Measuring the effeciency of medical tourism industry in EU members states

ANDROUTSOU, LORENA and METAXAS, THEODORE (2018): Measuring the effeciency of medical tourism industry in EU members states.

Abstract

Under the Directive 2011/24/EU, medical tourism and cross-border health are interrelated terms regarding the freedom to move to get the most accessible medical treatment into EU Member State within the defined procedures for reimbursement. Little known empirically regarding the efficiency of the cross-border health/medical tourism industry. This study aims to measure its efficiency in Europe for the years 2010-2014, by using Data Envelopment Analysis (DEA). Data obtained from OECD and the European Core Health Indicators (ECHI), which is collecting the data through Eurostat. Eurostat collects data on health care activities and provides data on hospital discharges, including the hospital discharges of non-residents and these include hospital discharges of in-patients and day care patients. The analysis uses “DEA.P, 2.1 for windows” by Coelli (1996). The results show that the Members States health systems were very efficient in handling non-residents in-patients, however when managing day cases/outpatients the efficiency scores dropped. The findings would have significant associations affecting intentions to revisit clinics and the destination country. In addition, will be useful to those seeking a better understanding of the cross-border health and medical tourism industry efficiency. Extending the findings of the European Commission report (2015c) by examining how well medical tourists are informed about the decision they are making, would be of perceived value. These are important indicators at European level by helping each Member State to measure its medical tourism services.

• Item Type: MPRA Paper
• Language: English
• Keywords: cross-border health, medical tourism, efficiency, DEA
• Subjects: I - Health, Education, and Welfare > I1 - Health > I11 - Analysis of Health Care Markets; Z - Other Special Topics > Z1 - Cultural Economics ; Economic Sociology ; Economic Anthropology > Z10 - General

References

Ancarani A., Mauro C.D., Giammanco M.D., 2009, The impact of managerial and organizational aspects on hospital wards’ efficiency: evidence from a case study, European Journal of Operational Research, 194,280-93. https://doi.org/10.1016/j.ejor.2007.11.046

Androutsou L., Geitona M., Yfantopoulos J., 2011, Measuring efficiency and productivity across hospitals in the regional health authority of Thessaly in Greece, Journal of Health Management 13,2,121-40. https://doi.org/10.1177/097206341101300201

Assaf A.G., Agbola F.W., 2011, Modelling the performance of Australian hotels: A DEA double bootstrap approach, Tourism Economics, 17,1,73–89. https://doi.org/10.5367/te.2011.0027

Beladi H., Chao C.C., Ee M.S., Hollas D., 2015, Medical tourism and health worker migration in developing countries, Economic Modelling, 46,391–396. https://doi.org/10.1016/j.econmod.2014.12.045

Banker R.D., Charnes A., Cooper W.W., 1984, Some models for estimation of technical and scale efficiencies in data envelopment analysis, Management Science, 30(10):1078-92. https://doi.org/10.1287/mnsc.30.9.1078

Barros C.A.P., 2006, The measurement of efficiency in Portuguese hotels using data envelopment analysis. Journal of Hospitality and Tourism Research, 30,3,378–400. https://doi.org/10.1177/1096348006286798

C364/1, 2000, Official Journal of the European Communities: Chapter of fundamental rights of the European Union, last accessed on 10 May 2018. http://www.europarl.europa.eu/charter/pdf/text_en.pdf

Caves D.W., Christensen L.R., Diewert W.E., 1982, The economic theory of index numbers and measurement of input, output and productivity, Econometrica, 50(6):1393-414. http://www.jstor.org/stable/1913388?seq=1#page_scan_tab_contents

Carrera P.M., Bridges J.F., 2006, Globalization and healthcare: understanding health and medical tourism, Expert Review of Pharmacoeconomics and Outcomes Research, 6,4,447–454. https://doi.org/10.1586/14737167.6.4.447

