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Asian Journal of Healthy and Science
p-ISSN: 2980-4302
e-ISSN: 2980-4310
Vol. 2 No. 9 September 2023
FACTORS INFLUENCING THE INTENTION OF INDONESIANS IN CONDUCTING
MEDICAL TOURISM TO MALAYSIA
Fransisca Kusuma Ningrum, Ferry Novrianto Suthiono, Martinus Prananta, Tara Farina
Srihadi
Bina Nusantara University, Indonesia
Abstract
Medical tourism is a diversification of medical treatment combined with tourism activities which
have now developed a lot and become the lifestyle of people around the world, including
Indonesia. There have been many comprehensive studies that discuss the relationship between
medical tourism and various factors that encourage someone to want to do medical tourism
activities, however previous research was conducted outside Indonesia. For this reason, the
purpose of this study was to find out whether the factors of quality of care, potential for saving,
and destination appeal affect the intention of the Indonesian people to take medical tourism trips
to Malaysia. The research was conducted using quantitative research methods with a survey
strategy for Indonesian people who are interested in medical tourism. The results are expected
to create collaboration between the government and health service stakeholders to support
medical tourism as a sustainable sector, creating quality medical services and in accordance with
the interests and needs of medical tourism travelers.
Keywords: medical tourism; intention; factors; Indonesia
INTRODUCTION
The phenomenon of medical tourism is a diversification of tourism by touching the world
of health which encourages economic growth and has a relatively significant contribution to the
tourism industry (Connell, 2013). Medical tourism itself is predicted to become a lifestyle and
has enormous potential (Pimpale, 2016). Many people are motivated to travel for medical
reasons, both for general check-up, treatment, and rehabilitation reasons. Medical tourism is a
form of effort to improve health through various efforts, alternatives or other medical services,
which are generally associated with recreational activities and are not carried out in the patient's
hometown (Laws, 1996). Heung et al., (2010) through their research describe the income that
can be obtained by a country through the medical tourism industry, where the contribution of
income that can be generated by this industry is around US $ 60 billion per year. In line with
this, Wong & Musa, (2012) project revenues of US$38–US$55 billion annually from the medical
tourism sector. Grand view research estimates that the market share and market size of medical
tourism will be valued at USD 4 billion in 2021 and is expected to continue to grow with an
annual growth rate of 32.51% from 2022 to 2030. Medical tourism has become a major
competitive area with many destinations, especially in developing countries (Çapar & Aslan,
2020).
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There have been many comprehensive studies that discuss the relationship between
medical tourism and various factors that encourage a person to want to carry out this medical
tourism activity (Vovk et al., 2021). Service quality is an important thing that affects the
satisfaction of medical tourists in determining the destination of their medical tourism
destinations (T.-H. Cham et al., 2021). The quality of service in question can be in the form of
food quality, hospital atmosphere, and services that positively have an impact and influence on
satisfaction, and the relationship successfully explains the formation of intentions (Han & Hyun,
2015). The same results were also obtained from a study conducted by Zarei & Maleki, (2019)
which showed that there are several factors that motivate a person to do medical tourism to
developing countries, one of which is the low cost of treatment and ease of access to this service.
So it is not surprising, several countries such as Thailand, Singapore and India have become
medical tourism centers for patients from the European continent.
Several other studies also try to see the relationship between a country's tourist attraction
factor and a person's interest in doing medical tourism. Bagga et al., (2020) stated that 45% of
medical tourism actors in India choose to stay for 5-15 days after undergoing medical treatment
and the average of these medical tourism actors combines the opportunity to travel/vacation
after undergoing medical treatment. In line with these findings, T. H. Cham et al., (2016) used
several analytical factors such as opportunities to combine vacations and medical care, suitable
places for relaxation after undergoing medical treatment, as well as a variety of tourist
destinations that can be enjoyed by medical tourism actors (country knowledge) in assessing
factors that influence patients from China in conducting medical tourism to Malaysia. As a
result, country knowledge, safety factors, accessibility, and reasonable prices have an important
role in influencing the interest of patients from China in conducting medical tourism to
Malaysia.
