Healthcare Travel Research Articles

Evaluating ChatGPT's Role in Assessing Turkey's Medical Tourism Trends

Background and Aims: The primary objective of this study is to evaluate the performance of the ChatGPT as an expert in the field of medical tourism. Another objective of this study is to assess its evaluations regarding the current state and future prospects of medical tourism in Turkey from an artificial intelligence perspective. Methods: Within the scope of the study's objectives, questions were created for ChatGPT regarding the current state and future prospects of medical tourism in Turkey. First, the draft questions were prepared by the authors of this article using the literature. All questions were evaluated by experts through online interviews. Totally 8 experts have been evaluated the questionnaires. These experts consisted of two tourism professors who had research on medical tourism, three major medical tourism hospital managers, one reconstructive aesthetician clinic owner, and the Turkish Healthcare Travel Council Founding Chairman. The second step of the research questionnaire was applied to the ChatGPT Model 4, which was trained as a medical tourism expert. than test the answers of the AI used the tools “Completeness of content, Lack of false information in the content, Evidence supporting the content, Appropriateness of the content, and Relevance,” referred as CLEAR. All answers were evaluated by 41 experts who had articles and research on medical tourism in Turkey. To explain the methodology appropriately, reporting was conducted using the METRICS checklist, which was prepared for artificial intelligence studies. Results: TThe general answers of ChatGPT 4-o were accurate, informative, and helpful, providing a good overview of medical tourism in Turkey. However, the responses lacked detail, did not provide evidence-based information, and did not always address the nuances and cultural/social impacts of medical tourism. ChatGPT 4-o views the future of Turkey’s medical tourism as shiny and will force the lead in general. Conclusions: This study is important for revealing data on the current and future state of medical tourism through artificial intelligence. However, only a few studies have been conducted on artificial intelligence and medical tourism. To the best of our knowledge, there is no existing literature that systematically evaluates the ChatGPT responses of medical tourism experts. In this regard, it is believed that the study will benefit both academics and practitioners.

Closing the distance gap: Evaluating patient travel distances in a community oncology practice.

157 Background: Patient travel distance is an important factor influencing healthcare access, health equity and outcomes. The Rural-Urban Commuting Area (RUCA) classification system categorizes geographic areas based on urbanization and commuting patterns to measure accessibility to healthcare. We study the relationship between RUCA and patient travel distance for a multi-site community-based, medical oncology practice in north-west Chicagoland area. Methods: Using patient ZIP code data and practice locations (clinics) from April 2023 to March 2024, we calculated and compared the straight-line, one-way, patient-clinic travel distance (travel distance) for about 20,000 patients at 5 clinics, using geospatial analysis techniques. We grouped clinics based on location and population characteristics, applied the RUCA classification to patient ZIP codes, and compared travel distances by RUCA categories. Results: The median travel distance for patients was 5.0 miles, with 82% of patients traveling 10 miles or less, and 89% traveling 15 miles or less. Table 1 shows % of patients traveling and travel distance by RUCA categories. Median travel distances for urban metro, suburban metro, and suburban small-town clinics were 4.8mi, 10.8mi and 20.6mi (Kruskal Wallis H-test, p <0.001). Within 50 miles of each clinic, median travel distance for patients from urban ZIP codes (4.8 mi) was lower compared to metropolitan, micropolitan, small town and all other RUCA categories. Conclusions: Preliminary findings indicate a significant association between RUCA and travel distance, with longer travel distances for patients in non-urban locales. Proximity of cancer care sites to the patient’s home reduces distance traveled, minimizing the burden on the patients and their families. Interventions addressing transportation needs (such as improving infrastructure, increasing transportation options, subsidizing healthcare travel, etc.) can be augmented with efforts to strengthen access to community-based sites (expansion of telehealth, incentivizing providers serving non-urban areas, etc.) to reduce patient and caregiver burden. Clinic Site Category % of patients traveling <5 mi <10mi <15mi <50mi >50mi A Suburban Metro 53.8% 30.7% 5.2% 9.1% 0.9% B Suburban Small Town 24.1% 40.6% 21.9% 12.3% 0.4% C Suburban Metro 45.7% 34.3% 5.01% 13.8% 1.0% D Suburban Metro 60.1% 23.9% 6.8% 7.9% 1.2% E Urban Metro 80.3% 9.7% 3.5% 5.2% 1.0% ALL SITES 54.7% 27.1% 7.2% 9.8% 0.9% Clinic Median travel distance in miles (% of patients) by patient RUCA within 50 miles of clinics Urban Metropolitan – High Commute Micropolitan – Flow to Large Urban Cluster Small Town – Flow to Small Urban Cluster All Other A 4.8 (98.2%) 27.5 (1.7%) 48.7 49.4 B 4.0 (42.3%) 8.6 (54.2%) 25.0 20.6 (3.2%) C 5.9 (95.2%) 17.7 (4.5%) 36.7 27.7 D 4.8 (97.1%) 23.7 (2.8%) 48.4 40.1 E 2.7 (98.9%) 32.3 (1.0%) 4.5 ALL 4.8 (91.2%) 10.8 (8.3%) 36.7 (0.1%) 20.6 (0.4%) 4.5

