The Study of Integrated Marketing Communication for Medical Tourism in Thailand

The Study of Integrated Marketing Communication for Medical Tourism in Thailand

Supak Nunabee¹, Kanokkarn Keawnuch²

¹Ph.D. candidate from the Graduate School of Tourism Management, National Institute of Development Administration, Thailand

²Associate Professor, Ph.D. from the Graduate School of Tourism Management, National Institute of Development Administration, Thailand

DOI: https://dx.doi.org/10.47772/IJRISS.2025.9020138

Received: 31 January 2025; Accepted: 05 February 2025; Published: 07 March 2025

ABSTRACT

The concept of medical tourism has witnessed substantial growth in recent years, with patients seeking high-quality medical services while simultaneously enjoying travel experiences. This study examines the integrated marketing communication (IMC) strategies utilized within the context of medical tourism in Thailand, a globally recognized leader in the field. By leveraging a combination of communication channels, including sales promotion, public relations, advertising, personal sales, electronic word-of-mouth (e-WOM), and electronic marketing. Data were collected from 304 respondents who were Middle Eastern medical travelers in Thailand. This research provides the key components of Thailand’s integrated marketing communication approach for medical tourism. Results were analyzed using the technique of confirmatory factor analysis. The findings indicate that the most critical component of integrated marketing communication in this context is electronic word-of-mouth (e-WOM), followed by public relations, advertising, personal sales, sales promotion, and, lastly, electronic marketing. The insights derived from this study offer valuable guidance for stakeholders seeking to enhance their marketing communication strategies within the medical tourism industry. As the healthcare and tourism sectors continue to evolve in tandem, this analysis highlights the importance of a well-coordinated integrated marketing communication strategy in strengthening the global competitiveness of medical tourism destinations such as Thailand.

Keywords: Integrated Marketing Communication, Medical Tourism 

INTRODUCTION

In recent years, medical tourism has become one of the most dynamically developing priority direction of Thai economy. The medical tourism industry has been growing in recent decades for several reasons, including the dissatisfaction of patients with health care in the country in which they live; restricted access to drugs at an appropriate rate, in a reasonable time or in a sensitive context; no sufficient insurance and revenue to pay for domestic procedures; increased consumerism and a wealth of information on medical travel. In other words, medical tourism has grown as a result of developments in the institutional context of medical care, of a more global economy of access to health and of new attitudes towards personal identity and medical care, facilitated by advances in international communication, transport and tourism. Thailand is one of the most popular tourist destinations in Asia, especially in South East Asia.

According to the World Tourism Organization (UNWTO), Thailand is the 10^th most popular destination in the world in 2017 with a 4^th position in terms of tourism receipts (World Tourism Organization, 2018). According to the International Healthcare Research Center (IHRC), Thailand’s medical tourism industry is ranked sixth in the world due to its lower medical costs and attractive tourist attractions. The market expects to increase by around 14% a year, according to the growth, which is around 12% annually, of international travelers to Thailand. Thailand is expected to receive 4 million international patients in 2017. These numbers of medical tourists reflect the competitiveness of Thailand compared to its competitors, particularly those competing nations within the ASEAN Economic Community (AEC), Singapore and Malaysia (Tunyaporn Laosophapirom, 2017)

At present, it is more competitive in the tourism industry. Tourism as an essential revenue-generating strategy for the region. As a result, in order to grow Thailand economy to increase its competitiveness and build tourism characteristics that are in line with the needs of tourists. Thailand attracts medical tourists because it offers high quality and readily accessible medical services at affordable rates, while enabling patients to combine treatment with vacationing.

In addition, to promote Medical Tourism in Thailand by using and understanding Integrated Marketing Communication (IMC) is greatly significant. This is because IMC is a marketing-oriented business strategy that encompasses and integrates all the many forms of communication and marketing within an organization. The market for medical tourism is growing beyond the needs of innovators and into the mainstream, which requires unavoidably the application of specialized attention and concentration in order to acquire a position of advantage in the competition. IMC would be the benefit tool for promoting medical tourism in Thailand. It is currently regarded as a holistic idea by a great number of authors and in a great number of studies (Daszkiewicz & Pukas, 2016; Finne & Grönroos, 2009; Mihart (Kailani), 2012; Porcu et al. (2017); Šeric et al., 2015). Therefore, the use of integrated marketing communications can provide businesses with a variety of advantages, including the flexibility to adapt each and every communication channel, the integration of several channels into a unified strategy, and many more.

