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Ayuningtyas D, Oktarina R, Pebrina A, Sakka A, Rozali R, Barinda S, Pramesti A. Indonesian air medical evacuation: Analyzing readiness and proposing an integrated standard procedure. J Public Health Res 2024; 13:22799036241237947. [PMID: 38577244 PMCID: PMC10989052 DOI: 10.1177/22799036241237947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 02/21/2024] [Indexed: 04/06/2024] Open
Abstract
Indonesia still faces challenges in providing healthcare services, and it is crucial to develop an air medical evacuation services system for at least two reasons. Firstly, Indonesia is an archipelagic country and a popular tourist destination. Secondly, there are still significant disparities in the number and types of healthcare facilities and health workers nationwide. To respond to the current situation, the healthcare providers and government have made some efforts regarding air medical evacuation but are showing an unintegrated system. This qualitative study aimed to explore the current implementation of air medical evacuation in Indonesia and to propose an integrated standard procedure that all related stakeholders can adopt at the national and regional levels. The study used a multi-case design analysis, collecting both primary and secondary data. Secondary data was gathered through desk studies to learn related policies and previous studies. Primary data was collected through observation and in-depth interviews with relevant stakeholders, including regulators, service providers, practitioners, and non-governmental organizations. The study found that there is currently a regulatory gap for the implementation of air medical evacuation services in Indonesia. The readiness of the Health Human Resources (HHR) is limited in terms of qualification and competency, and the definitive infrastructure of air medical evacuation requires improvement since the providers continue to use the airport for civil transportation. Besides, the interaction pattern between stakeholders needs to be integrated into standardized procedures. Therefore, the study recommends proposing an integrated standard procedure and actionable recommendations to advocate for all stakeholders.
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Affiliation(s)
- Dumilah Ayuningtyas
- Health Policy and Administration Department, Faculty of Public Health, Universitas Indonesia, Depok, Republic of Indonesia
| | - Ratih Oktarina
- Health Policy and Administration Department, Faculty of Public Health, Universitas Indonesia, Depok, Republic of Indonesia
| | - Anita Pebrina
- Health Policy and Administration Department, Faculty of Public Health, Universitas Indonesia, Depok, Republic of Indonesia
| | - Ambo Sakka
- Faculty of Public Health, Universitas Halu Oleo Kendari, Sulawesi, Republic of Indonesia
| | - Roni Rozali
- Ministry of Health, Jakarta, Republic of Indonesia
| | - Sandra Barinda
- National Agency of Drug and Food Control, Jakarta, Republic of Indonesia
| | - Alya Pramesti
- Health Policy and Administration Department, Faculty of Public Health, Universitas Indonesia, Depok, Republic of Indonesia
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Asa GA, Fauk NK, McLean C, Ward PR. Medical tourism among Indonesians: a scoping review. BMC Health Serv Res 2024; 24:49. [PMID: 38200510 PMCID: PMC10782758 DOI: 10.1186/s12913-023-10528-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND International medical travel or medical tourism is not a new phenomenon in many countries, including among Indonesians. Indonesia is reported as a major source of patients from the lower, middle, to upper classes for its neighbouring countries. This scoping review aims to synthesise evidence on supporting factors for Indonesians taking medical tourism and what needs to be improved in Indonesia's health system. METHODS We conducted a scoping review guided by a framework provided by Arksey and O'Malley. We systematically searched existing literature from 5 databases, including MEDLINE, PubMed, Scopus, ProQuest, and Wiley. Data were extracted based on study details, study design, characteristics of participants and results. Analysis followed the three-stage procedure outlined by Thomas and Harden: (1) coding the text line by line, interpreting the data and identifying concepts or themes; (2) developing descriptive themes by grouping similar concepts in theme and subtheme and (3) generating analytical themes by reviewing preliminary themes and discussing the addition or revision of themes. RESULTS A total of 25 articles were included in this review. The review highlights a broad range of facilitators for medical tourism among Indonesians: (i) availability of health services, medical specialities, and person-centred care, (ii) region adjacency, transport, and health agency, (iii) affordability of medical treatment, (iv) religious and socio-cultural factors, and (v) reasons patients reported distrust in Indonesian doctors. CONCLUSION The findings indicate improvements in the Indonesian health system are necessary if the increasing rates of international medical tourism by Indonesian people are to change. Addressing the factors identified in this scoping review through avenues including policy may increase people's satisfaction and trust towards health care and treatment in Indonesia, thereby reducing the number of Indonesian people taking medical tourism.
