Occupation, ( 5) Income , and (6) Visit’s Frequency. In order to understand the sample population that be based on demographics. Tables 4.1 through 4.6summarizes these data by the respondents’ general information. Respondents (N= 70) stated their gender and Table 4.1 illustrates this data.  A majority  of  the  respondents,  33 (47.14%) respondents  were  male, while  37 (52.86%) of the respondents were female.




Table 4.1: Descriptive Statistics of Gender
The following Table 4.2 demonstrates the age of the survey’s respondents. There were 44(62.86%) respondents were from the age bracket of 18 — 25, 24 (34.29%) respondents came from the 26- 35 age bracket, 2 (2.86%) respondents came from 36 — 45age bracket. The largest number of respondents came from the age bracket from 18-25.






Table 4.2: Descriptive Statistics of Age
Table  4.3  shows   the country  of  residence  or  nationality  of  the respondents. All of the 70 respondents are from Shanghai China. Because the topic of this research is to identify influencing factors that lead Shanghai medical tourists to choose UK as medical tourism destination.

Country of residence

Shanghai China

Table 4.3: Descriptive Statistics of country of residence
Table 4.4 demonstrates the occupation of the respondents. The biggest part of respondents addressed they were other occupation, a total of 40(57.14%) respondents. This is trailed by the second largest respondents, which are engineering 9 (12.86%) respondents. There were 8 (11.43) respondents that are students, while 6(8.57%) respondents are in Computer Science industry. Others are Artist and educator.



Computer science




Legal profession


Not employed




Table 4.4 Descriptive Statistics of occupation
Table4.5 illustrates the respondents’ income in US dollars per month. There were respondents said that their income is about 1500BRP per month 34(48.5%). 18 (25.7%) respondents stated that they are earning more than 3000BRP per month. A tot of 12(17.1%) respondents stated that they are earning about 2500BRP per month. 6 (8.5%) respondents said that their salary is about 2000BRP per month.







Table 4.5 Descriptive Statistics of income( per month)
The frequency of visit of Chinese tourists to UK is shown in Table 4.6 as below. There were 14 respondents (20%) ticked they have been to UK, while 56 respondents (80%) said they have not visited UK before.