Revisiting the Policy Implications of Medical Tourism in the Post-COVID-19 Pandemic From a Malaysian Perspective: A Qualitative Study.

Background Malaysia has been one of the most prominent destination countries for medical tourism. The industry received significant government support to create a conducive environment for its growth, such as the provision of an investment tax allowance for the facilities participating in medical tourism and the establishment of the Malaysia Healthcare Travel Council (MHTC) to coordinate collaboration between various industry stakeholders to promote medical tourism activities at the international level and facilitate inbound medical tourists. The establishment of the MHTC facilitates collaboration between various industry stakeholders. In addition to facilitating medical tourism activities, MHTC is also involved in analysing relevant data, including but not limited to the socio-demography of medical tourists, the trend of their healthcare service utilisation, revenue generated, and market intelligence to promote the industry's growth. The council serves as a medium to facilitate the collaboration of stakeholders such as the hospitals participating in medical tourism, the Association of Private Hospitals Malaysia, the Malaysian Society for Quality in Health, and various government agencies, including the Ministry of Health and the Department of Immigration, Malaysia. We explore the policy-related implications of medical tourism and its relationship with the Malaysian national healthcare system. Methodology We revisited Pocock and Phua's conceptual framework of policy implications for medical tourism to explore its relevance after more than a decade of intensive government support and the aftermath of the COVID-19 pandemic. We employed a qualitative case study design using semi-structured, in-depth interviews with stakeholders from the Ministry of Health Malaysia, the private health sector, professional bodies, academics, and health-related civil society organisations. Results Our study found that many issues identified in the original framework remain relevant after over a decade. However, we also identified additional implications, such as the role of insurance portability in encouraging the growth of international hospital accreditation and the issue of equitable access to healthcare within the context of the current Malaysian healthcare system in the aftermath of COVID-19. Conclusion Due to its vulnerability, there is a need to develop a strategic collaboration that includes incorporating medical tourism activities into a broader framework, such as promoting aged care within the retirement destinations package for expatriates, which could ensure its sustainability instead of relying solely on medical tourism activities. In the meantime, policy implications arising from the industry remain relevant and should be addressed through a comprehensive structural reform of the national healthcare system involving stakeholders from the public and private health sectors.

Delivering a net zero National Health Service: where does otorhinolaryngology - head and neck surgery stand?

The National Health Service (NHS) recognised the risk to public health brought by climate change by launching the Greener NHS National Programme in 2020. These organisational changes aim to attain net zero direct carbon emissions. This article reviews the literature on initiatives aimed at mitigating the environmental impact of ENT practice. Systematic review of the literature using scientific, healthcare and general interest (public domain) databases. The initiatives reviewed can be broken down into strategies for mitigating the carbon footprint of long patient stay, use of operative theatres and healthcare travel. The carbon footprint of in-patient stay can be mitigated by a shift towards day-case surgery. The ENT community is currently focused on the reduction of theatre waste and the use of disposable instruments. Furthermore, supply chains and healthcare delivery models are being redesigned to reduce travel. Future areas of development include designing waterless theatre scrubs, waste-trapping technologies for anaesthetic gases and a continuing investment in virtual healthcare.