LITERATURE REVIEW

Medical Tourism

Medical tourism was defined by Tourism Research and Marketing (2006) as any mode of travel from the usual place of residence to a destination where medical or surgical services are given or performed. Travel must require more than one night away from the country of residence. Medical tourism is also known as health tourism, health care tourism, therapeutic vacation as well as many other names which basically refer to the definitions presented below. Healthcare tourism was defined twenty years ago by Goodrich & Goodrich as “the attempt on the part of a tourist facility or destination to attract tourists by deliberately promoting its health-care services and facilities, in addition to its regular tourist amenities”.

Figure 1 the relationship between Medical Tourism and Wellness Tourism

Source: Hall, 2011

In the past few years, the new idea of Medical Tourism has emerged; it combines health care and leisure travel. The trend of traveling to another region or country for medical reasons has risen in popularity, especially in developed countries. The basic goal of foreign traveling patients is to obtain quality treatment combined with high-end health care facilities in recognized hospitals. Modern hospital facilities, customized treatment services, certified medical staff, and cost-efficient health care procedures are main factors for medical tourism. In many developed countries, such as the United States, the United Kingdom, Japan, Australia, etc., the cost of health care is rising. As a result, more and more individuals overseas are finding affordable health care facilities.

Overview of Medical Tourism in Thailand

Medical tourism has also been identified as involving patients from high-income countries traveling to cheaper and better treatment in low-and middle-income countries. Other assurance schemes and awards such as the Thailand Hospital Accreditation Program (HA), led by the Hospital Quality Improvement & Accreditation Institute (ISO), are also certified to the quality of Thailand’s medical services. According to a report by the Healthcare Accreditation Institute (2016), there are currently 761 public and private hospitals accredited by HA. Safety and quality are an important concern among international patients.

Thailand are such a good choice for overseas patients looking for affordable, high quality treatment. For the purposes of medical tourism, the challenge is in finding a location whose hospitals fit both descriptions. If the suitable destination country has other attractions as well, then it becomes a highly desirable place for medical tourists to visit. Medical tourism in Thailand shines very brightly on the world stage. Its increasingly high-tech economy reflects heavy investment in healthcare and infrastructure, while offering a modest living cost that is more typically seen in developing countries around the world. Thai hospitals have gained a well-deserved reputation for excellence, with advanced equipment and internationally qualified physicians, which provide excellent care at a fraction of the costs of hospitals in countries like the United States.

Thailand network of quality medical facilities offers extensive information on other traditionally associated expensive private hospitals such as short waiting periods as well as the careful and unstressed nature of staff. The generous hospitality of Thailand and national harmony provide the ideal accompaniment to medical care, with a friendly atmosphere in Thailand that helps to keep patients happy during their recovery. Accessibility is another primary benefit for medical tourism in Thailand. A visit to Thailand has never been easier to arrange thanks to the excellence of international airports across the country and the low-cost airlines enabling rapid transport.

The Thailand Board of Investment (2016) indicated that the potential of Thailand as a medical tourism center described as follows: for example, elective surgery in Thailand’s best private hospitals is often one-tenth the cost of the same operation if performed in the United States. With the value of Organization for Economic Cooperation and Development [OECD] nations’ health care sector having been estimated to be as high as US$3 trillion and the United States at US$2 trillion, the potential for Thailand is significant. (Medical Tourism Index, 2017).

Table 1 Medical Tourism Compare Prices (In selected countries)

Thailand also has a reputation for providing excellent medical care, and doctors are well-trained to very high standards. This has assisted Thailand in its position as a regional leader in medical tourism (Noree, Hanefield & Smith, 2016). Furthermore, it has been reported that Thailand faces strong competition from potential providers of medical tourism on the domestic market, as well as from Asian rivals such as Singapore, Malaysia and South Korea, all of whom are trying to become regional leaders in medical services (Wanwisa Ngamsangchaikit, 2017).

Consequently, according to the Thai government adopted a five-year strategic plan to develop the country’s capacity into a “Centre for Excellent Health in Asia.” Beyond medical tourism, Thailand is also extending its ability not just in medical tourism but also in other related areas as, “Thailand excels in the medical care it delivers on a daily basis to patients from over 190 countries, and the Kingdom is also gaining recognition as a location for research and for clinical trials (Thailand Board of Investment, 2016).”

