The Impact Of Medical Tourism On Healthcare Management In Dubai

Background Study

Question:

Discuss about the Management Issues of Medical Tourism in Dubai.

The research paper aims to find out the issue of medical tourism in Dubai and its impact on the healthcare management of the country. The healthcare management facilities of Dubai are considered as one of the best in the world (Othman et al. 2015). The healthcare sector of the country is continuously expanding and it is incorporating many foreign investments and partnerships to provide international standard services to the citizens as well as foreign patients who come to Dubai to avail the best quality healthcare services. There are many healthcare institutions in Dubai that have introduced management facilities to suit the needs of the foreign patients and that has led to increase in the medical tourism in the country. Medical tourism is one of the biggest trends in the healthcare sector of Dubai and the following research paper will focus on the impact of medical tourism on the healthcare management (Chuang et al. 2014). The researcher will collect primary data from the hospitals to know about the extent of medical tourism happening in Dubai and its implications on the management.

Medical tourism has become a new trend in the healthcare sector. It refers to the event of people travelling to other countries to avail the medical treatment. In the past, it was observed that people from less developed countries used to travel to developed countries to avail highly advanced medical treatment, which was not available in the home country due to lack of infrastructure, education, capital investment etc. (van Weel et al. 2018). However, in the recent years, the trend has changed significantly. People from the developed countries are travelling to the developing countries to avail the treatment at a lower cost. Many of the developing countries have improved their medical facilities with foreign investments as well as capital formation in the economy. For example, few Asian countries, such as, India, China, Malaysia, Singapore, and Thailand, some Middle Eastern countries, such as, UAE, Israel, Jordon, and African countries like South Africa have become popular destinations for medical tourism in the recent years due to their improved healthcare facilities at a lower cost (Abubakar and Ilkan 2016). Dubai has earned its fame in this field with advanced healthcare technology, efficient healthcare management, and reasonable cost, availability of highly experienced and educated doctors providing the best quality healthcare services.

As Dubai has been collaborating with foreign investors in the healthcare projects to provide improved healthcare facilities, over the years, it has become one of the favorite destinations of the people from developed as well as developing countries for availing the best quality medical treatment. The management of the healthcare institutions have changed their policies as well as incorporated many new policies to welcome the foreign patients to Dubai, as medical tourism not only helps to improve the quality of medical services in the country, but also contributes significantly in the economy through the inflow of foreign exchange (Han and Hyun 2015). Through this research study, the research will be focusing various aspects of medical tourism in Dubai and its implications in the healthcare management in the country.

Advancement of Medical Facilities in Dubai

The aim of the research paper is to evaluate various aspects of medical tourism in Dubai and its impact on the healthcare management services of the city. UAE is one of the most developed countries in the Middle East and due to its location, it has an advantageous position among all other medical tourism destination. Coupled with geographical advantage, Dubai has made proper investment in the healthcare services to improve the quality. Through this paper, the researcher aims to find out the effects of medical tourism on the healthcare sector of Dubai as well as on the economy of Dubai.

The objectives of this research study are as follows.

• To find out pros and cons of medical tourism in Dubai
• To assess the impact of medical tourism on the management of the healthcare services in Dubai
• To evaluate the effect of medical tourism on the economy of Dubai

• What are the advantages and disadvantages of medical tourism in the healthcare services of Dubai?
• What is the impact of medical tourism on the healthcare management in Dubai?
• What are the effects of medical tourism on the economy of Dubai?

H0 (Null hypothesis): Medical tourism has a positive impact on the healthcare management of Dubai.

H1 (Alternative hypothesis): Medical tourism does not have a positive impact on the healthcare management of Dubai.

Medical tourism is a very important topic in the healthcare services of the world. People now prefer to travel to other countries with improved medical facilities rather than suffer for not having good treatment facilities in their home country. Dubai is one of the most developed cities, not only in the Middle East, but also in the world. The economy of Dubai is very strong and that has been reflected in all the sectors of the economy. Healthcare management is no exception. Dubai has been able to make improvements in all type of medical facilities in the past few decades and thus, there has been rapid increase in the number of incoming foreign patients in Dubai (van Weel et al. 2018). People from developed and developing countries come to Dubai to avail the best quality treatment at a reasonable price. This has been contributing significantly in the economic growth of the city through foreign capital inflow. The foreign money is beneficial for Dubai as that can be reinvested in the healthcare management of Dubai. Therefore, the researcher will be doing this study to evaluate the impact of medical tourism in Dubai on the management of the healthcare services and assess that if it has been contributing positively in the improvement of the healthcare services.