Frequency of visit




Table 4.6 Frequency of visit
In answering the question about the influencing factors affecting means, standard deviations and preference of Chinese medical visitors were calculated to class the influencing factors according to important respondents’ perception with regard to their decision in receiving medical therapy in the hospitals in the Britain. Giving quick service and exceptional patient care(Mean= 4.55, Standard Deviation = 0.623) positioned second importance, the hospitals with excellent facilities and excellent  medical treatments (Mean= 4.47, Standard Deviation = 0.700) ranked the third  significance, and the clinics that gives high technology medical supplies (Mean= 4.42, Standard Deviation = 0.713) positioned the fourth in significance. These four top most significant factors come from Product’s category. This shows that respondents value the product they are availing more than the other factors in the three categories of place, promotion and price. The respondents ranked the hospitals accepting claims and insurance plan coverage (Mean= 4.44, Standard Deviation = 0.786) ranked the fifth in importance. As sixth in significance (Mean= 4.41, Standard Deviation = 0.673), affordable medical treatment costs ranked seventh in significance, the hospitals provide fund with value was rated by the respondents (Mean= 4.39, Standard Deviation = 0.869)
5.0 Conclusions and Recommendations
Consumers progressively are attempting other options to their local hospitals and specialists, from traveling to another country for quick surgery, basic care at new medical centers in drugstores and discounters, specialists say. The number of individuals heading to other countries for “medical tourism” could bounce fifteen times in the following decade, to nearly 260 thousand Chinese a year searching for better medical treatment like hip replacement ,prostate and shoulder surgery and even plastic surgery, according to China Daily . A growing number of tourists have been lured by the combination of affordable medical care with attentive room service to pack a suitcase and board a plane. For a large number of medical tourists, the actual attraction is the price. The London Clinic Cancer Centre and The Cromwell Hospital Cancer Centre are the hospitals in UK, that have  an  international  accreditation  and  it  provides  quality  health  care  at  a reasonable prices. These hospitals are staffed by doctors trained at major medical centers in the UK, USA or other developed countries in Europe. Despite the fact that cost is an obvious factor which effect medical visitors searching medical tourism in other countries, the objective of this study is to identify the factors which influence medical visitors in picking hospitals in UK as medical tourism destination. This study will be helpful to the international hospitals in United Kingdom which they can hold a clear understanding on what medical travelers value and what they are looking for and most when they come to the Great Britain for health care services. Moreover, UK’s Tourism Authority will also obtain advantage through understanding preference of the clients in seeking medical treatment in United Kingdom. This will help other hospitals in their development to turn into a medical hub for tourists. Similar studies have been made to comprehend the emergence of the medical tourism industry. Josef Woodman, the creator of “Patients Beyond Borders: Everybody’s Guide to Affordable, World-class Medical Tourism”, evaluated that around 2900,000 individuals got medical treatment abroad in 2008. Forages, people have been flying outboard to seeking medical care that would fulfill their needs. Studies  have  shown  that  price  is  the  main  attraction  of  medical  tourism. Foreign patients would agree to avail medical treatment overseas if treatment’s price is much lesser than the price in their home land. While most would consider that medical travelers search for fast medical and inexpensive attention only, some facts in Company report regarding medical tourism and a May 2009 McKinsey indicated otherwise. The report specifies that 40% of medical travelers hunt for advanced technology, whereas 32% seek for better healthcare. Another  15%  seek  faster  medical  services  while  only  9%  of travelers  seek  lower  costs  as  their  primary  consideration. This is also the fact with this research. The findings of this paper emphasize the finding of the McKinsey and Company report. Price is not the main reason which influences voyagers to avail the medical services of the hospitals in other countries. Rather they favor the hospitals in UK on account of the certified doctors and specialist, quick service and excellent patient care, superb facilities and excellent medical treatments and high technology medical facilities.
This study was conducted to determine the influencing factors preferred by potential consumers from China in  choosing  hospitals  in  UK  for  health  care  services. A descriptive research has been performed to portray the relationship between factors involved and to clarify why some factors are esteemed more critical than the others. Chapter III talks about the research framework of the review. A total   of  70 respondents  finished  the  questionnaire. The last part in this study incorporates the conclusion from the analysis done in the previous chapter. It will answer the research questions expressed in the review and will attempt to respond to the objectives of the review. It will also examine some future research studies which can be directed to deeply investigate the factors which affect the preference of Chinese clients in selecting United Kingdom healing facilities as medical tourism destination.
Despite the fact that the most clear motivation behind why cost is the key predominant figure universal restorative visitors’ choice to travel abroad for medicinal treatment, the most compelling component drawing in patients or clients to come to UK ended up being the doctor’s facility item. Tourists would need master and ensured quick services, special patient care and authorities, eminent hardware and superb therapeutic medications, and high innovation restorative center. This research only demonstrates that second rate health care wouldn’t obtain a cut of the market’s medical tourism share. With emerging medical hubs such as Jordan ,Singapore, Malaysia and India and other European countries, competition is getting fiercer than before. UK should  focus on  improving  and  developing  the  quality  of  doctors  and  staff and   the   quality   of   health   care services, medical   procedures   offered and lower the price. Also, dissemination of information  is additionally vital in pulling in consumers abroad. Information about liabilities, for example, carelessness and malpractice ought to be stated clearly in legitimate contracts. Safety issues ought to also be addressed in every hospital’s site for the reason that clients will have an idea with regards to the measures the hospital is doing to provide for a safe, secure and hygienic environment for their patients. staffs that are fluent in Chinese should also be present in the premises otherwise interpreters should be present to prevent any miscommunications. This research study is concentrated on the influencing factors that affect preference of clients in choosing hospitals in United Kingdom as medical tourism destination. A qualitative approach of research study of satisfaction of international medical holidaymakers and customer loyalty of medical vacationers that received medical treatments in UK would permit deeper understanding for the reasons that medical sightseers return or revisit to UK for health care services, as a suggestion on future researches. Personal interviews would result on comprehensive and lengthy findings on the research objective.
Another recommendation is a study of customer perception on the overall service quality  of  the  various  hospitals  in  UK. This research could determine the hotels and airline suppliers that cater to medical visitors. Diverse package deals that hotels and airline suppliers regularly offer to medical tourists could also be investigated in this review. A future research study on customer perception of UK’s image picture as a medical tourism hub in Europe would allow an in depth knowledge  of UK’s competitive strengths and core competencies which could be utilized as an advantage for the nation to compete in the emerging worldwide medical tourism industry.
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A research on medical tourism of UK(一个关于英国医疗旅行的研究调查)

My objective of this questionnaire is to identify influencing factors that lead Shanghai medical tourists to choose UK as medical tourism destination.