Charnes A., Cooper W.W., Rhodes E., 1978, Measuring efficiency of decision-making units, European Journal of Operational Research, 2,6,429-44. https://doi.org/10.1016/0377-2217(78)90138-8

Coelli T., 1996, A guide to DEAP version 2.1: a data envelopment analysis (computer) program. Centre for efficiency and productivity analysis. University of New England. CEPA Working; Papers No.08/96. ISSN 1327-435X. ISBN 1 86389 4969; 96/08. http://www.owlnet.rice.edu/~econ380/DEAP.PDF

Coelli T., Perelman S., 1996, Comparison of parametric and nonparametric distance functions: with application to European railways, CREPP Discussion paper. Liege: University of Liege, 96-1011. http://hdl.handle.net/2268/35665

Coelli T., Rao D.S.P., O” Donell, Battase G.E., 2005, An introduction to efficiency and productivity analysis, Springer. http://facweb.knowlton.ohio-state.edu/pviton/courses/crp394/coelli_Intro_effic.pdf

Cook W., Seiford L., 2009, Data envelopment analysis (DEA) - thirty years on, European Journal of Operational Research ,192,1,1-17. https://doi.org/10.1016/j.ejor.2008.01.032

Debata B.R., Patnaik B., Mahapatra S.S., Sreekumar S., 2013, Efficiency measurement amongst medical tourism service providers in India, International Journal for Responsible Tourism, 2,1. http://repec.turismulresponsabil.ro/RePEc/amfarchive/2013-1/2013-1-1-24-31.pdf

Eurobarometer 414, 2015, Preferences of Europeans towards tourism, Conducted by TNS Political & Social at the request of the European Commission, Directorate-General for Internal Market, Industry, Entrepreneurship and SMEs, European Union, 2015, last accessed on 10 May 2018. http://ec.europa.eu/commfrontoffice/publicopinion/flash/fl_414_en.pdf

Eurobarometer 425, 2015, Patients’ rights in cross-border healthcare in the European Union, Conducted by TNS Opinion & Social at the request of the European Commission, Directorate-General for Health and Consumers (SANCO), European Union, 2015, last accessed on 10 May 2018. http://ec.europa.eu/commfrontoffice/publicopinion/archives/ebs/ebs_425_sum_en.pdf

European Commission, 2011, Directive 2011/24/EU of the European Parliament and of the Council, on the application of patients’ rights in cross-border healthcare, Official Journal of the European Union, 9 March 2011, last accessed on 10 May 2018. http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2011:088:0045:0065:EN:PDF

European Commission, 2014, Impact of information on patients’ choice within the context of the Directive 2011/24/EU of the European Parliament and of the Council on the application of patients’ rights in cross-border healthcare, Final Report, August 2014. PMID: 26068214 European Commission, 2015a, European patients’ rights day: 10 benefits the EU brings to patients, last accessed on 10 May 2018.https://ec.europa.eu/health/sites/health/files/patient_safety/docs/2015_eu_patients_factsheet_en.pdf

European Commission, 2015b, Cross-border Healthcare report highlights advances and efforts at EU and national levels, Health and Food Safety, 03 September 2015, last accessed on 10 May 2018. http://ec.europa.eu/dgs/health_food-safety/dyna/enews/enews.cfm?al_id=1616

European Commission, 2015c. Operation of Directive 2011/24/EU on the application of patients’ rights in cross-border healthcare, Report from the Commission to the European Parliament and the Council, COM(2015) 421 final, 04 September 2015, last accessed on 10 May 2018. https://ec.europa.eu/health/sites/health/files/cross_border_care/docs/2015_operation_report_dir201124eu_en.pdf

European Commission, 2016, Study on better cross-border cooperation for high-cost capital investments in health, Directorate-General for Health and Food Safety Directorate B — Health systems, medical products and innovation Unit B.3 — Cross-border Healthcare, eHealth, November 2016, last accessed on 10 May 2018. https://ec.europa.eu/health/sites/health/files/cross_border_care/docs/hci_frep_en.pdf