This research paper will comprise of five chapters. The first chapter is the introductory chapter, which presents the background study, research aim, objectives, questions, research rationale and structure of the research. This chapter introduces the research topic to the reader. The second chapter describes various arguments and supporting theories from previous literature and scholarly articles. The researcher will study the academic papers from various online and printed sources and present the relevant theories and information to establish his points in pursuing the research study. Third chapter presents the research methodology, which presents the research procedures to be followed by the research while conducting the research. In the forth chapter, the analysis of the collected data and discussion of the findings will be presented. The fifth and last chapter is the concluding chapter, where the researcher establishes the connection between the research objectives and findings and provides recommendations based on the analysis and draws a conclusion to the research.

Impact of Medical Tourism on Healthcare Management in Dubai

The second chapter focuses on the literature review on the different aspects of medical tourism, its advantages and disadvantages, healthcare management in Dubai and impact of medical tourism on the healthcare services and on the economy. The researcher will study various scholarly articles to gain knowledge about the research topic and research methodology that he will be pursuing to complete the research. Plenty of academic journals, books, magazines, online publications, websites etc. will be explored by the researcher to gather information about the subject of the research. He also focuses on the views of other authors regarding relevant topics as well as gets idea about the research methodology. Literature review helps the researcher as well as the readers to get acquainted with the research topic through the views of other authors.

The history of medical tourism goes back a long way. The trend was started by the Greek pilgrims thousand years back when they travelled to a small town for medical treatment from the eastern Mediterranean region. The trend became quite popular in the 18^th and 19^th centuries in Europe and some parts in Asia where people used to travel to other places to improve their health and to avail medical facilities (Hanefeld, Smith and Noree 2016). In the recent times, people travel to other places to avail the treatment either due to high cost of the health care services or due to advanced technology in healthcare. As medical science has been improving and inventing new technologies, the scopes for healthcare facilities have improved multiple times. In the developed countries, the level of capital investment is very high than that in the developing countries and hence, the healthcare sector can invest in the R&D in a bigger manner. Thus, the healthcare sectors of the developed countries are more advanced and efficient in terms of technology of treatment and medicines. On the other hand, the service sector is more efficient in the developing countries where human capital is cheap due to its abundance. The less cost of labor enables the healthcare management to provide the services at a lower cost than that in the developed countries (Fetscherin and Stephano 2016). Hence, when people, across the world, travel to other countries for treatment, they have to choose between better treatment at a higher cost or at an affordable cost. Hence, in the present world, patients have started to travel for medical purposes to the developed countries, such as, UK, USA and developing countries, such as, India.

As stated by Ormond and Sulianti (2017), similar to other services, medical tourism also has pros and cons or risks. The benefits of medical tourism can be enjoyed by both the patients and the country providing the services. As the patients can enjoy the better healthcare, sometimes they do not get satisfied with the healthcare management in the foreign country due to many reasons. Lee and Fernando (2015) depict that the primary benefit of medical tourism is the lower cost. The advanced treatments have become so costly that cost of travelling, staying and availing treatment abroad has become cheaper than the cost of surgery or any other critical treatment in the reputed hospitals of the developed countries. Travelling offers the patients the freedom to choose the country they want to travel as well the hospital that suits their need and budget. Breaking the bank for only one treatment is not feasible and there are many treatments that are not covered by general medical insurance. Hence, people travel to another country that suits their preferences. Another advantage is that, the treatment procedure is faster for the foreign patients due to their visa limitation. The post-operative care is also faster for them as they do not get much time to stay longer in the foreign country. The patients can also explore the new places if they get scopes after the treatment. That adds extra revenue from tourism for the country. Apart from that, many patients opt for unconventional cosmetic surgeries, which they feel comfortable to do in another country, due to lower cost and privacy.

Advantages and Disadvantages of Medical Tourism

Gmelch and Kaul (2018) highlight that medical tourism also has some disadvantages. The major con is the patients often do not know about the qualification and reputation of the doctors and the hospitals before selecting one. They often have to trust blindly once they chose one doctor or hospital after coming to the country. They also have to trust the medical tourism facilitators, as they do not have the proper knowledge about the reputation of the hospitals in a foreign country. Incorrect information can result in bad experience, inefficient treatment and healthcare services and wastage of resources (Hanefeld et al. 2014). The patients are often unable to do proper research about the cost, medical facilities and qualifications and level of service before going there and that sometimes lead to more than expected expenditure. The foreign patients require proper insurance, and if they cannot provide that, they are either rejected by the hospitals for providing services or they have to pay very high charge. Then the travelling cost exceeds their treatment cost at home and the patients experience major financial setback. The legal permits and papers can also throw in some problems anytime in a foreign country and the patients must be ready for the consequences. Apart from that, language and cultural barriers can also sometimes create major problems for the foreign patients and make them nervous and misguided while availing treatment in a foreign country (Ormond and Sulianti 2017).

