The Growth of Medical Tourism Combines Health Innovation with Global Mobility

Journal of Dentistry and Oral Research (ISSN 2767-4037) The Growth of Medical Tourism Combines Health Innovation with Global Mobility. Fuad Husain Akbar 1 , Hasta Handayani Idrus 2,3 , Tuti Ningseh 4 , Mustafa Bin Jaapar 5 , Putri Rejeki 6 , Riki Kristanto 7

1. Department Dental Public Health, Faculty of Dentistry, Hasanuddin University, Makassar, Indonesia. 2. Department of Biomedical Sciences, Postgraduate School, Hasanuddin University, Makassar, Indonesia. 3. Center for Biomedical Research, Research Organization for Health, National Research and Innovation Agency (BRIN). 4. Department of Family Oral Health, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Malaysia. 5. Department of Family Oral Health, Ministry of Oral Health, Malaysia. 6. Department of Preventive & Public Health Dentistry, Faculty of Medicine, Udayana University, Bali, Indonesia. 7. Department of Odontology, Faculty of Medicine, Udayana University, Bali, Indonesia. *Corresponding author Fuad Husain Akbar , Tamalanrea Indah, Tamalanrea District, Makassar City, South Sulawesi 90245. Email : [email protected] Received Date : November 13, 2024 Accepted Date : November 14, 2024 Published Date : December 16, 2024 Copyright © 2024 Fuad Husain Akbar. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Objectives: The study investigates the expanding field of dental tourism within the broader context of medical tourism, exploring the factors that drive its growth, its economic implications, and the satisfaction of patients who seek dental care abroad. Methods: Employing the PRISMA systematic review method, the authors searched academic databases for articles published from 2015 to 2024, using keywords related to dental and medical tourism. The search yielded numerous articles, from which eight were selected based on relevance and quality criteria. Results: The review found that dental tourism is propelled by the search for affordable yet quality dental care, with patients from developed countries increasingly traveling to developing nations for treatments. Key factors include the high cost of local healthcare, long wait times, and the allure of better value. The internet and low-cost air travel are instrumental in enabling this trend. Patients report high satisfaction, with quality of care, accessibility, and the attractiveness of the destination being key determinants. Conclusions: The study concludes that dental tourism is a burgeoning sector within medical tourism, offering substantial economic advantages to host countries. It underscores the importance of maintaining high standards of care and patient satisfaction, while also recognizing the ethical and legal challenges that must be addressed to ensure the responsible development of dental tourism. Keywords : Dental tourism, medical tourism, patient satisfaction, economic implications. INTRODUCTION The development of the times and increasingly rapid global competition demands innovations, including in the health sector (1). Currently, innovations in the health sector are developing by combining tourism with health services which is known as medical tourism and is a special tourism phenomenon that takes on global characteristics because increasing tourist mobility (2,3). Medical tourism is a specific type of movement in which people travel across borders with the aim of receiving medical treatment (4). According to the definition of the World Tourism Organization (WHO), health and medical tourism refers to people who travel from their place of permanent residence to maintain, improve or regain physical and mental health for a period of more than 24 hours and less than one year (5,6). According to the World Tourism Organization (UNWTO), “health tourism” is organized travel that primarily promotes physical, mental, and/or spiritual well-being, using medical or health-based activities (6). Health tourism occurs for several reasons in countries of origin, such as high prices of health services (7), long waiting lists, dissatisfaction with health services, lack of certain medical services or technologies (8,9), and legal prohibitions on certain medical services. Medical tourism is becoming the largest industry in the world. The number of tourists and turnover of this industry continues to increase. The medical tourism industry is growing rapidly. It is worth noting that the global medical tourism market was valued at around US$46.46 billion Research Article 1www.directivepublications.org

