Service Quality in Iran’s Medical Tourism: Hospitals in Shiraz City

Document Type : Original Article


1 Clinical Research Development Center, Shiraz University of Medical Sciences, Nemazee Hospital, Shiraz, IR Iran

2 Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, IR Iran

3 Department of Health Services Management, Isfahan University of Medical Sciences, Isfahan, IR Iran

4 Department of Health Services Management, Shiraz University of Medical Sciences, Shiraz, IR Iran


Introduction: Medical tourism is a main source of national income. Thus, evaluating the viewpoints of medical tourists about the quality of service provided by healthcare centers may be useful in planning to develop this industry. The present study aimed to measure the gap between medical tourists' expectations and perceptions of the quality of service offered by the hospitals in Shiraz using the SERVQUAL model.
Methods: This cross-sectional study was performed on 200 medical tourists referred to hospitals in the city of Shiraz which is located in the south of Iran. The subjects were selected randomly over the first 6 months of 2013. Data collection tools were a descriptive questionnaire and an adaptation of the SERVQUAL questionnaire.
Results: The results showed that the mean age of medical tourists was 49.67 and most of them were from Oman. Overall, the patients' expectations exceeded their perceptions of the provided quality of service, and all gap mean scores were negative. The largest negative gap score pertained to reliability with an overall average of -0.59, followed by responsibility, assurance, tangibility, empathy, and access to care.
Conclusion: The research findings can effectively help managers identify problems with the current quality of service and improve performance so as to increase the medical tourists' satisfaction level. Also, highlighting the most important service attributes, which are highly attractive to patients, will help authorities improve their operation performance and develop innovative ideas on both strategic and tactical levels.