Understanding patients heterogeneity in healthcare travel and hospital choice - A latent class analysis with covariates

Access to health care is key to well-being, and it is increasingly clear that aggregated accessibility analysis is hard to reflect people's actual healthcare behaviour. This paper employs a patient-based healthcare travel survey to obtain a nuanced picture of how healthcare travel varies across patients. The existing literature shows transportation is an essential factor in accessing health care; however, most studies focus on separate healthcare travel mode choices or hospital choices for certain segments of patients, making it difficult to derive clear profiles of patients. Also, the attitudinal factors in healthcare travel have long been neglected. This research explores the joint hospital choice and travel behaviour of patients. We conducted an online survey with patients in Shanghai to identify the heterogeneity in healthcare travel behaviour and hospital choice. A latent class model with covariates is adopted to identify different patient types that exhibited distinct hospital choices and healthcare travel behaviour. Attitudinal factors are included in our model to form clear-separated clusters. Four categories of patients are identified: public transit patients, car-oriented patients, near-hospital patients, and non-downtown hospital patients, which differ in sociodemographic characteristics, healthcare-seeking behaviour, and public transit accessibility. Our research shows that a substantial share of non-downtown hospital patients should not be underestimated in healthcare travel demand analysis. The behaviour of public transit and non-downtown patients requires improvement of quality and public transit accessibility in non-downtown tertiary hospitals. Our study contributes to a better understanding of the market segments of patients and tailored healthcare and transport policies to meet patient healthcare travel demand.

Remote scanning support in magnetic resonance imaging: Friend or foe?

IntroductionRecent advances in technology have seen the introduction of remote scanning capabilities become a reality for departments, allowing staff to remotely access, observe and even scan without being by the scanner side. The COVID-19 pandemic has accelerated use of remote working which also aligns with the direction of travel for healthcare more widely. However for technology to succeed it needs to be acceptable for use by radiographers in clinical practice. MethodsFollowing trial of a remote scanning technology, a group of radiographers were surveyed for their views on its use in practice. The survey was based on the Technology Acceptance Model as well as providing opportunity for open feedback on views regarding the technology. ResultsPerceived ease of use was high but appears to have little influence over overall intention to use. Perceived usefulness was lower and demonstrated correlations with attitude towards and intended use of the remote technology, suggesting that this is a key area to address which would positively impact on acceptance. Other considerations that would help support effective implementation were highlighted with the majority stating the technology as friend rather than foe. ConclusionAs an early evaluation of practitioner views on remote scanning within MRI, the results highlight the areas that would benefit from further development before further roll out in practice. A clear vision of its use and robust governance is needed to effectively support its implementation and acceptance by radiographers. Implications for practiceIntroducing remote scanning technology has potential to support training and share skills of experienced radiographers across multiple locations. It has the potential to transform the way MRI departments work and increase safer supervision to enable wider utilization of the support workforce.

Domestic medical tourists from north-east to south India

The practice of travelling from one country to another in need of healthcare has existed in the world since the ancient period. The nature, trend, and dimension of healthcare travel have been changing in the 21st century with the influence of dynamic advanced technology and this phenomenon popular as medical tourism. Domestic medical tourism is a part of medical tourism, where the activities of intra-regional medical tourists are bounded within their country. Domestic medical tourism is apparent in a large country like India. North Eastern Region (NER) is an important part of India which is made up of eight small states. Residents of NER flock to different parts of the country as domestic medical tourists due to the scarcity of healthcare infrastructure and services. This study focused on those NER residents who visited three major hospitals in Tamil Nadu. We try to analyze push and pull healthcare motivation factors and simultaneously evaluate the travel experience of north eastern domestic medical tourists. The study was adopted as cross-sectional where 110 respondents were conducted for face-to-face interviews from May 2019 to June 2019.