Journal of Dentistry and Oral Research (ISSN 2767-4037) in 2016, and is expected to continue to increase by around 15% year on year10 and grow tremendously, by 2027 to reach a turnover of over $200 billion (11,12). However, it is stated that apart from the advantages there are also significant disadvantages to dental tourism. A major issue for patients undertaking dental tourism is accountability. Accountability implies the professional, moral, legal and ethical obligations of the practitioner regarding treatment outcomes (13). The tourism industry is fundamentally different from other physical goods manufacturing industries (14). The main components of the tourism supply chain are products, distributors and resources (15). Medical tourism or medical tourism plays a marketing role that has been shaped by medical, economic, social forces and countless potential factors in the health sector (16). Medical tourism is not limited to simple medical services, but is a new industry with high added value that creates new profits through integration with tour1ism services (17). Medical tourism contributes to destination country economic growth and job creation, leading to sustainability opportunities (18). Many countries have successfully competed in the medical tourism market by offering a variety of services and have several branches, one of which is dental tourism. Dental Tourism: According to the American Dental Association (ADA), Dental Tourism is defined as the activity of traveling abroad in order to obtain dental care (19), divided into two, namely general care and special care (20). Dental Tourism involves individuals seeking standardized, appropriate, and effective dental care outside the local health care system and may be accompanied by a vacation or vice versa (21,22). In general, there are two types of dental tourists. The first type is known as the classic dental tourist, who travels abroad either for the sole purpose of receiving dental treatment, or for dental treatment and holiday. The second type is known as migrant dental tourists, who return to their home country for holiday or to visit relatives and then access dental care during their visit (23). The majority of dental tourists are those who live in developed countries and seek affordable dental care in less developed countries, both because of lower prices and shorter waiting times (24,25). Patients from developed countries, especially America and Australia, tend to travel to developing countries in Asia, including Malaysia, India, and Thailand Indonesia, etc. to receive cost-effective oral health care (26,27). This trend has occurred and led to advances in the travel industry for dental care, with an estimated 3-4 million patients traveling for dental care each year (28). People in Indonesia have also been making international medical trips to neighboring countries with better health services for years. The various health conditions of Indonesians treated in neighboring countries include cardiology treatments, orthopedic procedures, cancer treatments, cosmetic and plastic surgery procedures, fertility treatments, dental treatments, ophthalmology procedures, and other treatments (29). Factors in the occurrence of Dental Tourism: The increasing number of patients who cross national borders and receive dental care at low-cost clinics generally classify the phenomenon of cross-border health services as ‘dental tourism’. Increased patient mobility is caused by various socio-economic factors (30). Some countries, have dental care prices that are unaffordable for many patients. The high price of local procedures encourages people to look for dental procedures that are relatively cheap (31), and can get quick access, patients understand that a lower price does not mean the quality will also be lower (32), recommendations from family/relatives who are satisfied with the services provided and the quality of services provided has a significant impact on patient satisfaction (1,33,34). Economical air travel also means transportation costs are much cheaper than the cost of dental procedures in the patient’s home country, and information on the internet plays a strong role in connecting ‘customers’ with dental health services (30,35). Perceptions of faster and more convenient services in other countries, as well as distrust of doctors in the country of origin are also factors supporting patient medical tourism, including in dental and oral health services (36,37). MATERIALS AND METHODS Design This research was conducted using a systematic review method using the Preferred Reporting Items for Systematic Reviews and Meta Analyzes (PRISMA) which contains a list and four-phase flow diagram that outlines all aspects of a systematic review (38). To identify related dental tourism topics, we applied several steps suggested in the framework by Levac in Asa (29,39), namely: (1) identifying research questions, (2) identifying relevant studies, (3) selecting studies, (4) mapping data, and (5) collect, summarize, and report the results obtained. Search Strategy Search was carried out on research articles published in 2015- 2024. The search was carried out using the Publish or Perish program, a software that provides and analyzes academic citations from various sources. Using the PubMed, Scopus, and ResearchGate databases. This database was chosen because it is one of the largest citation databases that provides access to literature on both health and tourism (29,40). Search articles using the terms medical tourism/dental tourism/ dental traveler in the title and abstract. We also searched for other literature using keywords on Google Scholar to increase the completeness of the search for available evidence. Data from all databases were reviewed, then all duplicate articles Research Article 2www.directivepublications.org