European Commission, 2017, DG Health and Food Safety, Public Health, Cross-border healthcare, Policy, last accessed on 10 May 2018. http://ec.europa.eu/health/cross_border_care/policy_en

European Commission, 2017b, The EU tourism Industry, Internal Market, Industry Entrepreneurship and SMEs, last accessed on 10 May 2018. https://ec.europa.eu/growth/sites/growth/files/infographic_tourism.jpg

European Core Health Indicators (ECHI), 2017, ECHI data tool, last accessed on 10 May 2018. http://ec.europa.eu/health/dyna/echi/datatool/index.cfm

Färe R., Grosskopf S., Valdmanis V., 1989, Capacity competition and efficiency in hospitals: a nonparametric approach, Journal of Productivity Analysis, 1,123-38. https://doi.org/10.1007/BF00157792

Färe R., Grosskopf S., Lovell C.A.K., 1994, Production frontiers, Cambridge: Cambridge University Press. http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.197.873&rep=rep1&type=pdf

Farrell M.J., 1957, The measurement of productive efficiency, Journal Royal Statistics Society, 120,3,153-281.

Fetscherina M., Stephano R.M., 2016, The Medical Tourism Index: Scale Development and Validation, Tourism Management 52,539-556. https://doi.org/10.1016/j.tourman.2015.08.010

Gan L., Gan F., James R., 2011, Medical tourism facilitators: Patterns of service differentiation, Journal of Vacation Marketing, 17,3. https://doi.org/10.1177/1356766711409181

Gan L., Gan F., James R., 2012, Survey of Consumers’ Perceptions Toward Medical Tourism (Study), March 6. SSRN: http://dx.doi.org/10.2139/ssrn.2194850

Geitona M., Androutsou L., Yfantopoulos J., 2013, Efficiency Assessment across Homogeneous Specialty Clinics in the Region of Thessaly, Greece, The Open Public Health Journal, 6,11-20. DOI: 10.2174/1874944501306010011

Glinos I.A., Baeten R., Maarse H., 2010, Purchasing health services abroad: practices of cross-border contracting and patient mobility in six European countries, Health Policy, 95,2-3,103-12. DOI:10.1016/j.healthpol.2009.11.016

Hall C.M., 2011, Health and medical tourism: a kill or cure for global public health? Tourism Review 66,1/2,4–15. https://doi.org/10.1108/16605371111127198

Halenur Soysal-Kurt, 2017, Measuring Tourism Efficiency of European Countries by Using Data Envelopment Analysis, European Scientific Journal, 13,10. https://eujournal.org/index.php/esj/article/view/9141

Halkos G., Tzeremes N., 2010, A conditional non-parametric analysis for measuring the efficiency of regional public healthcare delivery, Health Policy 1010,6,10021. DOI: http://dx.doi.org/10.1016/j.healthpol.2010.10.021

Han H., Hyun S.S., 2015, Customer retention in the medical tourism industry: Impact of quality, satisfaction, trust, and price reasonableness, Tourism Management, 46,20–29. https://doi.org/10.1016/j.tourman.2014.06.003

Hanefeld J., Horsfall D., Lunt N., Smith R., 2013, Medical Tourism: A Cost or Benefit to the NHS? PLoS ONE 8,(10). https://doi.org/10.1371/journal.pone.0070406

Hollingsworth B., Dawson P., Maniadakis N., 1999, Efficiency measurement of health care: a review of non-parametric methods and applications, Health Care, Management Science 2,3,161-72. https://doi.org/10.1023/A:101908782

Hopkins L., Labonté. R., Runnels V., Packer C., 2010, Medical tourism today: What is the state of existing knowledge? Journal of Public Health Policy, 31(2):185–198. https://doi.org/10.1057/jphp.2010.10