Conceptualizing Essential Components Affecting Health Tourism Satisfaction in Asia: Does Context Matter?

ABSTRACT Asian countries, specifically Thailand, Singapore, Malaysia, and India, are documented as the preferred health tourism destinations among healthcare travelers. Despite the significant increase in global revenue over the last fifteen years, there is still a lack of comprehensive understanding about the factor affecting health tourist satisfaction in this region. Using the critical literature review technique, this study suggests that the commonly adopted SERVQUAL dimensions do not cover the overall aspects of health tourism satisfaction. Instead, we propose seven key attributes of healthcare service and four attributes of tourism destination. Although conceptual components of the proposed framework are not contextually driven, empirical findings may vary due to the standard of service provisions across health tourism destinations. The proposed model will also mitigate the managerial difficulties in designing an appropriate health tourism service.

Sustainable medical tourism: Investigating health-care travel in Indonesia and Malaysia

ABSTRACT Medical tourism has developed rapidly and international health care has become a global industry. Indonesia has a great opportunity in the field of medical tourism, but Malaysia still ranks more highly in credibility by domestic and foreign residents in checking their health. The purpose of this study is to identify potential development of medical services with the concept of medical tourism in Indonesia by comparing with Malaysia. This study uses combination of quantitative and qualitative approaches. In the initial stage, an explorative quantitative study was conducted and processed using factor analysis. Respondents consisted of 200 patients both from Indonesia and Malaysia who had studied medical tourism. To identify obstacles and solutions in implementing medical tourism-based medical services, researchers used descriptive qualitative research, in-depth interviews are conducted to obtain more detailed information, involving 11 informants from both the medical providers (general practitioners, specialist doctors, nurses, Indonesian Doctors Association Management, Health Services) and patients. The results showed that the perception of patients using health services regarding medical tourism services based on medical tourism in Indonesia and Malaysia demonstrates: trust, communication interactions, excellent service, affordable medical costs, modern medical technology, holistic service, increased patient expectations, short distances, and an Interesting Tourism object.

Understanding the influence of “feeling at home” on healthcare travelers’ well-being: a comparison of Airbnb and hotel homescapes

ABSTRACT Although there is the saying “there’s no place like home”, research on a traveler’s sense of feeling at home in an accommodation and its influence on their well-being is underrepresented. Particularly, given the increase of peer-to-peer accommodations and healthcare travel segment, this gap is notable. Analyzing data including 420 respondents who stayed at an Airbnb and 320 who stayed at hotel accommodations, structural equation modeling tested the effect of an “accommodations homescape” on a healthcare traveler’s sense of feeling at home and well-being. The findings have strategic implications that emphasize the need to engineer home-like environments for particular traveler segments.

Employee Healthcare Travel Programs: Promise or Hype?

Employee Healthcare Travel Programs: Promise or Hype?

Grey System Theory in the Study of Medical Tourism Industry and Its Economic Impact.

The Asia-Pacific region is known as a favorite destination for global medical travelers due to its medical expertise, innovative technology, safety, attractive tourism destination and cost advantage in the recent decade. This study contributes to propose an approach which effectively assesses performance of medical tourism industry based on considering the economic impact factors as well as provides a conceptual framework for the industry analysis. Grey system theory is utilized as a major analyzing approach. According to that, factors impact on the sustainable development of medical tourism in Asia-Pacific region could be identified. The performance of each destination in this region was simultaneously revealed. The results presented an overall perspective of the medical tourism industry in the scope of the Asia-Pacific region, and in Taiwan particularly. Data was collected on six major destinations including Singapore, Thailand, India, South Korea, Malaysia and Taiwan. The results proved that tourism sources and healthcare medical infrastructures play a crucial role in promoting the healthcare travel industry, while cost advantage and marketing effectiveness were less considered. In addition, performance analyse indicated that Thailand has a good performance and stands in the top ranking, followed by Malaysia, India, Singapore, South Korea and Taiwan, respectively. The revenue of Taiwan has increased slowly in the last six years, with a market worth approximately NT$20.5 billion, and the number of medical travelers is expected to increase to 777,523 by 2025. The findings of this study are expected to provide useful information for the medical tourism industry and related key players in strategic planning.

