4.4 Case study strategy
4.4.3 Case study design for theory building
The following presents the details of the process of the aim of this case study.
4.4.3 Case study design for theory building
Case study is apt for exploring, explaining, understanding and describing the research problem or question (Farquhar, 2012). In particular, Eisenhardt (1989) indicates that case studies can be used to accomplish various aims: to provide description, test theory or generate theory (p. 533). This study aims to develop a model of CPV as KSF of MT in South Korea. The overall process of building a theory from the case study have been thus adopted from Eisenhardt (1989) and applied to this study as shown in Figure 17.
The procedure was described as following eight steps. This is presented through Chapters 2-6 in the thesis. The five formulated research questions from the previous chapter were firstly answered based on the literature, and the key inquiries of this research were explored within this case study design.
Figure 17 Process of building theory from case study research Adapted by Eisenhardt (1998).
Step 1. Getting started: Developing conceptual framework with research questions
Activity Reason Application to this study
Possible prior constructs, define research questions
Focuses efforts better, provides better grounding of constructs measures, retains theoretical flexibility
Conceptual framework with the potential key elements has developed based on the identified gaps in the literature through Chapters 2 and 3. In particular, this has employed the key research models of industry and consumer perspectives based on the studies of Heung et al. (2011) and Wang (2012). To focus on the specific investigation, the five research questions are created and answered based on the literature.
RQ1. How is medical tourism defined and understood?
In the literature, there are two different views to explain the term. Some (Carrera and Bridges, 2006; Cohen, 2010; Smith and Puczko, 2009) see it as travel abroad or to
Bookman and Bookman, 2007) see it as combination of travel abroad for medical treatment and tourism activities or a holiday. Also, in more detail, the others (Edelheit, 2008; Deloitte, 2008; Yu and Ko, 2012) include more specific purposes such as cost-savings, shorter waiting times, better quality and accessibility for travelling to another country.
However, some authors indicate that the definition is unclear (Reddy et al., 2010), unsettled (Cormany & Baloglu, 2011) and poorly defined or under-examined (Snyder et al., 2013). Thus, this current study starts to seek an understanding of the term medical tourism.
RQ2. How do medical tourism providers and prospective customers understand the benefits and sacrifices associated with medical tourism?
In the literature, it is clear that the purpose of medical tourism is for cost-savings, shorter waiting times, better quality treatment, and easy accessibility and availability which cannot be found in the home countries (Connell, 2006; 2011, Deloitte, 2008; Ye et al., 2011; Yu and Ko, 2012). While visiting another country for medical treatment, people also have the opportunity, desire or expectation to experience other tourism services such as food, accommodation, attractions or culture, as well as other support services such as government policies and regulations (Bookman and Bookman, 2007;
Cormany, 2008; Eman, 2011).
On the other hand, the literature reveals a number of negative aspects such as fees, proximity and risks in terms of patient safety and follow-up care, ethical and legal issues, language and cultural differences (York, 2008; Hall, 2011; Johnston et al., 2010;
Lunt et al., 2011; Snyder et al, 2013).
However, there is a lack of empirical understanding of the consumer perceptions of medical tourism regarding the benefits and sacrifices, even though customer-perceived value is an integral part of decision-making, and it is well described as the division.
Thus, this research seeks to understand the perceptions of medical tourism regarding the benefits and sacrifices from both sides of industry and consumers.
RQ3. What are the key factors that underpin medical, tourism and support services concerning choice of destination?
In the literature, Eman (2011) particularly identifies that medical tourism is the combination of divisions on medical and healthcare services, tourism and travel services, and support services in terms of service aspects, while Cormany (2008) similarly emphasises the four important components of medical services, hospitality support, tourism appeal and governmental policies for a medical tourism destination.
Yet none of studies appears in an investigation of these important components for medical tourism. Thus, this research seeks to understand how and what elements of each medical, tourism and support service are considered to be important for choosing a medical tourism destination.
RQ4. What are the contributing factors that counteract and undermine the aspirational and preferential decision-making of medical tourist consumers?
In general, the negative consumer perceptions of medical tourism take an undesirable role in decision-making. In the literature, three studies by Wang (2012), Zhang et al.
(2013) and An (2014) have investigated the negative aspects of the choice of medical tourism destinations such as potential travel-related risks to health, and physical and psychological distance. However, these factors are all examined for their degree of influences among the arranged constructs. Thus, this research seeks to examine how and what negative consumer perceptions of medical tourism will influence choosing a medical tourism destination.
RQ5. What are the most significant key success factors driving medical tourism which are unique to South Korea’s medical tourism services?
The customer is the key element in measuring the success of a business operation in the tourism and hospitality industry. Customer-perceived value is an integral part of customer intention and satisfaction (Cronin et al., 2000; Dodds et al., 1991; Duman and Mattila, 2005; Gallarza and Sura, 2006; Hutchinson et al., 2009; Zabkar et al., 2010). In this respect, investigating customer-perceived value forms the key success factors driving medical tourism.
However, in the literature, there is a lack of studies on the subjects related to
customer-tourism development (Heung et al., 2011), and more importantly, of studies on both sides of industry and consumers. Thus, this research suggests the most significant key success factors by investigating the elements of CPV regarding benefits and sacrifices for South Korean medical tourism, exploring both sides of industry and consumers.
Step 2. Selecting the case, units and units of analysis
Activity Reason Application to this study
Specified
The case, “An investigation into CPV as KSF of medical tourism in South Korea” within an embedded design, is chosen for an in-depth understanding of this emerging phenomenon of medical tourism. The specified units are KTO and KHIDI (South Korean government bodies), South Korean medical tourism industry stakeholders, and prospective medical tourists. The units of analysis are presented as:
CPV of MT and the factors that influence MTD, KSF of MT in South Korea, and CPV as KSF.
Step 3. Crafting instruments
Activity Reason Application to this study Multiple
The multiple data collection methods are used to obtain qualitative data, which are in-depth interviews, qualitative survey and document reviews.
Step 4. Entering the field
Activity Reason Application to this study Overlap data
Additional field notes and materials are kept during the field study from the 6th Korean medical tourism forum and a course of the 2nd international medical tourism experts at the Korean Medical Tourism Association. In particular, an executive director at KTO is firstly contacted for an in-depth interview.
The two industry reports, which are obtained during the interview, are included for an additional support of the data analysis.
Step 5. Analysing data (presented in Chapter 5)
Activity Reason Application to this study Units
All the relevant documents and transcripts from research participants are first analysed to gain a familiarity with the data. This mainly provides the keywords and findings from all the answers of the research participants. Thematic analyses are then employed with regard to the units of analysis in this case study: CPV of MT and the factors that influence MTD, KSF of MT in South Korea, and CPV as KSF.
Step 6. Shaping constructs (presented in Chapter 5)
Activity Reason Application to this study
Units of analysis, analysis are provided with keywords and descriptions, and the emergent themes were presented by interpreting the meanings of the contexts from research participants.
Step 7. Enfolding literature (presented in Chapter 6)
Activity Reason Application to this study
Comparison
The key models for the units of analysis based on the thematic map are developed. The key literature, key theoretical research models and conceptual frameworks are all brought together in Chapter 6 to find and discuss their similarities or differences.
In particular, the main model of this case study is presented by providing the interpretations of the key elements with support from relevant literature.
Step 8. Reaching closure (presented in Chapter 6)
Activity Reason Application to this study
Theoretical Chapter 6 by developing a model of CPV as KSF in SKMT. It is evaluated by comparing another similar existing model.
Based on this case study design, the following presents the multiple data collection techniques to answer the research questions sufficiently.