Keywords

1 Introduction and Literature Review: Determinants Regarding Visit and Revisit Intentions

Medical tourism generally means to the act of travelling to a foreign country to pursue healthcare services. Economically, medical travel has profited several southern countries, including Malaysia, Thailand, and India, Cuba, Costa Rica, Mexico, South Africa, where the cost of medical procedures is extremely low compared to those of more northern countries [1]. Greece nowadays is a great Medical Tourism destination. Determinants regarding Visit and Revisit intentions are Travel Motivation, Perceived Risks, Healthcare Services Quality, Travel Constrains and Perceived Destination Image. Rendering to International Genealogical Index (IGI) global, travel motivation is the internal situation of an individual, or particular needs and desires of the tourists that can be believed as one of the highly significant psychological influences of tourist actions [2] (IGI, 1988). Travel motivations is a topic of a key importance regarding and consumer behavior [3]. In [4] the authors argued that push and pull theory is the well accepted globally because is strongly connected in tourism destination choice.

The perceived likelihood that an encounter might reveal a human being to risk jerry can affect travel choices if the seeming risk is considered to be away from an appropriate concentration [5]. In tourist decision-making, perceived risks grasp the utmost effect regarding of destination choice [6]. In [7] the authors supported that Perceived Risks have a significant impact on Revision Intention in medical tourism.

According to studies [8, 9], satisfaction regarding healthcare services quality significantly predicts the revisit possibility and the commitment to recommend others to visit the same destination of international tourists. Quality services in business as well in travel industry is one of the goals of many public and private organizations [10,11,12] and their marketing strategy. Services quality have a direct effect on visit and revisit tourist behaviors [13] their satisfaction and commitment [14]. Many researchers apply Quality Models to evaluate Service Quality such as FEQM [15] and MALCOLM excellence model [16, 17].

Travel Constraints have been researched considerably in the field of tourism [18]. The existence of Travel Constraints does not inevitably cause the deny the choice of travelling. In addition, Travel constraints have an impact on travel behavior connected with individuals’ decision regarding when, where and how they travel if the decide to do so including the frequency of traveling [19]. Remaining diseases might similarly limit patients from travelling, for instance in cases of cardiac, or orthopaedical conditions [20]. Ethical, economical, social and legal limitations regarding medical tourism regarding reproductive care are also consider as Travel Constraints [21]. In [7] the authors argued that Travel Constraints have a significant effect on Revisit Intentions.

Destination image suggests individuals’ ideas, beliefs, and impressions of a travel destination [22]. Destination image consists of attribute-based and holistic parameters and impressions as well as psychological and practical traits [23]. In addition, it is the Perceived Destination Image that produces expectations which are possible to be unreal at the time of the visit due to various circumstances [24].

Internet endlessly delivers a constant viable market worldwide [25] creating a Destination Image. Medical as well as CBRC services industrialists used communication tools in order people get familiar of their amenities [26]. Internet entrance permit physicians to obtain various assistance from medical marketing plus patients requesting for particular provisions and facilities [27] worth to Visit and Revisit. In [28] the authors argued that there is a significant effect of Perceived Destination Image on Revisit Intentions. In [29] the authors define Revisit Intentions as the plans of visiting again a destination that fulfill visitors’ expectations and satisfied their needs. In addition, Revisit Intentions could become evidence by giving with pleasure suggestions to others [29]. In Zhang, Chen and Li [30], the authors claimed that tourist travel motivations have a direct effect on Revisit Intentions.

1.1 Statistical Hypotheses

The research hypotheses are the following ones:

Ho1: Travel Motivations have a significant relationship with Revisit Intentions.

Ho2: Perceived Risks have a significant relationship with Revisit Intentions.

Ho3: Healthcare Services’ Quality has a significant effect on Revisit Intentions.

Ho4: Travel Constrains have a significant relationship with Revisit Intentions.

Ho5: Perceived Destination Image has a significant effect on Revisit Intentions.

2 Sample-Methodology

To test the research hypotheses, a survey was conducted on a convenient sample of 540 medical tourists who answered a questionnaire, which was distributed electronically in the format of a google form. For the data analysis the study used multivariate data analysis. When the respondents made the choice claiming that there were medical tourists, a questionnaire was released for them. For other kinds of tourists another appropriated questionnaire was released according to their choice. 331 (61,3%) were females whereas 209 (38,7%) were males. For the data analysis the study used Multivariate Data analysis as well as Implicative Statistical Analysis. Implicative Statistical Analysis is a unique analysis providing a Similarity Diagram, a Hierarchical tree and an Implicative diagram [31,32,33].