Factors affecting the travel mode choice of the urban elderly in healthcare activity: comparison between core area and suburban area

This study investigated the travel characteristics and influential factors of travel mode choice for healthcare activity by the elderly in core area and suburb. The results of descriptive analysis and multinomial logistic models show that: (1) Bus and walking are main modes for the elderly to seek medical treatment. The elderly in suburb travel longer distance and are more dependent on bus than those in core area. (2) The service efficiency improvements of hospitals could promote the elderly in core area to choose green modes, while those in suburb are more likely to utilize cars to obtain high-quality medical resources. (3) For long-distance travel, the influence of family economic backgrounds on the mode choice is more significant in suburb, and the difference of family economic will further aggravate the internal differentiation in long-distance travel among the elderly in suburb. (4) Interestingly, the elderly in core area tend to utilize cars to seek for healthcare when they live with their offspring, while those in suburb tend to use cars and taxis when they have serious illness and require companion. Finally, relevant policies and suggestions were proposed to improve the accessibility and fairness of healthcare travel for the elderly.

The economic burden of advanced gastric cancer in Taiwan

BackgroundGastric cancer is one of the leading causes of cancer-related deaths in both sexes worldwide, especially in Eastern Asia. This study aimed to estimate the economic burden of advanced gastric cancer (AGC) in Taiwan.MethodsThe costs of AGC in 2013 were estimated using resource use data from a chart review study (n = 122 with AGC) and national statistics. Annual per-patient costs, where patients’ follow-up periods were adjusted for, were estimated with 82 patients who had complete resource use data. The costs were composed of direct medical costs, direct non-medical costs (healthcare travel and caregiver costs), morbidity costs, and mortality costs. Relevant unit costs were retrieved mainly from literature and national statistics, and applied to the resource use data. A broad definition of morbidity and mortality costs was employed to value the productivity loss in patients with unpaid employment, economically inactive and unemployed as well as the life years after the age of retirement. Their narrow definitions were also used in sensitivity analyses, using age- and/or sex-specific employment rates. Forgone future earnings/productivity loss were discounted at 3%. Annual per-patient costs were projected to estimate the total costs of AGC at the national level with an estimated number of patients with AGC (N = 2611) in Taiwan in 2013.ResultsThe mean age of the 82 patients was 59.3 (SD: 11.9) years, and 67.1% were male. Per-patient costs were US$26,431 for direct medical costs, US$4669 for direct non-medical costs, US$5758 for morbidity costs, and US$145,990 for mortality costs (per death). These per-patient costs were projected to incur total AGC costs of US$423 million at the national-level. Mortality costs accounted for 77.3% of the total costs, followed by direct medical costs (16.3%), morbidity costs (3.6%), and direct non-medical costs (2.9%).ConclusionAGC was found to exert a significant economic burden in Taiwan, incurring US$423 million in 2013. This represents about 0.08% of the Taiwanese economy. Mortality costs appeared to be the single greatest contributor to the burden, followed by direct medical costs. Early detection and providing effective treatments will help to reduce its burden on patients, caregivers and society as a whole.A poster of this study was presented at the 2016 American Society of Clinical Oncology (ASCO) Gastrointestinal Cancers Symposium in San Francisco, CA, USA.

The Influence of Destination Image on Medical Tourist’s Intention for Future Destination Choice

This study proposed to explore how the image of a destination could influence medical tourists in choosing a destination as their future medical and tourism destination choice. Scholars argued that destination image had a significant relationship with behavioral intentions. Destination image influence not only the decision-making process but also conditions after-decision-making behaviors of tourists. In the current study context, the future destination choice behavior referred to the intention to revisit the previous destination and the intention to spread the positive word-of-mouth to others. For this study, inbound medical tourists from private hospitals registered with Malaysia Healthcare Travel Council (MHTC) in Penang, Malacca, Kuala Lumpur and Selangor in Malaysia will be approached quantitatively by survey questionnaires. This study will contribute to an understanding of the significant factors influencing medical tourists’ intention for future destination choice.