Horowitz M.D., Rosensweig J.A., Jones C.A., 2007, Medical Tourism: Globalization of the Healthcare Marketplace, MedGenMed, 9,33. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2234298/

Jacobs J.P., Horowitz M.D., Mavroudis C., Siegel A., Robert M., 2013, Sade, Surgical Tourism: the Role of Cardiothoracic Surgery Societies in Evaluating International Surgery Centers, The Annals Thoracic Surgery, July 96,1,10.1016. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3885903/

Jenner E.A., 2008, Unsettled borders of care: medical tourism as a new dimension in America’s health care crisis, Care for Major Health Problems and Population Health Concerns, Impacts on Patients, Providers and Policy, Research in the Sociology of Health Care, 235-249. http://www.emeraldinsight.com/doi/pdfplus/10.1016/S0275-4959%2808%2926011-4

Jin-Li Hu, Fang-Yu Yeh, Tsai Yun-Chih, 2014. Regional Traffic and Medical Services and Cost Efficiency of International Tourist Hotels in Taiwan, International Business Research, 7,10. http://dx.doi.org/10.5539/ibr.v7n10p36

Johnson T.J., Garman A.N. 2010, Impact of medical travel on imports and exports of medical services, Health Policy, Dec 98,2-3,171-7. doi: 10.1016/j.healthpol.2010.06.006.

Keckley P.H., Underwood, 2008, Medical Tourism: Consumers in Search of Value is Deloitte’s report. http://www.globalwellnesssummit.com/wp-content/uploads/Industry-Research/Americas/2008-deloitte-medical-tourism-consumers.pdf

Khushalani J., Ozcan Y.A., 2017, Are hospitals producing quality care efficiently? An analysis using Dynamic Network Data Envelopment Analysis (DEA), Socio-Economic Planning Sciences, Dec 60,15-23. https://doi.org/10.1016/j.seps.2017.01.009

Ko T.G., 2011. Medical tourism system model, International Journal of Tourism Sciences, 11,1,18–51. https://doi.org/10.1080/15980634.2011.11434634

Legido-Quigley H., Glinos I., Baeten R., McKee M., 2007. Patient mobility in the European Union. BMJ, 334,7586,188–90. http://researchonline.lshtm.ac.uk/10426/1/188.full%20%281%29.pdf

Leleu H., Moises J., Valdmanis V.G., 2014, How do payer mix and technical inefficiency affect hospital profit? A weighted DEA approach, Operations Research for Health Care, 3,4,231–237. https://doi.org/10.1016/j.orhc.2014.06.002

Linna M., Häkkinen U., Magnussen J., 2006. Comparing hospital cost efficiency between Norway and Finland, Health Policy, 77,3,268–278. http://dx.doi.org/10.1016/j.healthpol.2005.07.019

Lovell C.A.K., 1996, Applying efficiency measurement techniques to the measurement of productivity, Journal of Productive Analysis, 7,2-3,329-40. https://doi.org/10.1007/BF00157047

Lunt N., Carrera P., 2010, Medical tourism: Assessing the evidence on treatment abroad. Maturitas, May. https://doi.org/10.1016/j.maturitas.2010.01.017

Lunt N., Smith R., Exworthy M., Green S.T., Horsfall D., Mannion R., 2012, Medical Tourism: Treatments, Markets and Health System Implications: A scoping review, OECD, Directorate for Employment, Labour and Social Affairs, https://www.oecd.org/els/health-systems/48723982.pdf

Maniadakis N., Kotsopoulos N., Prezerakos P., Yfantopoulos J., 2007, Measuring intra-hospital clinic efficiency and productivity: application to a Greek university general hospital, European Research Study; vol. XI, 1-2,95-110. http://www.ersj.eu/repec/ers/papers/08_12_p8.pdf