Based on studies related to previous literature, research sampling was entirely carried out
in various Asian countries other than Indonesia, such as India and Malaysia. In addition, there
is no research that describes in more depth the factors that affect the intention of the Indonesian
people in conducting medical tourism to Malaysia, even though in practice there are not a few
Indonesians who like to seek treatment and do medical tourism. This fact is in line with the
market analysis conducted by UNESCAP, the United Nations Economic and Social
Commission (UN) for Asia Pacific in 2007 which illustrates that medical tourists in Malaysia
are 60% from Indonesia. According to Komari & Djafar, (2021), some of the reasons why
Indonesians choose to seek treatment in Malaysia are Malaysian doctors never direct patients to
seek treatment in certain hospitals, clear and transparent diagnoses, clear communication and
procedures so that the cost of treatment becomes cheaper, and trust hospitals in Malaysia.
Therefore, this study aims to see more about the factors that influence the intention of the
Indonesian people in conducting medical tourism to Malaysia, especially related to service
quality variables, potential savings in medical costs, and tourist attractions of the destination
country.
The research questions for this article are:
1. Does the quality of service affect the intention of the Indonesian people to do medical tourism
to Malaysia?
2. Does the potential savings in medical costs in the destination country affect the intention of
the Indonesian people to conduct medical tourism to Malaysia?
3. Does the tourist attraction of the destination country affect the intention of the Indonesian
people to do medical tourism to Malaysia?
Meanwhile, the objectives to be achieved from this research are:
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1. Knowing the relationship between the level of service quality, the potential savings in medical
costs and the tourist attraction of the destination country to the intention of the Indonesian
people to conduct medical tourism to Malaysia
2. Provide an overview to the government and health service stakeholders, both in the country
of origin and destination country of medical tourism, regarding factors that affect a person's
intention in conducting medical tourism to Malaysia
3. Collaboration between health service stakeholders and the government to support medical
tourism as a sustainable sector
4. Creating quality medical services that are in accordance with the interests and needs of
medical tourism travelers.
RESEARCH METHODS
The research method used in this study is a quantitative research method with a survey
research strategy, which is to collect information from several people to describe, compare or
explain their knowledge, attitudes and behaviors (Sekaran & Bougie, 2016). The research was
carried out in the real environment without any interference from the research using the concept
of field studies. The data analysis unit is individual, where the survey is aimed at seeing the
perception of each individual towards the phenomenon and the reasons for their medical tourism
to Malaysia. Data will only be collected in one period to measure and see responses from
individuals.
The population in this study is Indonesian and the sample used is Indonesians who are
interested and have never done medical tourism to Malaysia. The independent parameters or
variables studied in this study consist of 3 variables, namely the quality of medical care, the
potential for saving medical costs and tourist attractions in the destination country. And for the
dependent variable is the intention to do medical tourism to Malaysia.
The survey method is the method that will be used in this study. The survey will be
distributed online using media such as WhatsApp and email. Surveys themselves are very
commonly used in various studies to collect quantitative and qualitative data, besides that the
costs that must be incurred are relatively low and the response speed is relatively high that can
be obtained from respondents. The survey will be distributed to Indonesians in various regions
such as Makassar, Mataram, Jakarta, and so on who are interested and have never undergone
inpatient or outpatient treatment in Malaysia. Furthermore, respondents will fill out a survey
consisting of 2 parts:
a. Respondent Profile
Includes name, gender, age, domicile, occupation, income span, and care you want to
undergo.
b. Approval Rate of Variables
Ask respondents for their opinions on the level of approval of the variables of medical
care quality, potential cost savings and tourist attractions in the destination country
The data collection method used is non-probability sampling with snowball sampling
technique which is a method to identify / select / take samples on a single network or
continuous chain of relationships. The total sample studied is a minimum of 110 samples
based on the calculation of all existing variables, both latent and manifest variables, so that
the minimum sample calculation is 5 X 22 = 110 samples. However, in this study, the number
of samples studied was 192 samples.