Economic burden of advanced gastric cancer (AGC) in Taiwan.

33 Background: Gastric cancer is one of the leading causes of cancer deaths in both sexes worldwide, especially in East Asia. This study aimed to estimate the economic burden of advanced gastric cancer (AGC) in Taiwan. Methods: The costs of AGC in 2013 were estimated using resource use data from a chart review study (n = 122 with AGC) and national statistics. Annual per-patient costs were estimated from 82 patients who had complete resource use data. The costs were composed of direct medical costs (inpatient, outpatients, and chemotherapy-related costs), direct non-medical costs (healthcare travel and caregiver costs), morbidity costs, and mortality costs. Relevant unit costs were retrieved mainly from literature and national statistics, and applied to the resource use data. Broad definitions of morbidity and mortality costs were employed to value the productivity loss in patients with unpaid employment, economically inactive and unemployed as well as the life years after the age of retirement. Narrow definitions were also used in sensitivity analyses, using age- and/or sex-specific employment rates. Forgone future earnings/productivity loss were discounted at 3%. Annual per-patient costs were projected to estimate the total costs of AGC at the national level with an estimated number of patients with AGC (N = 2,611) in 2013 in Taiwan. Results: The mean age of the 82 patients was 59.3 (SD: 11.9) years, and 67.1% were male. Per-patient costs were US$26,431 for direct medical costs, US$4,669 for direct non-medical costs, US$5,758 for morbidity costs, and US$145,990 for mortality costs (per death). These per-patient costs were projected to incur total AGC costs of US$423 million in 2013 in Taiwan. Mortality costs accounted for 77.3% of the total costs, followed by direct medical costs (16.3%), morbidity costs (3.6%), and direct non-medical costs (2.9%). Conclusions: The total costs of AGC in Taiwan were estimated to be about US$423million in 2013. Such high costs, despite relatively low AGC incidence/prevalence rates in Taiwan, were mainly due to high mortality rates and high mortality costs (per death). Reducing mortality rates and providing effective treatments may help to reduce its burden on patients, caregivers and society as a whole.

Multidrug-Resistant Tuberculosis. Recommendations for Reducing Risk during Travel for Healthcare and Humanitarian Work

Healthcare and humanitarian workers who travel to work where the incidence of multidrug-resistant tuberculosis (MDR TB) is high and potential transmission may occur are at risk of infection and disease due to these resistant strains. Transmission occurs due to inadequate transmission control practices and the inability to provide timely and accurate diagnosis and treatment of persons with MDR TB. Patients risk exposure if active TB is unrecognized in workers after they return to lower-risk settings. Guidance for risk reduction measures for workers in high-risk areas is limited, and no studies confirm the efficacy of treatment regimens for latent TB infection due to MDR TB. Bacille Calmette-Guérin (BCG) vaccination decreases the risk of active TB and possibly latent infection. IFN-γ release assays differentiate TB infection from BCG vaccination effect. A series of risk reduction measures are provided as a potential strategy. These measures include risk reductions before travel, including risk assessment, TB screening, education, respirator fit testing, and BCG vaccination. Measures during travel include use of respirators in settings where this may not be common practice, transmission control practices, triaging of patients with consistent symptoms, providing education for good cough etiquette, and provision of care in well-ventilated areas, including open air areas. Risk reduction measures after return include TB screening 8 to 10 weeks later and recommendations for management of latent TB infection in areas where the likelihood of MDR TB exposure is high.