  1. Ayoubian A, Tourani S, Hashemi Dehaghi Z. Medical tourism attraction of Tehran hospitals. Int J Travel Med Glob Health. 2013;1(2):95-8.
  2. Hall CM. Introduction to tourism: development, dimensions and issues: Longman; 1998.
  3. Caballero-Danell S, Mugomba C. Medical tourism and its entrepreneurial opportunities: A conceptual framework for entry into the industry. 2007.
  4. Lunt N. Medical tourism: treatments, markets and health system implications: a scoping review: OECD, Directorate for Employment, Labour and Social Affairs; 2011.
  5. Piazolo M, Zanca NA. The economics of medical tourism a case study for the USA and India. Óbuda University, Keleti Faculty of Economics, India. 2010.
  6. Kazemi Z. Study of effective factors for attracting medical tourist in Iran. Research paper requirements for the MS degree, Lulea University of Technology, Netherlands. 2007.
  7. Izadi M, Ayoobian A, Nasiri T, Joneidi N, Fazel M, Hosseinpourfard M. Situation of health tourism in Iran; opportunity or threat. Mil Med J. 2012;14(2):69-75.
  8. Jabbari A, Ferdosi M, Keyvanara M, Agharahimi Z. Stakeholders’ analysis of the medical tourism industry: development strategies in Isfahan. J Educ Health Promot. 2013;2.
  9. Jabbari A, Najar A, Nezamdoost F, Ebrahimipour H. Are Mashhad hospitals ready for medical tourists? Int J Health System Disaster Manag. 2014;2(3):170.
  10. Jabbari A, Agharahimi Z, Hosseini S, Safari F. Capabilities of infertility tourism in Isfahan: A qualitative study 1. Int J Health System Disaster Manag. 2013;1(2):99.
  11. Masoud F, Alireza J, Mahmoud K, Zahra A. A systematic review of publications studies on medical tourism. J Educ Health Promot. 2013;2.
  12. Zarchi MR, Jabbari A, Rahimi SH, Shafaghat T, Abbasi S. Preparation and Designing a Checklist for Health Care Marketing Mix, with Medical Tourism Approach. Int J Travle Med Glob Health. 2014;1(3):103-8.
  13. Jabbari A, Delgoshaei B, Mardani R, Tabibi SJ. Medical tourism in Iran: Issues and challenges. J Educ Health Promot. 2012;1.
  14. Jabbari A, Kavosi Z, Gholami M. Medical tourists' profile in Shiraz. Int J Health System Disaster Manag. 2014;2(4):232.
  15. Rokni L, Pourahmad A, Langroudi MHM, Mahmoudi MR, Heidarzadeh N. Appraisal the potential of central Iran, in the context of health tourism. Iran J Public Health. 2013;42(3):272.
  16. Jabbari A, Zarchi MKR, Kavosi Z, Shafaghat T, Keshtkaran A. The marketing mix and development of medical tourism in Shiraz. Mater Sociomed. 2013;25(1):32.
  17. Cronin Jr JJ, Taylor SA. Measuring service quality: a reexamination and extension. J Mark. 1992:55-68.
  18. Parasuraman A, Berry LL, Zeithaml VA. Understanding customer expectations of service. Sloan Manag Rev. 1991;32(3):39-48.
  19. Parasuraman A, Zeithaml VA, Berry LL. A conceptual model of service quality and its implications for future research. J Mark. 1985:41-50.
  20. Parasuraman A, Zeithaml VA, Berry LL. Servqual: A Multiple-Item Scale for Measuring Consumer Perceptions of Service Quality dalam Journal of Retailing. J Retailing. 1988;64(1):12-39.
  21. Zeithaml VA, Berry LL, Parasuraman A. The nature and determinants of customer expectations of service. J Aca Mark Sci. 1993;21(1):1-12.
  22. Seth N, Deshmukh S, Vrat P. Service quality models: a review. Int J Quality Reliability Manag. 2005;22(9):913-49.
  23. Zeithaml VA, Bitner MJ, Gremler DD. Services marketing: Integrating customer focus across the firm. 2006.
  24. Lin H-C, Xirasagar S, Laditka JN. Patient perceptions of service quality in group versus solo practice clinics. Int J Qual Health Care. 2004;16(6):437-45.
  25. Rao KD, Peters DH, Bandeen-Roche K. Towards patient-centered health services in India—a scale to measure patient perceptions of quality. Int J Qual Health Care. 2006;18(6):414-21.
  26. Van Duong D, Binns CW, Lee AH, Hipgrave DB. Measuring client-perceived quality of maternity services in rural Vietnam. Int J Qual Health Care. 2004;16(6):447-52.
  27. Speight J. Assessing patient satisfaction: concepts, applications, and measurement. Value Health. 2005;8(s1):S6-S8.
  28. Cheng Lim P, Tang NK. A study of patients' expectations and satisfaction in Singapore hospitals. Int J Health Care Qual Assur. 2000;13(7):290-9.
  29. Andaleeb SS, Siddiqui N, Khandakar S. Patient satisfaction with health services in Bangladesh. Health Policy Plan. 2007;22(4):263-73.
  30. Peprah AA, Atarah BA. Assessing Patient’s Satisfaction using SERVQUAL Model: A Case of Sunyani Regional Hospital, Ghana. Int J Bus Soc Res. 2014;4(2):133-43.
  31. Shaarbafchizadeh N, Tourani S, Abolhassani N, Bastani P, Aazami S. Medical Tourism industry; Challenges and Opportunities. Jökull Journal. 2013;63(10):119-33.
  32. Ahmad ZB, Yusuf WZBW, Sidi NSBS. Johor’s Potential as Medical Tourist Destination: Measurement of Service Quality used Medical Tourism (MT)-SERVQUAL. 2014.
  33. Udupa AR, Kotreshwar G. Implications of Service Quality Model for Medical tourism in India. Asian J Manag. 2010;1(2):65-8.
  34. Guiry M, Vequist DG. Traveling abroad for medical care: US medical tourists' expectations and perceptions of service quality. Health Mark Q. 2011;28(3):253-69.
  35. Cho WH, Lee H, Kim C, Lee S, Choi KS. The impact of visit frequency on the relationship between service quality and outpatient satisfaction: a South Korean study. Health Serv Res. 2004;39(1):13-34.
  36. Karassavidou E, Glaveli N, Papadopoulos CT. Health Care Quality in Greek NHS Hospitals: No one knows better than patients. 2008.
  37. Wong JC. Service quality measurement in a medical imaging department. Int J Health Care Qual Assur. 2002;15(5):206-12.
  38. Yeşilada F, Direktör E. Health care service quality: A comparison of public and private hospitals. Afr J Bus Manag. 2010;4(6):962-71.
  39. Amin M, Zahora Nasharuddin S. Hospital service quality and its effects on patient satisfaction and behavioural intention. Clinical Governance: An International Journal. 2013;18(3):238-54.
  40. Tang C, Luo Z, Fang P, Zhang F. Do patients choose community health services (CHS) for first treatment in China? Results from a community health survey in urban areas. J Community Health. 2013;38(5):864-72.
  41. You L-m, Aiken LH, Sloane DM, Liu K, He G-p, Hu Y, et al. Hospital nursing, care quality, and patient satisfaction: cross-sectional surveys of nurses and patients in hospitals in China and Europe. Int J Nurs Stud. 2013;50(2):154-61.