Medical Tourist Behavior

Travelers who use medical tourism services constitute a sizable group in terms of health or inherited disorders, demanding annual health check-ups, rehabilitation, and other medical treatments. They can take a vacation and receive medical care at the same time (Surapong and Piyanuch, 2003). The sample group for the study of medical tourism behavior among international medical tourists included 400 foreign medical tourists who used medical services in Thailand at hospitals and medical tourism service providers. According to the study’s findings, the bulk of the tourists were males aged 31 and older, with a career as an expert or executive and an average monthly income of 2,000–4,000 USD. They stayed in Bangkok for recuperation after obtaining medical services before traveling to Chiang Mai and Phuket. Tourists preferred dental services, followed by annual health check-ups, LASIK, plastic surgery, and hip or knee replacements. The treatment cost approximately $1,300 USD, and the stay in Thailand lasted approximately 18 days (Pimpa et al., 2009).

The behavior of Middle Eastern medical travelers in this study utilizing integrated marketing communication (IMC) within Thailand’s medical tourism sector represents a crucial intersection of healthcare and cultural expectations. As Thailand has emerged as a premier destination for medical tourism, attracting millions of international patients annually due to its high-quality, affordable healthcare, the specific behaviors and preferences of Middle Eastern travelers have garnered attention. This demographic often seeks advanced medical treatments combined with luxury experiences that resonate with their cultural values and religious practices, making their approach to medical tourism unique and noteworthy.

In addition to receiving treatment that was less expensive than receiving healthcare in their native nation, medical tourists travelled to Thailand for the medical services largely for relaxation purposes. The medical professionals in Thailand were highly known for using cutting-edge tools and technology. As indicated by those who had traveled to be treated there or used the facility, tourists also came to use the hospital’s services because it offered excellent medical treatment. Due to the lack of specialists and lengthy waiting times in their home countries, numerous tourists come to Thailand specifically to receive medical treatment. The majority of medical tourists who came to use the services were pleased with the medical care offered by the hospitals they used and were expected to revisit to use the service in the future.

Integrated Marketing Communication

Integrated Marketing Communication (IMC) is a strategic approach that combines various marketing tools and channels to deliver a unified and consistent message to target audiences. IMC ensures that all communication efforts are aligned to create synergy, enhance brand equity, and improve customer engagement (Belch & Belch, 2021). The following sections explore the key components of IMC: sales promotion, public relations, advertising, personal sales, electronic Word of Mouth (eWOM), and electronic marketing.

Sales Promotion

Sales promotion refers to short-term incentives designed to encourage immediate purchase or engagement with a product or service. It includes discounts, coupons, contests, and loyalty programs. According to Kotler and Keller (2016), sales promotion is a critical component of IMC because it directly influences consumer behavior and drives short-term sales. Research by Chandon, Wansink, and Laurent (2000) highlights that sales promotions not only attract new customers but also reinforce loyalty among existing ones. However, over-reliance on sales promotions can erode brand equity if not integrated with other IMC tools.

Public Relations

Public relations involve managing a brand’s reputation and fostering positive relationships with stakeholders through media coverage, events, and community engagement. Public relations is a vital IMC component because it builds credibility and trust, which are essential for long-term brand success (Grunig & Hunt, 1984). In the context of IMC, public relations complements advertising and sales promotion by creating a favorable environment for marketing efforts. For example, a well-executed public relations campaign can amplify the impact of advertising by generating earned media coverage (Kitchen & Burgmann, 2015).

Advertising

Advertising is one of the most visible components of IMC, involving paid media to promote products or services. It plays a crucial role in building brand awareness and shaping consumer perceptions. According to Belch and Belch (2021), advertising is most effective when integrated with other IMC tools to reinforce the brand message across multiple touchpoints. Studies by Keller (2009) emphasize that consistent advertising messages across channels enhance brand recall and customer loyalty. Digital advertising, in particular, has become a dominant force in IMC due to its ability to target specific audiences and measure campaign effectiveness.

