Sociology Mind
2012. Vol.2, No.4, 458-464
Published Online October 2012 in SciRes (
Copyright © 2012 SciRes.
The Research of Medical Tourism Policy Network in Taiwan
I.-C. Liu
Department of Social and Policy Sc ie nc es , Yuan Ze University, Zhongli, Chinese Taipei
Received April 9th, 2012; revised Ma y 20th, 2012; accepted June 3rd, 2012
Recently, the concept of medical tourism is gaining eminence in the field of health and medicine. “Medi-
cal Tourism” is a term involving people who travel to a different place to receive treatment for a disease,
ailment, or condition, and who are seeking lower cost of care, higher quality of care, better access to care,
or different care than they could receive at home. Currently, Taiwan government also declares its ambi-
tions to become one of the best choices of cross-country medical care for international visitors. The gov-
ernment believes that Taiwan offers excellent medical care, so can take advantage of business opportuni-
ties in medical tourism as it has gained a reputation in the world and is particularly respected by the Chi-
nese. A recent economic cooperation framework agreement (CEFA) between China and Taiwan will en-
courage trade and tourism between two entities across Taiwan Strait. The major purpose of this paper is to
describe and analyze medical tourism policy network in Taiwan. This approach emphasizes the interac-
tion and outcomes between actors in policy network. The paper utilizes literature review and supplements
by in-depth interviews to examine Taiwan experience of medical tourism policy from the stage model of
public policy implementation. The paper finds that medical tourism policy in Taiwan is a growing indus-
try with government and hospitals’ participation. Thus, efforts should be made to encourage collaboration
between the government, medical care providers, and tourism industry.
Keywords: Medical Tourism; Policy Network; Medical Care; Network Management
Medical tourism, also called “medical treatment abroad”,
“medical travel” is a booming international industry where
patients seek healthcare from sources outside their country.
Usually every type of medical treatment is available abroad
with over 50 countries identifying as destinations in medical
tourism. In the past several years, more than 180,000 Ameri-
cans, Canadians, and Europeans have visited India, Thailand,
and Antigua to get immediate and high quality medical services
(Cetron, Micco, & Davies, 2006; Teh & Chug, 2005). The
practice of enjoying the local scenery or humanistic character-
istics of tourism and simultaneously receiving dental, surgical,
and other treatments has already become a global trend. This
international trend has captured the attention of policy makers,
relevant enterprises, and academics.
Purposes and Methods
Given the importance and popularity of medical tourism, it is
surprising that it has not received much scholarly attention.
There is not yet a systematic stream of research in the tourism
and medical care domain. Some scholars from fields of medi-
cine and law have examined specific issues like health effects,
risk of treatment, and applicability of existing laws for interna-
tional medical services (Balaban & Marano, 2010; Brady, 2007;
Burkett, 2007). Other studies discuss medical tourism service
development in individual countries, like India, Thailand, and
Malaysia (Aizura, 2009; Chee, 2007). Most papers provide a
macro-level analysis of medical tourism, and only a few focus
on consumer decision factors in seeking medical tourism (Altin,
Singal, & Kara, 2011; Heung, Kucukusta, & Song, 2011).
Previous research discusses the development of the new
cross-sector service requires coordination among key stake-
holders such as hospitals, medical travel agencies, hotels, and
public sectors. However, a discussion of policy stakeholders’
roles in medical tourism is lacking. This study focuses on the
interaction between most salient stakeholders in providing ser-
vices from a policy network approach.
Though previous research highlights the importance of
medical tourism issue, incomplete analysis in the relevant lit-
erature increases the importance of Taiwan’s case. Therefore,
the major purpose of this study is to analyze the operation of
the medical tourism policy network in Taiwan. The Taiwanese
government believes this new medical industry can generate
considerable revenue, and is currently trying to be one of the
best choices for international visitors. Making Taiwan’s
healthcare industry more attractive to international clientele
within Asia’s highly competitive medical tourism market has
become a priority for the national government. As Taiwan is a
relative newcomer to the area of medical tourism, the govern-
ment plays an important role in organizing the relevant sectors
and resources. With a relatively modest 85,000 medical tourists
visiting facilities of hospitals in 2011, Taiwan’s government
and healthcare providers have had to take a more proactive and
coordinated approach to recognize and develop areas of the
international medical tourism market (Marius, 2012). Therefore,
the study uses Taiwan as a case study.