Journal of Dentistry and Oral Research (ISSN 2767-4037) were removed, by screening articles based on title and abstract. Research Criteria To find appropriate literature we have determined inclusion and exclusion criteria as a guide in selecting journals for this literature review. Inclusion Criteria: - Articles in English - Articles with full text - Articles that are directly related to the discussion material Exclusion Criteria: - Inaccessible articles - Articles from magazines/news/case reports - Articles from the book section - Duplicate Articles Data Collection Data collection in this literature review was obtained using article data searched from search databases based on criteria set by the researcher. Based on the database search carried out, according to the literature review steps, there were 74 articles identified based on the keywords entered. Then, from the data that emerged, there were 7 titles/abstracts that were related to the research questions and met the inclusion and exclusion criteria. The reported data is analyzed and presented in the form of figures and tables for later review. Figure 1. PRISMA Flowchart Research Article 3www.directivepublications.org

Journal of Dentistry and Oral Research (ISSN 2767-4037) RESULTS Table 1. Characteristics of Dental Tourism Articles Name Title Purpose Results Ahmadimanesh, Fatemeh Paydar, Mohammad Mahdi, Asadi-Gangraj, Ebrahim, 2019 (2) Designing a mathematical model for dental tourism supply chain The aim of this research is to determine the importance of dental tourism and assess the income level of this sector for destination countries, especially in developing countries. In addition, the use of the proposed model can make a significant contribution to dental tourism managers in strategic decision making The results obtained show that the proposed model can be used for effective strategic and investment planning. One important application of this research is to provide suggestions for designing the proposed supply chain network using the output of mathematical models Hnin Nu Nu Lwin, Prattana Punnakitikashem & Trin Thananusak (2021) (41) The level and determinants of international patient satisfaction with dental tourism in Bangkok, Thailand to analyze the level of international patient satisfaction with dental tourism experience in Bangkok, and to identify the determinants that significantly influence patient satisfaction. It was found that international patients were very satisfied with the experience their dental tour in Bangkok. In addition, the research results show that the quality of dental care, location accessibility and destination attractiveness have a positive and significant influence on dental tourist satisfaction. This study provides valuable input for dental healthcare providers by highlighting the determinants and their relationships on dental tourist satisfaction to overcome challenges in a competitive market This. Flavia Dana Oltean, Manuela Rozalia Gabor, Aurélia-Felicia Stancioiu, Mihaela Kardos Marta Kiss and Roxana Cristina Marinescu (2020) (3) Aspects of Marketing in Dental Tourism Factor of Sustainable Development in Romania To provide comprehensive empirical evidence of Dental clinics and tourism agencies’ point of view on Romanian dental tourism. The results show that both entities have little information, but they are interested in investing, promoting, and creating partnerships to create a sustainable dental tourism industry. Dental tourism can contribute greatly to the country’s image and help extend activity seasonal tourism by increasing the strategic marketing of dental clinics and tourism institutions towards sustainable health tourism. Nexhipi, Olla (2018) 42 Medical Tourism Management Challenges - The Case of Dental Tourism in Albania This writing reviewing data regarding factors that influence client choices. In addition, this study provides information about the main tools used dental tourists to choose whether to obtain dental services in their respective country of residence or in Albania. Provides an overview of the actual promotion of dental services and further recommendations to attract more customers are provided, taking into account that the quality offered is competitive in the Balkans. Jaapar, Mustaffa a, d, Ghazali Musa b, Sedigheh Moghavvemi c, Roslan Saub d, (2017) (43) Dental tourism: Examining tourist profiles, motivation and satisfaction To measure tourist profile, travel motivation, and satisfaction among physician tourists teeth coming to Malaysia. Based on the level of importance, the main motivating factor is quality dental care, access to dental care information, and cost savings. Tourists are very satisfied with the dental care services they receive in that country. Meanwhile, the quality of dental care, access to dental care information and supporting services have a positive effect on tourist satisfaction; cost savings and cultural similarity have a negative influence. Based on the research findings, we propose some managerial and marketing recommendations. Research Article 4www.directivepublications.org