As stated by Inhorn (2017), the healthcare sector and management of Dubai is one of the best in the Middle East and the gulf countries. The city has best hospitals and highly qualified doctors and they provide very high quality medical services to the citizens as well as to the foreigners who come to Dubai for medical purposes. The cost of health care is also affordable in Dubai, which attracts patients from the developed countries. Ashraf (2014) shows that, in the past few decades, there has been immense growth in the healthcare sector of Dubai. In spite of the economic slowdown in Dubai, the healthcare services experienced considerable rapid development. Not only hospitals and other type of medical institutions are established and improved, but the study of healthcare management has improved too, and has been drawing a large number of native and international students to Dubai. The sector has also attracted major international investors and companies, who invested huge amount of capital in the healthcare sector for the development. Dubai had aimed to be the global destination for the domestic as well as the international patients and offer cost effective and high quality treatment and healthcare management services to the medical tourists. From the numbers of medical tourists each year, it can be said that Dubai has been successful in its objectives. It has successfully achieved popularity from the patients from the developed as well as developing countries in the past few years.

Cherian, Alkhatib and Aggarwal (2018) show that, as the population of the UAE and other Gulf Countries are increasing due to longer life span and migrated population, the demand for healthcare is increasing too. Along with that, the cost of healthcare is also rising. There is increase in the chronic diseases among the native and the migrated population and that pushed Dubai to bring in more capital investors as well as credible and authentic healthcare service providers. That would not only help the domestic patients, but would also attract foreign patients by putting up a positive advertisement. With increasing competition in the market, the healthcare management and the service providers are forced to raise their standards and lower the cost (Rayes, Hassali and Abduelkarem 2015). That has been beneficial for the patients. The Ministry of Health, Dubai Health Authority (DHA), Dubai Healthcare City (DHAA) and Health Authority of Abu Dhabi (HAAD) are the organizations that work to achieve the goals of the healthcare sector of Dubai (Matias 2016).

Healthcare Management Policies for Foreign Patients

The healthcare sector of Dubai has experienced big growth in the past few years and among numerous branches medical services, the cardiac treatment, medical spas, cosmetic surgery, ophthalmology have gained the major amount of popularity (allianceexperts.com 2016). As the cost of equipment and services has increased globally by 30-40% in the past 3-4 years, Dubai health services also experienced the impact. Overconsumption of the healthcare services, rising cost of medical equipment, high competition among the medical professionals and doctors, have all led to increase in the cost of healthcare management. The government of Dubai has taken initiatives to control the rising cost by establishing public private partnerships as 70% of the expenditure of the government are done on the healthcare sector (D’Mello 2017). The objective is to encourage the private sector or investors to participate in the mission of making Dubai a global medical destination for the people across the world through the infrastructural development and quality improvement. Political stability of Dubai has given adequate support for these initiatives (Shah et al. 2017).

The business opportunity has also increased in Dubai in the past few years. There are rising demand for the highly qualified doctors and aesthetic surgeons along with Lasik professionals, rejuvenation treatment and dentistry departments, as the healthcare sector is expanding. The level of cosmetic surgery has also achieved advanced stages in Dubai and that has been attracting a huge number of patients from all over the world (Jassmi  2016). However, Dubai offers these advanced treatments at a cost, which is comparatively much lower than in the highly developed countries, like USA, UK, and Australia. Hence, the instance of medical tourism has increased quite rapidly in Dubai.

usuaebusiness.org (2016) shows that, the healthcare sector of UAE has been going through structural changes and has the potential to experience a record growth of 60% in the next 5 years, worth of Dh 103 million. The healthcare management of Dubai has been shifting its focus from more conventional healthcare to more health consciousness among the masses. Medical tourism is a big contributory factor in the growth of the healthcare management in Dubai. According to the UAE Vision 2021 National Agenda, UAE has been working towards achieving the status of world class healthcare services and come in the list of advanced countries providing the highest quality of healthcare (Colliers International 2014). Thus, the healthcare management is adopting itself to the rapidly changing needs and demands of the younger and more health conscious generation. The population is now tech savvy and enjoys the digital connectivity with the rest of the world. This young generation is pushing the healthcare sector of Dubai to improve its service quality in the medical field. In this process, the interaction between the masses and health management leads to a better service standard and high competition keeps the price at a lower level. The services have become more personalized and upgraded to incorporate the digitalization and advancement of technology to make it at par with the world class services.

Economic Benefits of Medical Tourism in Dubai

UAE accounts for 26% of the total fund of the healthcare facilities given by the GCC governments (D’Mello 2017). The country is also promoting medical tourism. The current revenue earned from medical tourism is worth of $17 billion or Dh64 billion (Meštrovi? 2015). The shift in preventive care services, increase in specialty services, more efficient and qualified professional from all over the world, high growth potential of the specific services in the healthcare. The introduction of medical tourism and compulsory insurance policies has been contributing in the growth of the healthcare management in Dubai. The improved infrastructural development of Dubai Healthcare City attracts both the patients and the investors to the city. The healthcare framework is provided by the UAE government and the private sector is providing capital support to achieve the goals (usuaebusiness.org 2016). The group has plans to expand in other regions also through acquisitions or from the scratch. Technology also plays a major role as it has enabled better monitoring of the patient health and reduced the costs of the services.