3 Results and Discussion

3.1 Correlations

According to correlation analysis results the posed Ho1 null hypotheses is confirmed. More especially Travel Motivations are significantly correlated with Visit and Revisit intentions (r = 0.703, p < 0.01), result that is supported by other authors [4, 30]. In addition, the posed Ho2 null hypotheses is confirmed. More especially Perceived Risks are significantly correlated with Visit and Revisit intentions (r = 0.337, p < 0.01), result that is in line with the result of [7]. Furthermore, the posed Ho3 null hypotheses is confirmed. More especially Healthcare Services’ Quality is significantly correlated with Visit and Revisit intentions (r = 0.769, p < 0.01), result which agrees with the result of [14, 34,35,36]. Also, the posed Ho4 null hypotheses is confirmed. More especially Travel Constrains are significantly correlated with Visit and Revisit intentions (r = 0.791, p < 0.01). This result is in line with the work of the authors [21,22,23]. Finally, the posed Ho5 null hypotheses is confirmed. More especially Perceived Destination Image is significantly correlated with Visit and Revisit intentions (r = 0.805, p < 0.01). The authors [29] have proof the same result [21].

3.2 Implicative Statistical Analysis

The similarity tree: The similarity tree presents classes of items grounded on similarity intensity. The similarity tree (see Fig. 1). Presents two distinct similarity classes (Group A, Group B). Group A entails two subgroups (Mot HsQ) and (VRI TRC). The first similarity subgroup (Mot HsQ) refers to similarity relation between Travel Motivations (Mot) conceptual construct and Healthcare Services’ Quality (HsQ). This similarity relation appears to be the higher similarity regarding the whole similarity tree (similarity: 0.823915] and represent the alike way employed by the research interviews to recognized that the perception toward Healthcare Services’ Quality is strongly connected with Travel Motivations. The second similarity subgroup refers to Travel Constrains (TRC) regarding Visit and Revisit Intentions (VRI). This is the second stronger similarity subgroup (similarity: 0.818806). According to this similarity group the influence of Travel Constrains to Visit and Revisit Intentions has been made evidence. The similarity group between the travel motivations, Healthcare Services’ Quality, Travel Constrains and Visit and Revisit Intentions is of a medium importance (similarity: 0.459289). The third important similarity is between Perceived Destination Image (PDI) and Perceived Risks (PeR) regarding the second similarity group, group B (similarity: 0.809996). This similarity represents the similar tactic employed by respondents to recognize perceived risks grasp the utmost effect regarding of Perceived Destination Image. The similarity between the two similarity Groups (similarity: 0.208137) is of a least importance.

Fig. 1
A dendrogram has three groups with 2 entities, each. M o t and H s Q are similar. V R I and T R C are similar. P D I and P e R are similar.

Similarity tree

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Implicative graph: In an implicative graph all the implications between variable, latent variables, or conceptual constructs and not only those that are the most statistically significant ones [37]. Implicative graph’ shape based on a threshold 0.99. There is only one implicative chain, PDI → PeR → TRC, MoT → HsQ → V → RI, which has implication intensity equal to 0.99 and appears in red color (see Fig. 2). The rule of this implicative chain attitudes toward Perceived Destination Image (PDI) have an impact on Perceived Risks (PeR) based on Travel Constrains (TRC) as well as on Travel Motivation (MoT), conceptual constructs that defined attitudes on Healthcare Services’ Quality (HsQ) closing to Visit and Revisit Intentions (VRI).

Fig. 2
An implicative graph begins with P D I, which leads to P e R. PeR then leads to T R C and MoT. T R C and M o T lead to H s Q, which in turn leads to V R I.

Implicative graph

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4 Conclusions

The current study examined the interrelations of the conceptual constructs named Travel Motivations, Perceived Risks, Healthcare Services’ Quality, Travel Constrains and Perceived Image Destination. Furthermore, the study evaluated their impact on Revisit Intentions in medical tourism. The study confirmed that all of them have a significant correlation with Revisit Intentions. It is worth noting that implicative chain begins with Perceived Destination Image (PDI) and leads to Visit and Revisit Intentions (VRI). Moreover, the attitudes toward Healthcare Services’ Quality (HsQ), leads to Visit and Revisit Intentions (VRI). Regarding managerial and marketing implications it is recommended that health providers and tourism services offer specialized arrangements and actions and pursue certification concerning the excellence, transparency of their services from the main international administrations. Health and tourism suppliers ought to construct cooperation and all-inclusive packages for patients and attendants to supply maximum care to patients and assistants. Greece is a country in which crime is minimal, almost non-existent, which makes it attractive, relatively economical, with excellent climate and weather conditions that favor access to the country both winter and summer, and the health services and health infrastructure are of a high standard. Based on the above, the bet of investing in medical tourism is high. Still a lot of research is ought to be done using new research methodologies involving big data sets of individuals [38] and big data procedures [39, 40]. In addition, AI and Cloud Computing Techniques may analyze [41,42,43] social media networks regarding medical tourism using an unsupervised machine learning technique [44] well known as latent Dirichlet allocation (LDA) as well as using a bibliometric analysis on the condition of policy research on medical tourism.