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Affiliation(s)
- Gregorius Abanit Asa
- Research Centre for Public Health, Equity and Human Flourishing (PHEHF), Torrens University Australia, Adelaide, South Australia, Australia.
| | - Nelsensius Klau Fauk
- Research Centre for Public Health, Equity and Human Flourishing (PHEHF), Torrens University Australia, Adelaide, South Australia, Australia
- Institute of Resource Governance and Social Change, Kupang, Indonesia
| | - Caitlan McLean
- Research Centre for Public Health, Equity and Human Flourishing (PHEHF), Torrens University Australia, Adelaide, South Australia, Australia
| | - Paul Russell Ward
- Research Centre for Public Health, Equity and Human Flourishing (PHEHF), Torrens University Australia, Adelaide, South Australia, Australia
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Rahman MS, Bag S, Hassan H, Hossain MA, Singh RK. Destination brand equity and tourist's revisit intention towards health tourism: an empirical study. BENCHMARKING-AN INTERNATIONAL JOURNAL 2022. [DOI: 10.1108/bij-03-2021-0173] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThis paper aims to investigate the relationship between destination brand equity and tourist's revisit intention towards health tourism destinations. The study also examines the mediating effect of destination brand association between destination-based brand equity and travellers' revisit intention for health tourism destinations.Design/methodology/approachA survey instrument is used to examine the relationships in the proposed model using the co-variance-based structural equation modelling (SEM) technique. The collected primary data from two hundred forty-six respondents (n = 246) are analysed to test the relationship amongst exogenous, mediating, moderating and endogenous constructs articulated in the proposed structural model.FindingsEmpirical findings reveal that destination brand equity influences the revisit intention of a traveller for health tourism via destination brand association. The perceived trust, reliability and soft issues of a traveller moderate the relationship between destination brand equity and destination brand association. Enduring travel involvement also proves a significant moderation effect on the relationship between destination brand association and the revisit intention of a traveller for a health tourism destination.Practical implicationsThis paper is an initial attempt to develop and empirically examine a conceptual model of the intention of a traveller to revisit a health tourism destination in a dynamic process of information search using the data collected from current travellers after medical tourism-related trips. Results suggest that stakeholders must focus on hedonic and utilitarian factors of the destination that are recognised by travellers to encourage revisit for medical tourism.Originality/valueAlthough there have been numerous studies on health tourism. However, to the best of the authors' knowledge, this research is a pioneer in the healthcare tourism literature that links destination brand equity, brand association and revisit intention of a traveller for health tourism. These findings extend the knowledge of how healthcare tourism that is embedded with destination brand equity and destination brand association. The study findings potentially benefit the marketers for gaining competitive advantages through considering the experience of a traveller.