This study used data analysis using Smart PLS software. Validity Test and Reliability Test
will be conducted on the statements used in the survey. The results of the validity test will
describe the validity or validity of the statements contained in the survey. Meanwhile, the
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reliability test is used to see the level of reliability of a survey, where a survey is said to be reliable
if the respondent's statements are stable or consistent.
RESULT AND DISCUSSION
The survey was distributed to 225 respondents and out of 225 respondents 192 respondents
(85.3%) answered that they were interested in doing medical tourism to Malaysia and had never
done medical tourism before, while 33 respondents (14.7%) answered that they were not
interested or had done medical tourism before. The demographic characteristics of the data used
are presented in Table 1 which shows that most respondents were female with a composition of
59.4% respondents (114 respondents), with 77 respondents with male gender (40.1%), and 1
respondent who chose not to mention gender. The highest age range was in the age range of 21-
30 years as many as 90 respondents (46.9%), followed by the age of 31-40 years as many as 51
respondents (26.6%), aged 41-50 years as many as 35 respondents and 16 respondents with an
age range of 51-60 years. In terms of education level, the S1 degree was 159 respondents (82.2%),
followed by 16 respondents and 14 respondents who graduated from high school / equivalent
and others with the level of education graduates D1, S3 each 1 respondent. Meanwhile, based
on profession and occupation, most of them are private employees, namely 168 respondents
(87.5%) then entrepreneurs as many as 10 respondents (5.21%), with income per year in the
range of < Rp 240 million per year. Meanwhile, based on the domicile of respondents, it is
dominated by respondents domiciled in DKI Jakarta, namely 47 respondents (24.2%).
Table 1 Respondent's Demographic Profile
Demographics
Category
Frequency
Percentage (%)
Gender
Woman
114
59.4%
Men
77
40.1%
Vote not to mention
1
0.5%
Age
21-30 Years
90
46.9%
31-40 Years
51
26.6%
41-50 Years
35
18.2%
51-60 Years
16
8.3%
Education
S1
159
82.8%
S2
16
8.3%
High School/Equivalent
13
7.3%
D1
1
0.5%
S3
1
0.5%
Work
Private Employees
168
87.50%
Self employed
10
5.21%
Not Working/ Retired
7
3.65%
Housewives
2
1.04%
Employees of SOEs
1
0.52%
Personal Trainer
1
0.52%
Pension
1
0.52%
Student
1
0.52%
Income/Year
< 240,000,000
104
54.7%
240.000.001 - 600.000.000
61
32.3%
Not Working
11
5.7%
600.000.001 - 1.200.000.000
9
4.7%
> 1,200,000,000
5
2.6%
Domicile
Jakarta
47
24.5%
Banten
35
18.2%
South Sulawesi
28
14.6%
West Nusa Tenggara
21
10.9%
West Java
16
8.3%
Bangka Belitung
10
5.2%
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East Java
10
5.2%
Bali
7
3.6%
North Sulawesi
5
2.6%
D I Yogyakarta
3
1.6%
South Sumatra
3
1.6%
North Sumatra
2
1.0%
Riau
1
0.5%
West Sulawesi
1
0.5%
Central Sulawesi
1
0.5%
East Kalimantan
1
0.5%
Buoys
1
0.5%
SEM PLS modeling
All constructs that are latent variables and item code which are manifest variables in
this study are designed to be modeled in Structural Equation Modelling-Partial Least Square
(SEM-PLS) (Memon et al., 2021).
Figure 1 Model PLS Path
From the test results of the three latent variables, the results of all the outer loading manifest
variable values were at a > value of 0.708 and for the R Square value was 17.5% which indicates
that the variable intention of the Indonesian people to conduct medical tourism to Malaysia can
be explained by 17.5% by the variables of quality of care, potential cost savings and tourist
attraction of the destination country.