Several initiatives have been taken to promote the medical tourism in Dubai. UAE has launched the first comprehensive electronic medical tourism portal of the world that enables the users to access all the information related to health, hospitality, facilities, travel, expenditures, and visa services. Dubai expects to receive more than 500,000 global medical tourists by the end of 2020. The visa processes have been simplified for the ease of the patients. In the first half of 2015, Dubai received 260,000 international patients, which signifies the success of their efforts on medical tourism (Nazzal 2017). It also has a plan of attracting minimum half million international patients in an year, which would contribute in the economy of Dubai with a revenue of Dh2.6 billion, that is, USD 0.07 billion by the year 2020 (Townsend 2017). Initiatives have been taken to construct 18 private and 4 government hospitals with the employee strength of more than 3800 (Ashraf 2014).

This chapter focuses on the methodology of the research paper. Research methodology represents the approach and strategies adopted by the researcher to address the research questions. To conduct a research paper, the researcher must follow a strategy or outline of the direction of the research. Methodology consists of research philosophy, approach, design, purpose, strategy, sampling techniques and data collection and analysis process. In the following section, the methodology for this research paper is illustrated.

Research philosophy throws light on the source, development and nature of knowledge. This is fundamentally the belief about the process of data collection about the research topic, and its analysis. This involves formulation of beliefs and assumption to conduct the research study (Ryan 2018). Identification of research philosophy is the first step of research methodology. The source and nature of the information and knowledge determine the choice of philosophy. Four major type of research philosophies are, pragmatism, positivism, realism and interpretivism. Pragmatism includes usage of both the qualitative and quantitative method of research. Positivism involves highly structured method on large samples by using quantitative method of research. It uses scientific application to get to the result in a logical way (Best and Kahn 2016). Under realism, the method of research, that is, either qualitative or quantitative, is chosen according to the relevance and suitability of the data. Lastly, under interpretivism, mostly qualitative research method is adopted for small samples. The researcher applies his interpretation skills to get the findings from the data (Bernard 2017).

Literature Review

In this research paper, the researcher aims to collect primary data from the patients who come from different countries to avail the healthcare facilities of Dubai. It will be collected through a survey questionnaire and the data will be analyzed using statistical tools, that is, the conclusion will be drawn using scientific method. Hence, positivism research philosophy will be chosen for this research.

Research approach follows from research philosophy. It is an important step while selecting the method of research. Induction, abduction and deduction are three major types of research approach. Induction approach focuses on generating new theories from unexplored topic of research, while deductive approach tests the assumptions of the hypothesis and the results against the established theories. Abductive research on the other hand, includes new puzzles and explains it by applying known theories through the research (Kennedy and Thornberg 2017). In this paper, the researcher will be applying deductive research approach. To test the research hypothesis, the researcher will apply relevant theories under deductive approach.

Research strategy refers to the plan of the researcher about the steps to be followed to answer the research questions. There must be a framework about how the researcher is planning to proceed with the research and what are the steps should be followed to execute the plan is the foundation of research strategy (Bryman 2015). There are various types of research strategy, such as, surveys, case studies, experiments, ethnography, grounded theory, archival research, narrative inquiry and action research. Experiments and surveys are the most common research strategies under deductive research approach. The researcher has chosen this strategy to get an idea about the perceptions of the patients who come to Dubai for medical treatment. This strategy is particularly helpful in getting the first hand knowledge about the research topic and finding out the areas where attention should be given (Robson and McCartan 2016).

Research design ensures that the evidences found for the research topic enables the researcher to address the research problems and questions effectively, logically and unambiguously (Lewis 2015). There are two major types of research design, namely, exploratory and explanatory. Under exploratory research, the researcher addresses a research topic, which has not been explored before. This design enables the researcher to conduct the study on an entirely new topic through exploration of the subject and related fields (Ioannidis et al. 2014). On the other hand, explanatory research design addresses a research topic or hypothesis in the light of established theories of other scholars on the related subjects. This design mainly focuses on the explanation of the research problem by testing the obtained data against some established theories. Hence, there is no scope for generating new theories for the research problem, rather the research questions are addressed by using supportive argument from other scholarly articles (Salazar, Crosby and DiClemente 2015).

In this research study on the medical tourism in Dubai, the researcher will be using explanatory research design as there is no need to generate a new theory from the medical data. The advantages and disadvantages of medical tourism and impact on the healthcare management and economy of Dubai can be explained from the data and supporting theories.

