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Korean J Intern Med > Volume 33(1); 2018 > Article
Choi, Kim, and Lee: Word-of-mouth in medical tourism: the major determinant for Emirati patients to visit Korea
To the Editor,
In Korea, increasing numbers of foreign patients of different nationalities are seeking treatment. While it has been known that Japanese or Chinese tourists visit Korea, seeking surgery for aesthetic purposes, South Korea’s general hospitals are witnessing an unconventional phenomenon. According to a survey performed in 2013 by the Korea Tourism Organization trying to clarify the cultural-related reasons for the choice of Korea as a travel destination, 59.5% of Chinese tourists visited Korea for vacation-related leisure and recreation, and a similar percentage of Emiratis visited for business purposes [1]. Despite the common notion that Asians visit Korea for cosmetic surgery, only 0.9% of Chinese visitors claimed to have visited for health-related issues, whereas the figure was 2.1% for United Arab Emirates (UAE) nationals, which was the second largest number among all foreign visitors. In other words, more Emiratis considered themselves to be medical tourists, while Asian tourists in general anticipated niche tourism, the actual trend in medical tourism [2]. According to the Samsung Medical Center (SMC) database, the total number of Emirati in- and outpatients was 99 in the first half of 2013, which increased to 320 in the second half of 2013. In the first half of 2014, the number surged to 764. Because we have thought that Korea is merely a newly-rising medical destination country in Far East Asia, the recent upsurge in the number of Emirati patients became the motivation for the current study to analyze the determinants of the medical tourism decision by Emirati patients from the perspective of patients themselves and Korean health professionals.
This study was performed at the International Health Services of SMC, one of the largest hospitals in Seoul, Korea, from December, 2014 to February, 2015. It included two types of questionnaire surveys designated for two different groups in SMC; one for inpatients of Emirati nationality, and the other for Korean health professionals. Thirty-three patients completed the survey in their own wards during the study period. During the study period, nine patients were admitted to the Department of Surgery, eight to Internal Medicine, six to Neurosurgery, four to Orthopedic Surgery, four to Neurology, and two to Pediatrics. The other survey was distributed and collected back from 29 health professionals (15 physicians and 14 caregivers) working in the International Health Services. The patient group was given a questionnaire asking to choose one answer among multiple choices. The latter group was given the same survey and asked to rate the choices in order of preference.
The patient survey comprised three sections. The first section of the questionnaire required patients to answer whether they voluntarily had decided to travel overseas for medical treatment. This was to find a correlation with the following question which asked them to rate the satisfaction level with their attending physician. The second section queried the main reason for medical tourism, the main determinant in choosing the institute as the medical tourism destination, and the source of information after the decision had been made. Patients were given the following drivers for medical tourism: government support and medical agency, word-of-mouth, internet, advanced medical care and technology, tourism, comparatively low medical bills, and good facilities. They could choose one choice per question, but the answers could be chosen multiple times for different questions. Lastly, the survey asked the patients to rate how likely they would be to recommend SMC to friends, family, and colleagues, with the aim of determining the importance of word-of-mouth in generating new medical tourism clients. A seven-point Likert scale was used.
For health professionals, we conducted a single-blinded survey to get accurate responses, by including questions with the same format discussing not only UAE, but also American and Russian patients. The respondents were not aware of the nature of the research or the actual subject group. These ‘placebo’ questions on patients from the United States—or mostly expatriates—and Russia helped the caregivers better characterize the Emirati group through comparison. Among the aforementioned seven choices, every respondent was told to predict and mark the two following factors: the primary determinant of the particular nationality group in deciding to come to SMC and the main channel or source of information after deciding to engage in medical tourism, from the standpoint of a health professional in a general hospital’s international clinic. Only the questionnaire on Emirati patients was used in the study to verify the perspective gap between patients and health professionals. Mann-Whitney U test was used for statistical analysis.
When 33 patients were asked to choose the reason to decide to travel abroad for medical purposes, 19 patients (57.6%) picked the pursuit of advanced medical care and technology. Support from government and medical agencies was chosen by nine (27.3%), while three (9.1%) picked word-of-mouth and two (6.1%) chose tourism.
The primary determinant for selecting the specific hospital (SMC) and the country as a medical destination was word-of-mouth for 20 patients (60.6%), advanced medical care and technology for eight patients (24.2%), and support from government and medical agencies for five (15.2%) (Fig. 1A).
The main source of information following the decision to travel to SMC, among three choices (government and medical agencies, word-of-mouth, and the internet), was government and medical agencies for 25 patients (75.8%). Four patients (12.1%) each chose word-of-mouth and the internet.
Twenty-three patients (69.7%) who voluntarily selected SMC were more satisfied with their care (6.8 ± 0.4) than the patients whose decision was not voluntary (5.8 ± 1.0, p = 0.006). Patients whose decision was influenced by word-of-mouth were more likely (6.8 ± 0.4) to recommend the institute to others, compared with those who were not as influenced by word-of-mouth (5.3 ± 1.2, p < 0.001).
When health professionals were asked to predict the primary determinant for Emirati patients in deciding to visit Korea, 16 (55.2%) out of 29 considered government support and/or medical agency. Eleven (37.9%) responded that advanced medical care and/or technology was the primary reason. One (3.4%) picked word-of-mouth and the last person (3.4%) chose tourism (Fig. 1B).
Thirteen (44.8%) out of 29 health professionals surmised that government support and/or medical agency was the main channel of information for UAE patients after the medical tourism decision had been made. Ten (34.5%) chose word-of-mouth, while the remaining six (20.7%) picked the internet.
Word-of-mouth plays an important role in motivating patients to travel abroad for medical purposes. But South Korea, one of the growing medical destination countries in Asia, lacks relevant studies, except those conducted on tourists from adjacent countries pursuing “niche tourism,” for aesthetic needs [2]. Before we conducted the study, patients from the UAE were considered as patients who seek lower cost health care or tourism [3]. UAE, along with other Middle East countries, has not drawn much interest of Korea regarding medical tourism. This is due to Dubai having initiated quality healthcare by building Healthcare City, and establishing a strong joint-venture network with Thailand, a traditionally popular destination for medical tourism [2,4]. The average health-related expenditure of Emirati nationals is high, albeit involving government support. Money is not an impediment to seeking health care, and allows selection of care that is more luxurious and advanced [5].
In conclusion, there was a perspective gap on medical tourism between Emirati patients and Korean health professionals. Word-of-mouth was demonstrated to be the major determinant for Emirati patients to visit Korea, although it is a newly-rising medical destination country in Far East Asia. As the increasing trend will not cease in the near future, this indicates the direction of future strategy planning of Korean general hospitals. We can suggest that not only is word-of-mouth important in medical tourism, but also there may exist a virtuous cycle of word-of-mouth, in which recommendation leads to subsequent cycles of recommendation.

Conflict of interest

No potential conflict of interest relevant to this article was reported.

Figure 1.
The determinants for selecting the institute as the medical tourism destination; from (A) the perspective of the United Arab Emirates patients themselves, and (B) the predictive perspective of the Korean health professionals.


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2. Connell J. Medical tourism: sea, sun, sand and… surgery. Tour Manag 2006;27:1093–1100.
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5. Margolis SA, Al-Marzouq S, Revel T, Reed RL. Patient satisfaction with primary health care services in the United Arab Emirates. Int J Qual Health Care 2003;15:241–249.
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