Table 2 Convergent validity and reliability values
Cronbach's Alpha
rho_A
Composite
Reliability
Average Variance
Extracted (AVE)
Destination Appeal
0.943
1.031
0.95
0.792
Intention To Conduct Medical Tourism
0.954
0.958
0.971
0.917
Potential for Saving
0.906
0.932
0.929
0.724
Quality Of Care
0.907
0.914
0.931
0.729
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Based on the results of validity and reliability tests, the results for Cronbach's
Alpha and Composite Reliability values of 3 variables are at a value of > 0.7 and the
Average Variance Extracted (AVE) value is at a value of > 0.5, this condition
indicates that all constructs have met the convergent validity requiremen.
Discriminant Validity Test
Based on the measurement results on discriminant validity, the HTMT
parameter is at a value of < 0.9 so that the model is declared valid. As for the Fornell
and Larcker Criterion measurements, the entire bolded diagonal value is already
worth more than the relationship coefficient between latent constructs, so under these
conditions it can be stated that the measurement model is valid.
Table 3 Discriminant Validity Value : HTMT
Destination
Appeal
Intention To Conduct
Medical Tourism
Potential
for
Saving
Quality
Of Care
Destination Appeal
Intention To Conduct
Medical Tourism
0.095
Potential for Saving
0.122
0.266
Quality Of Care
0.099
0.407
0.328
Table 4 Discriminant Validity Value : Fornell and Larcker Criterion
Destination
Appeal
Intention To Conduct
Medical Tourism
Potential for Saving
Quality
Of Care
Destination Appeal
0.89
Intention To Conduct
Medical Tourism
0.126
0.957
Potential for Saving
0.132
0.261
0.851
Quality Of Care
0.117
0.384
0.302
0.854
Test the Hypothesis
Table 5 Hypothesis Test Results
Origina
l Sample
(O)
Sample
Mean
(M)
Standard
Deviation
(STDEV)
T Statistics
(O/STDEV)
P Values
Decision
Quality Of Care ->
Intention
0.33
0.327
0.076
4.346
0
Accepted
Potential for Saving -
> Intention
0.152
0.163
0.07
2.16
0.015
Accepted
Destination Appeal -
> Intention
0.067
0.065
0.109
0.615
0.269
Rejected
Based on the hypothesis testing carried out against the three hypotheses
proposed in this study, the results were obtained that two hypotheses were accepted
and one hypothesis was rejected.
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H1 : The quality of service affects the intention of the Indonesian people to conduct
medical tourism to Malaysia (Accepted)
Where based on the test results, the p value shows a value of 0.000 (< 0.005).
H2 : Potential cost savings that must be incurred in the destination country affect the
intention of the Indonesian people in conducting medical tourism to Malaysia
(Accepted)
Based on the tests carried out, obtained a p value of 0.015 (< 0.005), this
condition indicates an accepted hypothesis.
H3 : Destination Appeal affects the intention of the Indonesian people in conducting
medical tourism to Malaysia (Rejected)
Based on the tests carried out, a p value of 0.269 (> 0.005) was obtained, this
condition shows that the hypothesis is rejected.
CONCLUSION
Based on the test results, it was concluded that from three variables, namely
quality of care, potential for saving, and destination appeal, there are two variables,
namely quality of care and potential for saving which shows the influence on the
interest of the Indonesian people to carry out medical tourism. to Malaysia. And it
can be concluded that the Indonesian people do not consider the tourist attraction
factor of the destination country when deciding to do medical tourism in Malaysia.
The limitation of this research is that this research only measures the interest of
Indonesians who have the potential to do medical tourism to Malaysia, research can
be developed to further measure the reasons for Indonesian people who have done
medical tourism to Malaysia and intend to do re-treatment (revisit).
This research can be used by governments in Indonesia and Malaysia in
assessing the potential of medical tourism in each country. The results of the research
are expected to create collaboration between the government and health service
stakeholders to support medical tourism as a sustainable sector, creating quality
medical services and in accordance with the interests and needs of medical tourism
travelers.
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Copyright holders:
Fransisca Kusuma Ningrum, Ferry Novrianto Suthiono, Martinus Prananta,
Tara Farina Srihadi (2023)
First publication right:
AJHS - Asian Journal of Healthy and Science
This article is licensed under a Creative Commons Attribution-ShareAlike 4.0
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