Two types of data are considered in any research project, primary and secondary. When the researcher collects the data directly from the field of occurrence, it is called primary data. On the other hand, when the data is collected from different sources, like, online publications, books, journals, newspapers, various official websites, literatures or any other sources, it is known as secondary data. Both types of data are extremely important in any research work. Primary data is usually collected from the individuals who are directly related to the topic of the research. It helps in getting the perspectives of people regarding the topic of the research, which in turn determine the direction of the research and its implications on the outcomes (Taylor, Bogdan and DeVault, 2015). The most common instruments for collecting the primary data are survey questionnaire, interview questions, feedbacks, appraisal forms, reflective checklists etc.  On the other hand, secondary data is helpful to get a perspective on the research topic from other author’s point of view. It also helps to validate the findings from the primary data (Neuman and Robson 2014).

In the current research study, the researcher will be collecting the primary data through a questionnaire survey on the foreign patients, who come to Dubai for treatment. The aim of the study is to find out the impact of medical tourism on the healthcare management of Dubai. To address this aim, primary data, that is, the direct response of the patients is more relevant than secondary data as perceptions of people can be the determining factors for the medical tourism phenomenon.

Sampling is very important for a survey. According to Smith (2015), sample is a subset of a population with the same characteristics. As the entire population cannot be studied, a small section is drawn scientifically that represents the similar features and will help in getting the data for the survey that represents the response of the entire population. Sampling has advantages of saving the cost and time for data collection. However, Etikan, Musa and Alkassim (2016) state that sampling method contain the risk of sampling error, which can lead to compromisation in the accuracy in case of quantitative analysis. Different types of sampling techniques are there, namely, simple random sampling, stratified sampling, cluster sampling, systematic sampling (Freeman 2017). These fall under the category of Probability sampling. Purposive sampling, snow ball sampling, quota sampling, and convenience sampling are the non probability sampling.

Simple random sampling is the most commonly used technique in research papers. It is chosen based on the sample size and nature of sampling. According to Palinkas et al. (2015), in this sampling, each of the samples has equal probability of being chosen. This sampling is easy to conduct and it usually produces unbiased outcomes. However, the chance of sampling error is also high in this case. The researcher will be using simple random sampling in this study by choosing 50 random patients in Dubai who have come from other countries to avail the advanced medical facilities in Dubai.

Pilot test is conducted prior to the actual and large scale survey for ensuring the effectiveness of the survey instrument. The main objective of the pilot test is to find out that if there is any issue with a potential negative impact on the outcomes of the survey in the future, then it should be ruled out even before the actual survey. For this pilot test, a very small subset is drawn. 5 foreign patients were selected randomly to fill out the survey questionnaire. It is observed with special attention that if they can understand all the questions clearly and if they could answer those in the first attempt only (Bryman and Bell 2015). After the completion of the survey, the participants were asked about their experiences, that is, if they found it easier to understand the questions and answer those easily or they found any question difficult to understand or vague. The participants were also asked whether they found any question objectionable or sensitive, which they would not have preferred to answer.

After the pilot test, it is found that, overall the respondents found the questionnaire quite comprehensible. They could understand the questions on personal details and confidently answered all of them. Regarding the question on availed medical treatment in Dubai in the last year, there is a new finding that can be added as an answer option in the actual survey. 2 out of 5 patients had come to Dubai for cardiac treatment. This option was not added previously in the list of answers. Regarding the questions in part 2, the participants had to think a little for questions number 4 and 5. The participants were not sure about whether the Dubai healthcare sector offers any special preference to the foreign patients, as they have no idea how the citizens were given preference. Hence, this question needed amendment. It was changed to ‘Being a foreign national, are you satisfied with the treatment you got in Dubai?’. This question solely focused on their treatment experience in Dubai. Question number 5 addresses the efficiency of the healthcare management of Dubai. The participants were not much aware about whether the healthcare management in Dubai is as efficient as that of the other advanced countries. The reason is that they have not visited any other country to avail the healthcare facility; hence, they do not have clear idea about the level of medical facilities in other countries. Thus, the 5^th question should be changed. It is framed as ‘Have you chosen the hospital based on their reputation?‘. This focused on the reputation of different hospitals of Dubai. The respondents are quite satisfied with the structure of the survey questionnaire and questions, as they did not face any difficulty in answering the questions.

Chapter 4 illustrates the analysis of the collected data and its findings along with explanation of those findings. The researcher has collected primary data directly from the foreign patients who have come to Dubai to avail the medical services. The sample size is chosen as 50 and simple random sampling technique is used to draw the sample subset from the bigger population. The primary data on the medical tourism was collected through a questionnaire survey, containing 16 close ended and 1 open ended question. The questionnaire had questions on demographic details and subjective factors. The findings and the discussions regarding the data and its analysis have been presented in this chapter.