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Österle A, Diesenreiter C, Glinsner B, Reichel E. Inbound and outbound medical travel in Austria. J Health Organ Manag 2021; ahead-of-print. [PMID: 33314874 PMCID: PMC9251641 DOI: 10.1108/jhom-04-2020-0129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The purpose of this paper is twofold: First, it analyzes demand and supply-side factors that influence patient flows to and from Austria. Second, building on the empirical research and existing conceptualizations, the study offers a general extended framework to guide future comparative analysis. Design/methodology/approach The paper draws on multiple data sources including a literature review, secondary data, website analysis and semi-structured interviews with patients and health providers. Content analysis was carried out to identify common motives for seeking care abroad and providers' orientation towards medical travel. Findings Outbound medical travel is largely determined by factors of access, affordability and vicinity, while inbound medical travel is predominately driven by a lack of adequate medical infrastructure in source countries and quality, both in terms of medical and service quality. Providers distinguish themselves according to the extent they take part in medical travel. Research limitations/implications The findings emerging from a single country case study approach cannot be generalized across settings and contexts, albeit contributing to a better understanding of current medical travel patterns in Europe. Originality/value Unlike most recent contributions, this study focuses both on inbound and outbound medical travel in Austria and investigates patient flows for distinctive treatments and drivers. While analysis of the supply-side of medical travel is often limited to tourism studies, this study provides a critical insight into developments in Europe from a health policy perspective, acknowledging that diverse medical travel patterns in Europe coexist.
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Affiliation(s)
- August Österle
- Department of Socioeconomics, Vienna University of Economics and Business, Vienna, Austria
| | - Carina Diesenreiter
- Department of Socioeconomics, Vienna University of Economics and Business, Vienna, Austria
| | | | - Eva Reichel
- Medical University of Vienna, Vienna, Austria
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Hoffman L, Crooks VA, Snyder J. A challenging entanglement: health care providers' perspectives on caring for ill and injured tourists on Cozumel Island, Mexico. Int J Qual Stud Health Well-being 2018; 13:1479583. [PMID: 29869593 PMCID: PMC5990945 DOI: 10.1080/17482631.2018.1479583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Purpose: Despite established knowledge that tourists often fall ill or are injured abroad, little is known about their treatment. The intent of this study was to explore health care professionals’ treatment provision experiences on Cozumel Island, Mexico. Methods: 13 semi-structured interviews were undertaken with professionals across a number of health care vocations on Cozumel Island. Interviews were transcribed and thematically analysed to determine common challenges faced in the provision of treatment for transnational tourists. Results: Three thematic challenges emerged from the data: human and physical resource deficiencies, medical (mis)perceptions held by patients and complexities surrounding remuneration of care. Health care providers employ unique strategies to mitigate these challenges. Conclusion: Although many of these challenges exist within other touristic and peripheral spaces, we suggest that the challenges experienced by Cozumel Island’s health care professionals, and their mitigation strategies, exist as part of a complex entanglement between the island’s health care sector and its dominant tourism landscape. We call on tangential tourism services to take a larger role in ensuring the ease of access to, and provision of quality health care services for tourists on Cozumel Island.
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Affiliation(s)
- Leon Hoffman
- a Department of Geography , Simon Fraser University , Burnaby , Canada
| | - Valorie A Crooks
- a Department of Geography , Simon Fraser University , Burnaby , Canada
| | - Jeremy Snyder
- b Faculty of Health Sciences , Simon Fraser University , Burnaby , Canada
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Durham J, Blondell SJ. A realist synthesis of cross-border patient movement from low and middle income countries to similar or higher income countries. Global Health 2017; 13:68. [PMID: 28851382 PMCID: PMC5575883 DOI: 10.1186/s12992-017-0287-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 08/10/2017] [Indexed: 11/10/2022] Open
Abstract
Patient travel across borders to access healthcare is becoming increasingly common and widespread. Patients moving from high income to middle income countries for healthcare is well documented, with patients seeking treatments that are cheaper or more readily available than at home. Less well understood is when patients move from one low income country to another or from a low income country to a higher income country. In this paper, a realist review was undertaken to explore why, in what contexts and how patients from lower income countries travel to countries with the same, or more advanced, economies for planned healthcare. Based on an initial scoping of the literature and discussions with key informants, we generated an initial theory and set of propositions about why, how, who and in what contexts people cross international borders for planned healthcare. We then systematically located and synthesized (1) peer-reviewed studies from the Scopus, Embase, Web of Science and Econlit databases; (2) non-indexed reports using key informants and Google; and (3) papers from the reference lists of included documents, to glean supportive or contradictory evidence for our initial propositions. As we reviewed the literature and extracted our data, we drew on the work of Pierre Bourdieu to understand the interplay between material and non-material capital and cognitive processes in decisions to cross borders for healthcare. Patient travel was largely undertaken due to a lack of services in the home country and/or unacceptability of local services, with decisions on when, and where, to travel, usually made within the patient's social networks. They were able to travel via use of multiple resources, including social networks, economic and cultural capital, and habitus. Those patients with greater volumes of the aforementioned factors had greater healthcare options; however, even those with limited resources engaged in patient travel. Patient movement challenges traditional ways of thinking about public health and the notion of health systems contained within the nation state. Further research is needed to better understand the effects of patient travel, and how to harness the benefits of patient travel without exacerbating existing health inequalities.