The remainder of this paper is structured as follows: Sections
3 and 4 present a literature review, including the concept of
policy network, and the development of medical tourism ser-
vices. Section 5 explains the current development of medical
tourism in Taiwan. Section 6 analyzes policy network man-
agement and the results of Taiwan’s medical tourism policy
based on semi-structured interviews with stakeholders. Inter-
view respondents were chosen not just by virtue of their in-
volvement in the process of policy implementation, but also by
virtue of their reputation in this policy issue. In-depth inter-
views were conducted learn their opinions about related practi-
cal issues and policy outcomes. Interviewees included person-
nel from the Department of Health, Tourism Bureau, Council
for Economic Planning, External Trade Development Council,
and other government departments. Interviewees from the pri-
vate sector included project management personnel responsible
for the implementation of hospital policies and related associa-
tions. Interviews were conducted beginning on March and end-
ing on July 2010. Finally, Section 7 provides the policy impli-
cations of this study.
The Concept of Policy Network
Public policy is made and implemented in networks of inde-
pendent public and private actors. Cross-sectoral partnerships
and multi-layered points of policy-making are seen as replacing
the hierarchical, centralized state (Rhodes, 1997; Richards &
Smith, 2002). Public policies are made via some kind of hybrid
arrangement involving a range of different actors, including
some representing private or nongovernmental institutions.
Linkages between organizations have become the central ana-
lytical focus for many social scientists (Rhodes, 1997). A net-
work is a partnership of institutions who work in close coopera-
tion towards specific goals with a sharing among them of costs,
profits and results. The concept of policy network has been
devel oped and re fined as a way to describ e, explain a nd predic t
the outcomes of policy-making via such hybrid arrangements
(Peterson & O’Toole Jr., 2001). The term “policy network”
generally describes structures involving cross-agency linkages
for implementing public affairs that remain unfinished by the
government. This innovative volume develops a network man-
agement approach to governance and public management, and
shows how governments can manage policy networks to en-
hance policy performance and public service delivery (Bevir &
Rhodes, 2003).
The public sector must rely on the contribution and coopera-
tion of policy stakeholders by building stable and constructive
interaction between network actors (Marin & Mayntz, 1991;
Richardson & Jordan, 1979). It is important to understand the
capacities required to successfully operate in network settings
differ from those needed to succeed at managing a single or-
ganization. The classical, mostly intraorganizational-inspired
management perspective that has guided public administration
for more than a century is simply inapplicable for multi-organ-
izational, multi-governmental, and multi-sectoral forms of gov-
ernance (Agranoff & McGuire, 2001). This study refers to pol-
icy networks as policy implementation arrangements and part-
nerships about medical tourism policy. The empirical analysis
focuses on medical tourism policy networks, which are organ-
ized by multi-sectoral organizations and managed by a network
manager. The coordination component of the network has been
called the hub or central core. It acts as a secretariat for the
network and coordinates network activities.
The Concept of Medical Tourism
The concept of medical tourism is not new. Since the first
millennium, rich people have visited mineral and hot springs,
spas, and sanatoria located by the sea and in the mountains for
the treatment of various ailments (Carrera & Bridges, 2006;
Das & Gupta, 2005; Mitra, 2005). Medical tourism is a term
commonly used to describe the practice of travelling abroad to
obtain medical services. Medical tourism may be defined as the
“provision of cost-effective medical care with due considera-
tion to quality in collaboration with tourism industry for foreign
patients who need specialized treatment and surgery.” Many
patients are traveling great distances to obtain medical care.
Also, rapid expansion of facilities for patients abroad has
helped to spur this industry growth. The purposes of medical
procedures for international patients are diverse, and may be a
cure for illness or improving wellness. Such services typically
include elective procedures and complex specialized surgeries
such as joint replacement (knee/hip), cardiac surgery, dental
surgery, and cosmetic surgeries (Sara & Mugomba, 2006; van
Demark, 2007).
Simply stated, medical tourism is the process of traveling
abroad to receive superior medical, dental, and cosmetic care
by highly skilled surgeons at modern medical facilities around
the world at a fraction of the price in the USA, UK, and Canada
(Bies & Zacharia, 2007; Bookman & Bookman, 2007). The
development of medical tourism services gives the global
medical tourist another source of high-quality medical surgery,
cosmetic plastic surgery, and dental care services at signify-
cantly l o wer prices.
The Growth of Global Medical Tourism Services
People may travel to far-flung developing countries to take
advantage of the medical services they provide (Bookman &
Bookman, 2007; Sara & Mugomba, 2006; Teh & Chug, 2005).
The following reasons are most often cited for this trend:
1) The main incentive appears to be cost savings. The signifi-
cantly lower costs allow for quality care and additional lei-
sure travel.
2) Patients are not subject to waiting lists or long waiting pe-
riods; this immediate access to service attracts patients from
countries that have public health care systems to countries
that offer medical tourism.
3) Patients are assured of excellent quality. To prove their
commitment to quality, many international health care pro-
viders opt to be accredited by organizations or by their local
accrediting organizations.
4) Patients are assured of access to the latest medical technol-
ogy. International medical care providers invest heavily in
the advanced equipment necessary to provide high-quality
medical servic e.