Medina E., Häkkinenb U., Linna M., Anthunc K.S., Kittelsend S.A.C., Rehnberg C., 2013, International hospital productivity comparison: Experiences from the Nordic countries, Health Policy, 112,80–87. http://dx.doi.org/10.1016/j.healthpol.2013.02.004

Meng-Chun Kao, Che-Yang Lin, Lai Mei-Chi, 2011, Exploring the efficiency of international tourism development in an emerging market, African Journal of Business Management 5,17, 7526-7532. https://doi.org/10.5897/AJBM11.581

Moran V., Jacobs R., 2013, An international comparison of efficiency of inpatient mental health care system, Health Policy, 112,88- 99. http://dx.doi.org/10.1016/j.healthpol.2013.06.011

Patterson I., 2006, Growing older: tourism and leisure behaviour of older adults. Wallingford: CABI.

Pulina M., Detotto C., Paba A., 2010, An investigation into the relationship between size and efficiency of the Italian hospitality sector: A window DEA approach, European Journal of Operational Research, 204,3,613–620. https://doi.org/10.1016/j.ejor.2009.11.006

Runnels V., Carrera P.M., 2012, Why do patients engage in medical tourism? Maturitas, 73,4,300–304. https://doi.org/10.1016/j.maturitas.2012.08.011

Sarantopoulos I., Katsoni V., Geitona M., 2014, A supply side investigation of medical tourism and ICT use in Greece, Social and Behavioral Science,s 148,370 – 377. https://doi.org/10.1016/j.sbspro.2014.07.055

Steinmann L., Zweifel P., 2003, On the (in)efficiency of Swiss hospitals, Applied Economics, 35,3,361–370. https://doi.org/10.1080/00036840210167183

Staat M., 2006, Efficiency of hospitals on Germany: A DEA-bootstrap approach, Applied Economics 5,216-26. https://hal.archives-ouvertes.fr/hal-00581903/document

Samut P., Cafrı R., 2016, Analysis of the Efficiency Determinants of Health Systems in OECD Countries by DEA and Panel Tobit, Social Indicators Research, 129,1,113–132. https://doi.org/10.1007/s11205-015-1094-3

The Global Wellness Tourism Economy, 2013, Report, last accessed on 10 May 2018. http://www.globalwellnesssummit.com/images/stories/pdf/wellness_tourism_economy_exec_sum_final_10022013.pdf

Tingting Y., Liang M., 2015, Evolutional model of tourism efficiency based on the DEA method: A case study of cities in Guangdong province, China, Asian Pacific, Journal of Tourism Research, 20,789-806. https://doi.org/10.1080/10941665.2014.932294

Turner L., 2012, Beyond "medical tourism": Canadian companies marketing medical travel, Globalization and Health, 8,16. https://doi.org/10.1186/1744-8603-8-16

Varabyova Y., Schreyögg J., 2013, International comparisons of the technical efficiency of the hospital sector: Panel data analysis of OECD countries using parametric and non-parametric approaches, Health Policy, 112,1-2,70–79. http://dx.doi.org/10.1016/j.healthpol.2013.03.003

Wang H., 2012, Value as a medical tourism driver. Managing Service Quality: An International Journal 22,5,465–491. https://doi.org/10.1108/09604521211281387

WHO, 2014, Footman K., Knai C., Baeten R., Glonti K., McKee M., Cross-border health care in Europe, Policy Summary 14, last accessed on 10 May 2018. http://www.euro.who.int/__data/assets/pdf_file/0009/26358/Cross-border-health-care-in-Europe-Eng.pdf

Wöber, K.W., 2008, Data Envelopment Analysis (DEA) to the field of travel and tourism, Journal of Travel and Tourism Marketing, 21,4,91-108. https://doi.org/10.1300/J073v21n04_07

Woo E., Schwartz Z., 2014, Towards Assessing the Knowledge Gap in Medical Tourism, Journal of Quality Assurance in Hospitality and Tourism, 15,2,213–226. https://doi.org/10.1080/1528008X.2014.889516