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Affiliation(s)
- Jo Durham
- The University of Queensland, School of Public Health, Herston, Qld, 4006, Australia.
| | - Sarah J Blondell
- The University of Queensland, School of Public Health, Herston, Qld, 4006, Australia
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Adams K, Snyder J, Crooks VA, Johnston R. Developing an informational tool for ethical engagement in medical tourism. Philos Ethics Humanit Med 2017; 12:4. [PMID: 28841897 PMCID: PMC5574152 DOI: 10.1186/s13010-017-0045-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 08/15/2017] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Medical tourism, the practice of persons intentionally travelling across international boundaries to access medical care, has drawn increasing attention from researchers, particularly in relation to potential ethical concerns of this practice. Researchers have expressed concern for potential negative impacts to individual safety, public health within both countries of origin for medical tourists and destination countries, and global health equity. However, these ethical concerns are not discussed within the sources of information commonly provided to medical tourists, and as such, medical tourists may not be aware of these concerns when engaging in medical tourism. This paper describes the methodology utilized to develop an information sheet intended to be disseminated to Canadian medical tourists to encourage contemplation and further public discussion of the ethical concerns in medical tourism. METHODS The methodology for developing the information sheet drew on an iterative process to consider stakeholder feedback on the content and use of the information sheet as it might inform prospective medical tourists' decision making. This methodology includes a literature review as well as formative research with Canadian public health professionals and former medical tourists. RESULTS The final information sheet underwent numerous revisions throughout the formative research process according to feedback from medical tourism stakeholders. These revisions focused primarily on making the information sheet concise with points that encourage individuals considering travelling for medical tourism to do further research regarding their safety both within the destination country, while travelling, and once returning to Canada, and the potential impacts of their trip on third parties. This methodology may be replicated for the development of information sheets intending to communicate ethical concerns of other practices to providers or consumers of a certain service.
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Affiliation(s)
- Krystyna Adams
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, 8888 University Drive, Burnaby, BC Canada
| | - Jeremy Snyder
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, 8888 University Drive, Burnaby, BC Canada
| | - Valorie A. Crooks
- Department of Geography, Simon Fraser University, Robert C. Brown Building, 8888 University Drive, Burnaby, BC Canada
| | - Rory Johnston
- Department of Geography, Simon Fraser University, Robert C. Brown Building, 8888 University Drive, Burnaby, BC Canada
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Medical tourism: A snapshot of evidence on treatment abroad. Maturitas 2016; 88:37-44. [DOI: 10.1016/j.maturitas.2016.03.001] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 02/25/2016] [Accepted: 03/03/2016] [Indexed: 11/24/2022]
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Whittaker A. ‘Outsourced’ patients and their companions: Stories from forced medical travellers. Glob Public Health 2015; 10:485-500. [DOI: 10.1080/17441692.2014.998696] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Bell D, Holliday R, Ormond M, Mainil T. Transnational healthcare, cross-border perspectives. Soc Sci Med 2014; 124:284-9. [PMID: 25467880 DOI: 10.1016/j.socscimed.2014.11.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | | | | | - Tomas Mainil
- NHTV Breda University of Applied Sciences, The Netherlands
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