Demographic factors are the socio-economic factors that depict the characteristics of the sample or participants. The age, gender profiles, income, residence, etc. fall under the category of demographic details. In this study, the age and gender profile, residence of the participants are considered along with number of visits to Dubai, departments of the healthcare services availed in the last year, and preference of hospitals. These data help to understand the preferences of the treatment and the regions from where people come to Dubai to avail the treatment.

Among the 50 participants of the survey, 52% are male and 48% are female. It can be said that there is no gender biasness among the patients or in the service providers.

It is seen that majority (28%) of the participants of the survey hail from different countries in Asia, followed by Europe (24%), different countries of the America (20%), Africa (14%), gulf countries (8%) and Gulf countries (6%). Although, this does not signify any major pattern in the residence of the international patients as the sample size is small, but it can be said that, a large number of patients come from Asia, America, and Europe apart from the domestic patients.r

Among the 50 participants, 26% availed the orthopedic treatment, which is the maximum. It is followed by 16% came for cardiac treatment, 14% for dermatology, 12% each for dental and fertility department, and 10% each for ophthalmology and cosmetic treatment. Thus, it can be said that, international patients have a preference for orthopedic, cardiac and dermatology treatment in Dubai. However, when a large sample will be considered, the trend might be different.

48% of the respondents reported that they have visited Dubai 1 to 3 times for the treatment, which may include the initial and follow up treatments. 24% visited only once, 22% visited 4 to 6 times. Only 4% visited 6-10 times and 2% visited more than 10 times. These respondents are expected to be the citizens of UAE and any Middle East and Gulf Countries, who does not need visa to go to Dubai for medical treatment.

The average age group of the participants is 36 to 55 years. 28% belonged to 36 to 45 years and 28% belonged to 46 to 55 years. 20% are under the group of 56 to 65 years. 16% are below 25% and only 8% are above the age of 65 years.

In case of preference of the hospitals, 54% preferred the private hospitals due to the better quality of service compared to the public hospitals. 46% prefer government hospitals.

Subjective factors are those which focus on addressing the particular issue of the research topic. In this matter, the questions are set in the manner, which can bring out relevant information on the patient’s perception about the medical tourism and efficiency of healthcare management of Dubai. The questions addressed the issue of comparatively lower cost, advanced medical technology in Dubai, post treatment care, efficiency of management, packages and discounts for the foreign patients and many more. The responses were collected in the Likert scale values, where 1 signifies strongly agree and 5 refers to strongly disagree. The findings are listed below.

Regarding the matter of quality of treatment offered in the Middle East and Gulf region, 46% agreed and 32% strongly agreed that Dubai provides the best quality of medical services. 14% however answered neutral, 4% disagreed and 4% strongly disagreed. Hence, it can be said that majority of the patients have the perception that Dubai offers the best quality healthcare among all the regions in the Middle East.

30% of the respondents strongly agreed and 40% agreed to question of whether the hospitals in Dubai have the most advanced technology. On the other hand, 26% answered neutral and very few, that is, only 2% disagreed and 2% disagreed. In this case also, it can be said from the findings that the international medical tourists come to Dubai as they perceive that Dubai healthcare sector has the most advanced technology.

It is found that 16% strongly agreed and 42% agreed to the question of whether Dubai provides high quality medical facilities at a substantially cheaper cost than their home country. 16% remained neutral, 22% disagreed and 2% strongly disagreed on this. Hence, majority says that the medical cost of advanced and critical treatment is really cheaper in Dubai than their home country and that is why they come to Dubai.

On the matter of whether the medical tourists are satisfied with the treatment they got in Dubai, 60% agreed and 14% strongly agreed. However, 18% answered neutral and 8% disagreed. None of the participants strongly disagreed. Hence, there is overall satisfaction regarding the treatment availed in Dubai.

50% of the respondents agreed and 22% strongly agreed to the question of choosing the hospitals based on the reputations. However, 14% answered neutral and 14% disagreed to this question. None of them strongly disagreed. Hence, it can be said that reputation of the hospitals matter to the medical tourists while selecting a hospital to get the treatment.

On the question of whether Dubai offers better quality healthcare services and management than their home country, 40% agreed, 38% answered neutral, 10% disagreed, 8% strongly disagreed and only 4% strongly agreed. Thus, it can be said that, majority does not perceive that the quality of healthcare management is exceptionally better in Dubai. Hence, cause of medical tourism can be the lower cost of healthcare in Dubai.

50% of the respondents agreed to the question on whether Dubai healthcare management gives proper importance to the patients’ right to information, safety and responsible care. However, 34% responded neutral, 10% strongly agreed, 4% disagreed, only 2% strongly disagreed. Thus, it can be said that majority of the respondents felt that the Dubai hospitals give significance to patients’ rights.

Regarding the question of packages and discounts offered by the hospitals to the international medical tourists, 40% agreed and 10% strongly agreed that those facilities are profitable for them. 26% responded neutral, 18% disagreed and 6% strongly disagreed about the facilities being profitable for them.