5) Patients are assured of surgeon expertise. Most surgeons
catering to international patients have received either their
basic medical education or postgraduate professional train-
ing from the best schools in the United States, United
Kingdom, or reputable Euro pean coun t r ie s .
6) The majority of medical tourists report that they received
personalized service from surgeons, nurses, and other
medical staff. The staff-to-patient ratio enables a high level
of personal care, and travelers attest to the quality and ex-
cellence of the service.
7) Patients benefit from longer hospital stays. One of the ad-
vantages of medical tourism is that international patients are
able to stay in the hospital for relatively long periods with-
out incurring substantial room charges.
8) Patients may enjoy the opportunity to travel. Although the
primary motivation for most customers is affordable sur-
Copyright © 2012 SciRes. 459
gery, the opportunity to visit exotic destinations is an addi-
tional attrac ti on for some pa ti e n ts.
In the following sections, the concept of medical tourism and
its attractions are discussed; thereafter, we examine the Tai-
wanese scenario, including the country’s policy planning and
implementation in this area.
Following the discussion of the concept of medical tourism
and its attraction, then the paper introduces Taiwan’s experi-
ence, includ i ng the policy deve lopment and implementation.
The Background of Taiwan Medical
Tourism Policy
Due to globalization of the economy and internalization of
health care profession, Taiwan has entered the industry in only
recent times. The main reason for Taiwan emerging as a re-
ferred destination is the inherent advantage of its health care
industry. In addition to its excellent and cost-effective medical
care services, there are several reasons why Taiwan is develop-
ing medical tourism services. These advantages include an
advanced economy, convenient transportation, stable social and
political climate, and multiple tourism resources.
After discussing the strengths of Taiwan’s surroundings, this
section briefly describes the major characteristics and advan-
tages of Taiwan’s National Health Insurance program (NHI).
To pursue social equity and meet the healthcare needs of the
elderly and poor population in Taiwan, The Bureau of National
Health Insurance launched the NHI in 1995. Enrollment in this
government-run, single-payer program is mandatory for all
citizens and for foreigners who reside in Taiwan for more than
four months (Chang, 2005). This program provides universal
coverage, low premiums, a comprehensive scope of benefits,
easy access to medical treatment, proper care for disadvantaged
groups, and a high level of public satisfaction (Cheng & Chu,
2007). NHI’s comprehensive benefit package includes preven-
tion, ambulatory care, inpatient services, and other needed ser-
vices. Less than 60 percent of Taiwan’s residents had health
insurance in 1995; by 2012 the number was more than 99 per-
cent. According to a careful study published in Health Affairs
two years ago, this huge expansion in coverage came virtually
free: it led to little if any increase in overall health care spend-
ing beyond normal growth due to rising population and in-
comes (Krugman, 2005). The NHI program has gained an in-
ternational reputation for its consistently high public satisfac-
tion rates; the program has attracted a lot of international atten-
tion. For example, in 2000, the Economist magazine ranked
Taiwan as the second healthiest country in the world. Accord-
ing to the Economist Intelligence Unit (EIU), this evaluates the
condition of health in 27 principal countries in accordance with
thirteen indices of health. Taiwan has abundant medical re-
sources: a total of 22.2 doctors and 56.3 beds per ten thousand
people, and an average occupation rate are 70%. Paul Krugman,
the 2008 winner of the Nobel Prize for Economics, lauds Tai-
wan’s NHI: “Taiwan, which moved 10 years ago from a US-
style system to a Canadian-style single-payer system, offers an
object lesson in the economic advantages of universal cover-
age” (Krugman, 2005). Previous research views NHI as the
gold standard for developing medical tourism policy by greatly
improving the convenience, accessibility, and affordability of
healthcare in Taiw an.
The study also introduces the strengths of medical care sys-
tem in Taiwan. The reasons why health travelers from devel-
oped countries journey to Taiwan are as diverse as the travelers
themselves, but the primary incentive for most medical tourists
is the excellence of the medical care system in this country. In
Taiwan, the strengths in medical tourism are: high quality of its
medical care system, affordable costs, and the modern technol-
ogy of medical care providers. Applying these advanced tech-
nologies effectively shortens the waiting period. In the course
of developing a top-quality medical system, Taiwan has simul-
taneously achieved a level of affordability and efficiency that is
attractive to international health travelers. Surgery fees in Tai-
wan are generally only about one-fifth to one-sixth of those in
the US and the UK. For example, the liver transplantation fee is
about 88,000 USD, which is 29% of US and 50% of Singapore.
The hip joint replacement fee is about 5900 USD, which is 17%
of US, 22% of UK, 59% of Singapore, and half of Thailand
(Woodman, 2008).