Personal Sales

Personal sales, or personal selling, involve direct interaction between sales representatives and potential customers. This IMC component is particularly effective for high-involvement products or services that require personalized attention (Kotler & Keller, 2016). Personal selling allows for two-way communication, enabling sales representatives to address customer concerns and build relationships. Research by Moncrief and Marshall (2005) highlights the importance of integrating personal sales with digital tools to enhance efficiency and effectiveness in modern IMC strategies.

Electronic Word of Mouth (e-WOM)

Electronic Word of Mouth (e-WOM) refers to the online sharing of opinions, reviews, and recommendations about products or services. Electronic Word of Mouth has become a powerful IMC tool due to its credibility and reach. According to Hennig-Thurau et al. (2004), e-WOM influences consumer decision-making more than traditional advertising because it is perceived as authentic and unbiased. Platforms like social media, review websites, and online forums facilitate e-WOM, making it an essential component of digital marketing strategies. In the context of IMC, e-WOM complements advertising and public relations by amplifying brand messages through user-generated content.

Electronic Marketing (e-Marketing)

Electronic marketing, or e-marketing, encompasses all marketing activities conducted through digital channels, including websites, email, social media, and mobile apps. E-marketing is a cornerstone of modern IMC because it enables brands to reach global audiences, personalize communication, and measure campaign performance in real time (Chaffey & Ellis-Chadwick, 2019). Research by Tiago and Veríssimo (2014) highlights that e-marketing enhances IMC by integrating data-driven insights into marketing strategies, enabling brands to deliver relevant and timely messages to their target audiences.

The integration of these components: sales promotion, public relations, advertising, personal sales, e-WOM, and e-marketing is essential for achieving IMC objectives. According to Schultz and Schultz (2004), successful IMC campaigns leverage the strengths of each component to create a cohesive and impactful brand message. For example, a campaign might use advertising to build awareness, public relations to generate credibility, sales promotion to drive immediate action, and e-WOM to sustain engagement. The synergy among these tools enhances the overall effectiveness of marketing efforts and ensures a consistent brand experience across all touchpoints.

METHODOLOGY

Population and Sample

The population of interest is Middle East medical travelers in Thailand. The annual report from the Department of Health Service Support shows that the number of medical travelers before the COVID-19 pandemic was higher than a million. Sampling was needed in this research in order to meet the availability of population elements, reduce the cost of data collection and save time (Cooper & Schindler, 2003). Therefore, the samples of the study are Middle Eastern medical travelers who obtained an annual health check-up at three private hospitals in Bangkok, Thailand. Bumrungrad International hospital, Vejthani hospital and Bangkok hospital represent the highest international quality and safety standards for foreign patients visiting these three hospitals for treatment and care through our consistent clinical standards and various international accreditations. This research adopts non-probability sampling to calculate sample sizes and to identify sampling techniques.

Research Tool

The questionnaire was chosen as the principal tool of quantitative research due to the large sample size and cost effectiveness. Both English and Arabic questionnaires were distributed to target samples. The questionnaire was used as a quantitative research tool to collect opinions and suggestions from a large population sample size (Mann, 2003). It was a series of closed-ended questions regarding integrated marketing communication, perception, satisfaction and revisit intention. The questionnaire was developed according to relevant documents, research papers and concepts to identify definition, research scope and structure. Developing questionnaire of research on a structural equation model of integrated marketing communication, perception, satisfaction and revisit intention of Middle East medical travelers. The questionnaire is five rating scales as follows:

Level 5: the highest level of agreement

Level 4: high level of agreement

Level 3: moderate level of agreement

Level 2: low level of agreement

Level 1: The lowest level of agreement

Data Analysis

Descriptive Statistics Analysis: The Descriptive Statistics method was used to dissect the individual information contained in the checklist, which the researcher found useful. In order to determine statistical significance, the information gathered was broken down into its constituent parts, which included the statistics that were used: frequency, percentage, mean, and standard deviation. Confirmatory Factory Analysis: CFA is a tool that allows researchers to either confirm or reject a biased hypothesis based on their findings. The factor examination can be conducted from either an exploratory or a confirmatory perspective, depending on the motivation for the examination (Hair et al., 2018). It’s a technique for determining how well a predetermined estimating hypothesis made up of estimated components and factors matches reality as captured by data. It’s a method for checking information coherence using models that allocate latent variables to a set of observable variables for indistinguishable reasons.

