MEDICAL TOURIST SATISFACTION AND DISSATISFACTION WITH DENTAL CARE SERVICES: AN EXPLORATORY CASE STUDY OLIVER KESAR, PhD, Associate Professor JOSIP MIKULIĆ, PhD, Associate Professor Faculty of Economics & Business, Zagreb, Croatia okesar@efzg.hr jmikulic@efzg.hr http://www.efzg.unizg.hr

PRESENTATION STRUCTURE Introduction HEALTH TOURISM: CONCEPTUAL FRAMEWORK TRENDS IN MEDICAL TOURISM DEVELOPMENT MEASURING PATIENT SATISFACTION IN HEALTH CARE DELIVERY RESEARCH METHODOLOGY AND DATA SOURCE RESULTS AND INTERPRETATION Conclusion

Introduction Health tourism  an increasingly important aspect of contemporary tourism development. Among the most promising tourism products, according to Croatia’s Strategy of tourism development. Convergence of health care and tourism systems has created a variety of health-related tourism services and packages. The focus of the research  Dental tourism.

thalassotherapy tourism 1. HEALTH TOURISM: CONCEPTUAL FRAMEWORK 1: Healing/hospital/ sanatorium tourism 2: Spa/thermal/ thalassotherapy tourism HEALTH TOURISM 3: Wellness tourism 4: Medical tourism Dental tourism

2. TRENDS IN MEDICAL TOURISM DEVELOPMENT Many reasons why people travel abroad for health care: dentistry, cosmetic/aesthetic, cardiac, bariatric, eye or orthopaedic surgery, IVF, transplantation, diagnostics, etc. Increasing number of countries have adjusted their health-care, tourism and legal systems to attract foreign patients. Tremendous growth of medical tourism is supported by: 1) GATS, 2) global health insurance and 3) the Internet. Rising awareness of negative aspects, ethical issues and controversies.

3. MEASURING PATIENT SATISFACTION IN HEALTH CARE DELIVERY SERVQUAL – the most frequently used approach. Growing interest in using nonlinear and asymmetric approaches relationship between attribute- and dimension-level satisfaction and overall satisfaction. The Kano model  three-factor approach of measuring customer (patient) satisfaction: 1) satisfiers, 2) dissatisfiers and 3) hybrid attributes.

4. RESEARCH METHODOLOGY AND DATA SOURCE Objective: to determine elements/attributes of dental care services that contribute most to creation of dental tourist satisfaction Elements/attributes examined: 1) Acceptability of prices; 2) Honoring scheduled appointments and deadlines; 3) Completeness of service program; 4) Quality of product/services; 5) Information availability about clinic and services; 6) Staff professionalism and competence.

4. RESEARCH METHODOLOGY AND DATA SOURCE Sample size: 253 international patients (48% from Italy, 44% from the UK, and 8% from Slovenia). Time frame: February 2017 Instrument: Self-completion questionnaire (SCQ). Analysis approach includes: Impact (determinance)-asymmetry analysis, and Impact-range analysis.

5. RESULTS AND INTERPRETATION All examined dental service attributes have a larger potential to create dissatisfaction than satisfaction.

5. RESULTS AND INTERPRETATION 4) Quality of product/services (IA4= -0.42; RIOS4= 1.93), and 6) Staff professionalism and competence (IA6 = -0.33; RIOS6: 1.57)  attributes with strong potential to create patient΄s dissatisfaction with delivered service. 2) Honoring scheduled appointments and deadlines (IA2-0.21; RIOS2= 0.73), and 5) Information availability about clinic/services (IA5 = -0.26; RIOS5: 0.82)  attributes with relatively low potential to create dissatisfaction.

5. RESULTS AND INTERPRETATION 1) Acceptability of prices (IA1= -0.11; RIOS1= 0.62)  relatively balanced potential to create satisfaction and dissatisfaction. 3) Completeness of the service program (IA3= -0.07; RIOS3: 1.13), only attribute that could be referred as a hybrid attribute  balanced potential to create satisfaction and dissatisfaction.

CONCLUSION Zagreb is an emerging dental tourism destination with high quality of dental care services. Main target market: developed EU countries. Quality of product/services and Staff professionalism and competence are the most influential attributes of dental service that create overall patient΄s experience. Dental service prices, if transparently communicated, have low influence on patient΄s experience.

Thank you for your attention! Oliver Kesar & Josip Mikulić Department of Tourism, Faculty of Economics & Business, University of Zagreb, Croatia E-mails: okesar@efzg.hr & jmikulic@efzg.hr