1. Have you ever been to UK?(您有去过英国吗) [单选题] [必答题]

○ Yes(去过)
○ No(没去过)


2. Do you know anything about medical tourism?(您对医疗旅游有什么了解吗?) [单选题] [必答题]

○ Yes(知道点)
○ No(不知道)Medical tourism is an economic movement entailing trade in services and symbolizes the splicing of at least two parts: tourism and medicine (Bookman & Bookman, 2007).(医疗旅游是一种经济活动涉及服务贸易和象征着至少两部分组成:旅游、医疗)


3. Which country do you think is the most common destination for Medical Tourism?(您认为哪个国家是医疗旅游最常见的目的地?) [单选题] [必答题]

○ North America(北美)
○ Malaysia(马来西亚)
○ UK(英国)
○ India(印度)
○ Turkey(土耳其)
○ Brazil(巴西)
○ Others(其他) _________________ *


Asian countries are based on the concept of a collective society, so they prefer recommendations from personal contacts to the Internet. (Korea Tourism Organization,2009)
4. Where do you get information about medical tourism destination?(您是通过什么渠道了解到关于医疗旅行地的信息呢?) [单选题] [必答题]

○ Through recommendations by friends, relatives and neighbours(亲戚朋友以及邻居们推荐的)
○ Internet(网络)
○ Television(adverts)(电视广告)
○ Media(其他传媒上)


5. Would you consider travelling in UK for surgery if it is necessery?(如果有必要的话,您会考虑去英国进行医疗旅行吗?) [单选题] [必答题]

○ Yes(会的)
○ No(不会)


6. Normally , only major surgery (significant treatments) will make you consider going abroad to have medical tourism(通常情况下,只有当人们遇到比较严重的疾病需要进行大手术时才会考虑去国外进行医疗旅行的对吗?) [单选题] [必答题]

○ Strongly agree(强烈同意)
○ Agree(同意)
○ Ambivalent(中立)
○ Disagree(不同意)
○ Strongly disagree(强烈不同意)


7. Do you have any concern and worries about your medical trip in UK?(如果您选择去英国进行医疗旅行会有什么顾虑吗) [单选题] [必答题]

○ communication difficulties(语言交流有障碍)
○ The reliability of doctors(对医生可靠性的怀疑)
○ After care(后续治疗如何跟进)


Snyder, Crooks and Turner(2011)highlighted that cost is an important factor for medical tourists traveling for medical care outside their country.
8. Do you think the strongest motivation for you to choose a medical tourism destination is cost-saving?(您认为您选择医疗旅游目的地的最大动机是节约成本吗?) [单选题] [必答题]

○ Yes(是的)
○ No(不是的)


9. Rank the following factors, which influence you to select the UK as your medical tourism destination. (Assign “1” to the most likely and “7” to the least)(为以下影响您选择英国作为您的医疗旅行目的地的因素评分,按其重要性评分,由1至7,“1”为影响最大的因素 “7”为影响最小的因素) [排序题,请在中括号内依次填入数字] [必答题]

[    ]Reputation(英国在医疗方面拥有良好的声誉)
[    ]The environment of this country is Safety(英国整体的环境是比较安全的)
[    ]Experience of Doctors in this country(英国的医生拥有丰富的经验)
[    ]Cost(价格比较适中)
[    ]Quality of health care(医疗质量较高)
[    ]Infrastructure(基础设施较本国完善)
[    ]Charming beautiful natural scenery, historical and cultural heritage(英国拥有优美的风景以及丰富的历史文化底蕴,使得在医疗结束后的旅行体验很好)


10. After you select your medical tourism destination, through whom did you organize your medical accommodation and travel(您在选择医疗旅游目的地后,将通过谁来组织安排您的医疗住宿和旅行) [单选题] [必答题]

○ Through Medical tourism operator(通过从事医疗旅行的一些专门机构来组织)
○ Friends and Relatives(朋友以及亲戚)
○ Directly with provider(直接与医院或者酒店方接洽)


11. Gender(您的性别) [单选题] [必答题]

○ Male(男性)
○ Female(女性)


12. Age(您的年龄段) [单选题] [必答题]

○ 18-25
○ 26-35
○ 36-45
○ Others(其他) _________________ *


13. Occupation(您的职业) [单选题] [必答题]

○ Artist/performer(艺术家/演员)
○ Computer science(IT行业)
○ Education(教育行业)
○ Engineering(工程师)
○ Government(政府机关)
○ Legal profession(律师)
○ Military(军人)
○ Not employed(待业)
○ Student(学生)
○ Others(其他)______


income [单选题] [必答题]

○ 1500BRP
○ 2000BRP
○ 2500BRP
○ 3000BRP



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