Journal of Dentistry and Oral Research (ISSN 2767-4037) Dhama, Kuldeep Patthi, Basavaraj Singla, Ashish Gupta, Ritu Niraj, Lav Kumar Ali, Irfan Kumar, Jishnu Krishna Prasad, Monika (2016) (40) Global Tourist Guide to Oral Care - A Systematic Review This review aims to assess the implications and feasibility of dental tourism in India. Government and industrial infrastructure supports the growth of dental tourism in India. Opportunities such as lower prices with good quality treatment in India are helping further progress in dental tourism. Ramos, Karen dan Cuamea, Onesimo (2023) (34) Dental tourism: factors influencing travelers’ revisit intention to the Mexican border The aim of this study was to determine the factors that influence the revisit intention (RI) of dental tourists to Tijuana, Mexico. Shows that cultural proximity, service quality, price and supporting services influence tourists’ return visit behavior after the COVID-19 pandemic lockdown. Kopmaz, Busra et.al (2019) (44) Dental website as new media tools for patients in dental health tourism To assess the effectiveness of websites effectively used as a media tool by dental health service organizations, which are currently active and also a promising component of health tourism in Turkey Scores related to “contact information” and “website layout” were lower in private institutions (n:146) than in public institutions (n:409) (p=0.000, p=0.011). It was observed that 80.8% (n:122) of websites with foreign language options (n:151), were private institutions); while public institutions only cover 19.2% (n:29) of the total. Scores for all subgroups on this scale were lower in organizations that offered a foreign language alternative compared to organizations that did not offer a foreign language option (p<0.05 Research Article 5www.directivepublications.org DISCUSSION A rapidly growing subset of medical tourism is dental tourism which is described by the American Dental Association as ‘the act of traveling to another country for the purpose of obtaining dental care’. This involves individuals seeking dental care outside the local healthcare system and may be accompanied by a vacation. The global market provides more opportunities for the growth of dental tourism. Because dental tourism is a subset of medical tourism, both have similar supply chains (2). Dental tourism has become an important and widespread part of the growth of medical tourism. Dental tourism can contribute greatly to the country’s image and help extend seasonal tourism activities by increasing the strategic marketing of dental clinics and tourism institutions towards sustainable health tourism (3). In addition, it is said that dental tourism or dental tourism also provides benefits seen from the increase in income turnover of a country due to the development of this trend (3). Large and drastic price differences play an important role in determining a patient’s decision to travel abroad to receive dental treatment (2). A study conducted by Nexhipi, it was found that tourists who visit to receive treatment at a dentist may travel for various reasons, which are usually Motivated by price considerations, people travel for dental treatment because the costs are cheap (42). Treatment quality is also a key indicator of medical product performance. The presence of a superior and skilled medical team is a major indicator of treatment quality (45). Providing an accurate diagnosis and effective treatment according to professional specifications is also considered very important (46). The quality of health services is assessed by the empathy, friendliness, politeness, competence and communication carried out by health service workers. Medical tourist satisfaction depends on the quality of service and professionalism of staff (47). Patient satisfaction with a health service depends on the patient’s personal evaluation of the health service and service provider they receive (41), in addition, it was found that cultural proximity and supporting services also play a role in providing a sense of patient satisfaction (34), this can encourage customer loyalty and word of mouth recommendations. mouth. Basically, this is important for the long-term success and sustainability of a health care agency. The development of dental tourism trends in a country is based on or influenced by the level of satisfaction of visiting patients, this occurs because of quality, good marketing management, government and industrial infrastructure that supports the growth of dental tourism (40), low prices, apart from medical costs, travel costs, accommodation and food is also a consideration for dental tourists, the destination of a country, the attraction of the destination includes national heritage, beautiful scenic locations, modern shopping centers and interesting cultural festivals (48), and in fact, this influences tourists’ decisions in choosing medical tourism (49), accessibility and facilities (50), a health service

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