First-line trastuzumab plus taxane-based chemotherapy for metastatic breast cancer: Cost-minimization analysis

To carry out a cost-minimization analysis including a comparison of the costs arising from first-line treatment by trastuzumab plus docetaxel versus trastuzumab plus paclitaxel in patients with metastatic breast cancer. All consecutive patients with human epidermal growth receptor 2-postive metastatic breast cancer who were treated at Besançon University Hospital and Saint Vincent private hospital between 2001 and 2010 by first-line therapy containing trastuzumab plus taxane were retrospectively studied. Economic analysis took into account costs related to drugs, hospitalization, and healthcare travel. Progression-free survival difference between the two treatments was not significant (p = 0.65). First-line treatment by trastuzumab plus taxane was estimated at approximately €68,000 (p = 0.74). The drug costs represented around 70-75% of the total cost, mainly related to the use of trastuzumab. Our economic analysis shows that although the costs of the two trastuzumab plus taxane regimens are similar, they may contribute to the on-going debate about the availability and use of innovative chemotherapy drugs, in particular in human epidermal growth factor receptor 2-positive metastatic breast cancer with new therapies such as trastuzumab-DM1 and pertuzumab.

Epidemiology of two large measles virus outbreaks in Catalonia

Measles cases in the European Region have been increasing in the last decade; this illustrates the challenge of what we are now encountering in the form of pediatric preventable diseases. In Catalonia, autochthonous measles was declared eliminated in the year 2000 as the result of high measles-mumps-rubella vaccine (MMR) coverage for first and second dose (15 mo and 4 y) since the mid-1990s. From then on, sporadic imported cases and small outbreaks appeared, until in 2006–2007 a large measles outbreak affecting mostly unvaccinated toddlers hit the Barcelona Health Region. Consequently, in January 2008, first dose administration of MMR was lowered from 15 to 12 mo of age. A new honeymoon period went by until the end of 2010, when several importations of cases triggered new sustained transmission of different wild measles virus genotypes, but this time striking young adults. The aim of this study is to show the effect of a change in MMR vaccination schedule policy, and the difference in age incidence and hospitalization rates of affected individuals between both outbreaks. Epidemiologic data were obtained by case interviews and review of medical records. Samples for virological confirmation and genotyping of cases were collected as established in the Measles Elimination plan guidelines. Incidence rate (IR), rate ratio (RR) and their 95% CI and hospitalization rate (HR) by age group were determined. Statistic z was used for comparing proportions. Total number of confirmed cases was 305 in the 2010 outbreak and 381 in the 2006–2007 outbreak; mean age 20 y (SD 14.8 y; 3 mo to 51 y) vs. 15 mo (SD 13.1 y; 1 mo to 50 y). Highest proportion of cases was set in ≥ 25 y (47%) vs. 24.2% in 2006 (p < 0.001). Differences in IR for ≤ 15 mo (49/100,000 vs. 278.2/100,000; RR: 3,9; 95%CI 2,9–5.4) and in overall HR 29.8% vs. 15.7% were all statistically significant (p < 0.001). The change of the month of age for the administration of the first MMR dose proved successful to protect infants. Yet, given the current epidemiological situation, continued awareness and efforts to reach young adult population, especially those at high risk of infection and transmission such as healthcare workers and travelers, are needed to stop the spread of the virus when importations occur.

TOWARDS A 6CS POSITIONING TYPOLOGY OF MEDICAL TOURISM DESTINATION IN INDIA

Medical Tourism was coined when people started looking for cost-effective treatments internationally. The success of this industry depends on the collaboration between private medical care providers and the tourism industry that focused on patients seeking critical and complex surgeries and other forms of specialized treatment. The main objective of this paper is to examine the perspectives of different stakeholders to position India as a global healthcare and medical tourism destination. Grounded theory was chosen as the main research methodology. Grounded theory is a systematic, inductive approach to help understand complex social processes. The main motivation that encouraged this choice is the ability of grounded theory to handle the emergence of problems identified by participants in a study. The principal data collection method was interview of likely stakeholders in the medical tourism industry in India. Using the constant comparison technique, data from interviews were coded and grouped into similar categories to identify patterns. This study highlighted the importance of branding in positioning India as a medical hub and the importance of public-private partnerships in exploring the emerging avenues in healthcare tourism. The research results will also help in gaining some valuable insights which will help all the interest groups and beneficiaries to make maximum advantage of healthcare travel.