44% of the respondents agreed and 24% strongly agreed to the question of whether the Dubai healthcare management should include some more facilities for the international medical tourists. Those could be profitable insurances, packages, membership cards etc. that would be beneficial for the foreign patients when they come to Dubai for treatment. However, 24% remained neutral and 8% disagreed.  

Figure 16: Post treatment services are also extremely efficient in the healthcare sector of Dubai

In the matter of efficiency of the post treatment services, Dubai hospitals do fairly well as 62% of the respondents agreed to this question and 10% strongly agreed. 24% responded neutral and 4% disagreed. None of them strongly disagreed. Hence, overall the hospitals provide good post treatment care, which helped them to earn good reputation among the foreign patients.

The last question in the survey questionnaire asked for suggestions from the respondents on if they would recommend others to visit Dubai for medical tourism. It is observed that, 15 respondents directly responded negative and around 6 people highlighted that Dubai should provide better and cheaper lodging, further lower cost for senior citizens and cheaper treatment for some special treatment. Rest of the respondents is quite satisfied with the facilities, accommodation and pre and post treatment care. Thus, they would like to suggest others to visit Dubai for their treatment (Refer to Appendix for the responses).

	Best treatment in Middle East and GCC	Most advanced technology	cheaper cost	Satisfaction level	Hospital reputation	Better health-care than my country	Patients’ right	Profitable packages	More facilities for the foreign patients	Efficient post treatment care
Best treatment in the entire Middle East and GCC	1
Most advanced technology	0.356486	1
Cheaper cost	0.369963	0.323571	1
Satisfaction level	0.568704	0.440072	0.402416	1
Hospital reputation	-0.06893	0.29259	-0.04965	0.275241	1
Better healthcare than my country	0.172093	0.083935	0.151453	0.112354	0.114862	1
Patients’ right	0.243831	0.329284	0.0755	0.330341	0.165801	0.160624	1
Profitable packages	0.36688	0.268614	0.411199	0.534365	0.100281	-0.02534	0.276112	1
More facilities for foreign patients	-0.30219	-0.01207	-0.29477	0.011736	0.20351	-0.17048	0.084381	0.136832	1
Efficient post treatment care	0.053524	0.175891	-0.03092	0.29969	0.501267	0.136289	0.254592	0.344365	0.211035	1

Table 1: Correlation among the factors

Correlation is performed on the subjective factors to find out the level of relation among the variables using MS Excel. The correlation coefficient value is evaluated on the basis of Pearson’s correlation coefficient, whose value ranges from +1 to -1. Positive correlation indicates that when the value of one variable increases, the other one increases too. The opposite happens in case of negative correlation. 0 indicates no correlation. From the table it is found that, majority of the variables are positively correlated with each other. Only in the case of correlation of choosing the hospital based on its reputation with best quality treatment in Dubai and cheaper cost are negatively correlated. That is reputation depends on the efficiency of management and quality of services provided and choice based on reputation is not related to cheaper cost and if best quality treatment is provided in Dubai. Better healthcare services than the respondent’s home country and profitable packages offered by the Dubai healthcare management are also negatively correlated. Whether the healthcare management should provide more facilities is negatively correlated with many other variables, such as, if Dubai provides best quality healthcare among all the regions of Middle East, have most advanced medical technology, cheaper and better medical services than the home countries of respondents. The perceptions about these factors cannot influence the perceptions about whether there should be more facilities for the foreign patients. Again, the efficiency of the post treatment care of the hospitals is negatively correlated with the cheaper healthcare facilities in Dubai. The responses about these variables do not necessarily mean insignificant outcomes, rather it signifies that different variables may be uncorrelated but have their own effect on the medical tourism in Dubai.

At the end of this chapter, it can be said that, although some of the variables are having negative correlations among themselves, but these have collective impact on the medical tourism in Dubai. Better medical facilities and technology, cheaper costs are the two major factors that influence the medical tourism. Along with that, the packages offered for the foreign patients, post treatment care, health insurance, and accommodation facilities are the major independent influencing factors for the medical tourism in Dubai. At the same time, it can be said, as more and more international patients are coming o Dubai for healthcare services, the hospitals are in continuous pressure and competition to improve their services. Even though they can afford to have and maintain the most advanced tools and equipment, the continuous and increasing inflow of foreign capital is beneficial to the healthcare management of Dubai to enhance their facilities and improve their services to attract more international medical tourists. The improvement of the services at a lower cost benefits the citizens of Dubai as well. Increased global competitiveness help the healthcare sector of Dubai to provide improved services at a lower cost, and medical tourism helps to increase the competitiveness. Hence, it can be deducted from the data analysis that the null hypothesis is accepted. Medical tourism has a significant positive impact on the healthcare management of Dubai

Conclusion and recommendation

This is the concluding chapter of the research paper. The researcher will discuss the verdict of the data analysis and its implications in this chapter and also provide some recommendations to address the new found issues from the research study. The researcher will establish the links of the findings with the objectives of the research. Quantitative and deductive research approach has been used in this paper to reach to the conclusion. Through a survey, the researcher collected primary data from foreign patients, who have come to Dubai to avail medical services. Those data were analyzed using quantitative method and the conclusion is reached after the analysis.