RESULTS

The study included 304 questionnaire respondents who were Middle East medical travelers in Thailand. There were 177 males and 127 females who participated in the survey. Most respondents were from Generation Y, which includes individuals aged between 24-39 years old, and the majority were married. Furthermore, in terms of educational level, most respondents had a bachelor’s degree. Most respondents were government employees. Lastly, regarding the respondents’ nationality, the majority were from Egypt.

The analysis results summarize that integrated marketing communication consists of 6 components, namely sales promotion, public relations, advertising, personal sales, electronic Word-of-Mouth (e-WOM), and electronic marketing. The sales promotion component comprises 4 observable variables, namely MCA1, MCA2, MCA4, and MCA5. The components of public relations are measured by observing 3 variables: MCB1, MCB2, and MCB3. The components of advertising are measured by observing 6 variables: MCC1, MCC2, MCC3, MCC4, MCC5, and MCC6. The components of personal sales are measured by observing 3 variables: MCD1, MCD2, and MCD4. The components of electronic Word-of-Mouth (e-WOM) are measured by observing 5 variables: MCE1, MCE2, MCE3, MCE4, and MCE5. The components of electronic marketing are measured by observing 4 variables: MCF2, MCF3, MCF4, and MCF5.

The results indicated that the significance of integrated marketing communication was rated at the highest level. The order of significance from most to least significant in integrated marketing communication components was as follows: electronic word-of-mouth (e-WOM) was the most significant, followed by public relations, advertising, personal sales, sales promotion, and finally, electronic marketing, which was the least significant.

The model fit the second confirmatory factor analysis of integrated marketing communication with significance after the researcher readjusted the model according to the model fit criteria.

Figure 2 Second Order Measurement Model of Integrated Marketing Communication

DISCUSSION

This study showed that the most important components of integrated marketing communication for medical tourism in Thailand are electronic word-of-mouth (e-WOM), when considering the weights of the variables from the standard weight coefficient values, it is evident that Electronic Word-of-Mouth (e-WOM) is of utmost importance, followed by public relations, advertising, personal sales, and sales promotion in descending order. This finding is in line with several studies that explored the implementation of electronic Word-of-Mouth (e-WOM) tools in the context of medical tourism and healthcare, emphasizing their role in influencing patient decisions and promoting healthcare services. Verhoef et al. (2019) highlighted how e-WOM on social media platforms significantly impacts patient choices for medical services, particularly in medical tourism, where trust and reputation are critical. Similarly, Yeoh, Othman, and Ahmad (2013) explored the role of e-WOM in promoting Malaysia as a medical tourism destination, finding that online reviews and testimonials enhance destination credibility and attract international patients.

In another study, Lunt and Carrera (2010) examined the influence of e-WOM on cross-border healthcare, showing that patient-generated content on forums and review sites helps prospective patients evaluate healthcare providers. Han and Hyun (2015) focused on the hospitality aspect of medical tourism, demonstrating that positive e-WOM about service quality and patient experiences fosters trust and loyalty among medical tourists. Moreover, Heung, Kucukusta, and Song (2011) analyzed the role of e-WOM in the decision-making process of medical tourists in Asia, revealing that online reviews and recommendations are among the most influential factors.

Lastly, Horowitz and Rosensweig (2007) discussed the growing reliance on e-WOM platforms for researching medical tourism destinations, emphasizing that patient testimonials and online discussions are critical in shaping perceptions of quality and safety. These studies collectively underscore the importance of e-WOM tools in building trust, enhancing reputation, and driving patient engagement in the healthcare and medical tourism sectors.

LIMITATIONS AND FUTURE RESEARCH

Middle Eastern Medical Travelers may have concerns about privacy and confidentiality, particularly regarding sensitive information. This could lead to a reluctance to participate or provide detailed responses in data collection efforts. Furthermore, accessing Middle Eastern Medical Travelers in Thailand for data collection purposes was difficult due to factors such as limited availability, mobility restrictions, or the transient nature of their stay. Identifying and reaching out to potential participants can be challenging. For future research, should prioritize market research and analysis by collaborating with government research institutions and industry associations to undertake market research and analysis on significant target markets for medical tourism. Findings from this research can guide the creation of focused integrated marketing communication (IMC) strategies customized to the interests and requirements of different segments of other international medical travelers.

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