The first objective was to find out the advantage and disadvantages of the medical tourism. The researcher has studied various academic articles by numerous scholars to find out different perspectives of the authors. By studying different articles, the researcher has found many aspects of the medical tourism. The better quality healthcare services and lower cost of healthcare are the two major advantages of medical tourism. The patients also get to explore new places once their treatment is completed. Visit of international tourists help the healthcare management of a country to be more efficient and competitive. To serve the patients with the world class services, the healthcare sector has to improve their quality of services, and provide those services at a comparatively lower cost than their competitors. That brings benefits to both the domestic as well as the foreign patients. They can avail good quality treatment at a lower cost.

The second objective of the paper was to evaluate the impact of medical tourism on the healthcare sector of Dubai. From the study of various reports and articles, it is observed that over the past few years more than 2.5 million people visited Dubai for medical treatment. The industry is worth of USD 17 billion and it is expected to increase its worth to USD 63 billion by 2021. It is found that, as the number of international patients is increasing over the years, the healthcare sector of Dubai has also been taking the initiatives to provide more world class services to the patients. The Ministry of Healthcare of Dubai has been implementing projects in collaboration with other private and public companies to develop more improved healthcare facilities. Many international as well as well domestic investors have come forward in Dubai to participate in the infrastructural development of the healthcare management in Dubai. The need for better services also increased the demand for the healthcare management studies in Dubai. The number of students enrolling for healthcare management courses has increased significantly and number of colleges and universities offering these courses also increased. Hence, it can be said that the efficiency of the healthcare sector has been enhanced due to positive impact of medical tourism.

The third objective of this research paper is to evaluate the effect of medical tourism on the economy of Dubai. Dubai is one of the most financially strong cities not only in UAE, but also in the entire Middle East and Gulf region. The city has seen rapid development and growth in the economy in the past few years, which has also been reflected in the healthcare sector. the city has developed many new projects and hospitals that can serve the international standard healthcare to the patients. Apart from the better quality of services, the increasing global competitiveness has made the services cheaper than in many other developed countries. Hence, availability of good quality and advanced healthcare at a moderate cost attracts the international patients to Dubai. This has an immense positive impact on the economy of Dubai. Millions of international patients spend millions of currency on the healthcare that adds significantly in the revenue of the UAE. Hence, the export of healthcare services has been a major source of foreign currency of UAE. There has been inflow of foreign investment also in this sector that has not only helped to build infrastructure but also helped to create the opportunities to provide the best healthcare services among the entire Middle East. Hence, it can be said that medical tourism has brought about a good improvement in the economy of Dubai.

There are certain ways to improve the quality and efficiency of the services, which can be found from the suggestions that the respondents gave in the last question of the survey questionnaire.

• Many respondents have reported that the service quality is good but not up to the Mark that they had expected. Hence, to make people suggest about the healthcare sector of Dubai, they must take frequent feedback from the international patients. There should be a form which the patients must fill at the end of their treatment. According to their feedback, the hospitals must implement the changes to amend the loopholes.
• Some respondents had complaints about special discounts for senior citizens. The hospitals must introduce new policies to include the senior foreign patients under their senior citizen discount schemes. This would help to attract more senior patients.
• The lodging should be made cheaper around the hospital area. The patients often face high accommodation charges when they come from another country and that discourages them from visiting again. Hence, the government of Dubai must interfere in the practice of charging unnecessary high prices for the lodging.
• The hospitals must introduce training programs to train their staff, even if they had a good degree in nursing or hospitality. They must be trained properly to handle the needs and demands of the foreign patients. As there would be cultural and language difference between the people of Dubai and of any other countries, the staff of the hospitals must be trained to deal with people from different backgrounds with different financial strength.

The limitations of this study are a few. Firstly, the researcher studied only primary data and not the secondary data from individual hospitals. To reduce the complexity and robustness of the research, the researcher has focused on a small sample. A small sample can have sampling fluctuation errors and biased outcomes. Secondly, the participants were asked only close ended questions to reduce the horizon of the study. Thus, in the future, the researcher can increase the sample size to get more accurate results. The questionnaire should contain both the open and close ended questions to get better and wide perspectives of the respondents. More statistical calculations should be performed to find out the dependency of the variables. Secondary analysis should also be conducted to get a deeper idea about the impact of medical tourism on the healthcare services of Dubai. It will also help to find out the problems that come with extensive medical tourism. Thus, in the future the researchers can address the new issues that would arise with the medical tourism.

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