The fourth strength is its professional team approach to
medical services. In Taiwan, doctors must possess a general
medical license or a professional medical license. Higher
medical qualifications include resident doctor training and fel-
lowships. Thus, doctors go through a varied and strict program
of medical education; medical students generally train for more
than ten years to become attending physicians. Taiwan’s last
strength is its ability to provide a comprehensive scope of
medical services, including preventive healthcare, plastic sur-
gery, dental surgery, weight control, sleep medicine, cardiac
surgery, joint replacement, organ transplantation, and much
more. Most hospitals offer health examination packages to
serve each patient’s unique needs, and treatments and recovery
regiments often combine traditional Chinese medicine with
Western medicine (Woodman, 2008).
Taiwan Medical Tourism Policy Planning and
This section presents some of the findings and observations
from our literature review and interviews with several partici-
pating hospitals. We specifically analyzed the topic of public
network interaction.
Government to assess the competitive advantage of interna-
tional medical service that should promote the focus of a spe-
cial medical services, its the one hand, can be linked to
“high-tech Taiwan,” the overall image of the establishment, but
also by the special medical service model review and improve
the relevant measures in order to stimulate the overall interna-
tional development of medical services. Such an initiative
would promote medical tourism for a wide range of profes-
sional medical services and would also enhance the image of
the country, immigration visa, air transport, legal issues, lan-
guage, and information technology.
In 2007, the government began to work in collaboration with
private medical institutes to focus on five items of medical
services: live liver transplants, craniofacial surgery, cardiovas-
cular surgery, and arthroplasty. The government presented a
“Medical Service Internationalization Flagship Program” pro-
ject (Flagship Program) and combined a special task force
called the Taiwan Task Force on Medical Travel (TTFMT)
with funding of more than NT$40 million in July 2007 to pro-
mote the island’s medical services abroad. Supported by the
Tourism Bureau, Government Information Office, Taiwan Ex-
ternal Trade Development Council, Chung-Hua Institution for
Economic Research, and Department of Health, TTFMT has
Copyright © 2012 SciRes.
created an alliance of more than 20 qualified hospitals to adver-
tise its excellent medical services to patients all over the world.
TTFMT is administrated by the Taiwan Nongovernmental
Hospitals and Clinics Association (TNHCA), which serves as,
is a platform for integrating resources and improving coopera-
tion across governmental organizations, relevant industries
(such as hotels, travel agents, transportation corporation, res-
taurants, and airline companies), and participating hospitals
(Liu, 2011). TNHCA as a network manager is responsible to
implement Flagship Program and maintains network’s interac-
tion smoothly.
In the policy network, institutions and hospitals play differ-
ent roles. The Tourism Bureau and Government Information
Office provide valuable information about scenery and help
promote Taiwan in the international media. The Taiwan Exter-
nal Trade Development Council is responsible for communi-
cating with overseas organizations. The Chung-Hua Institution
for Economic Research is responsible for the academic, field,
and statistics research needed for TTFMT’s marketing survey
reports (Woodman, 2008).
TTFMT considers several potential target markets. The first
potential target market is to focus on China as a major source of
clients for Taiwanese medical services. As relations with its
former rival China improve, Taiwan’s government is confident
that the island can seize a large share of a huge market of Chi-
nese tourists seeking quality medical care overseas. As the ris-
ing middle or upper income class in Mainland China outstrips
that nation’s ability to provide quality healthcare, nearby Tai-
wan offers a convenient and viable alternative (Sui, 2011).
The market is set to expand when Taiwan opens to Chinese
tourists on a foreign individual travel basis in early 2011. The
Taiwanese government announced on December 2011 that they
had revised the country’s immigration rules specifically re-
garding permits for people arriving from Mainland China. Un-
der the new rules, beginning in 2012, Chinese nationals can
legally enter Taiwan specifically for the purpose of having
health checkups, elective or non-urgent surgery, and cosmetic
surgery procedures. These Mainland Chinese tourists are al-
lowed to stay in Taiwan for up to 15 days, which includes a
three day shopping and tourism allocation, in addition to their
medical treatment days. Taiwanese private medical facilities
that are qualified to provide these services meanwhile can apply
to the National Immigration Agency (NIA) for visas on behalf
of their prospective Chinese patients. These applications will be
given top priority for processing by the NIA and will take
around five business days to review and approve, with poten-
tially life-threatening cases put on a 4 hour fast track (Marius,
2012). From 2012, visitors from mainland China have been
allowed to travel to nearby Taiwan for the express purpose of
medical tourism. Newly established agencies are expected to
flourish in response to this initiative and would assist medical
tourists traveling to Taiwan throughout the year to take advan-
tage of this cross-strait agreement.
The second potential market is Chinese Americans. For ex-
ample, a trip to culturally friendly Taiwan can help take some
of the financial sting out of an expensive medical procedure for
millions of Chinese Americans living in the US without health
insurance. Besides targeting medical tourists from mainland
China and Chinese Americans as major customers, the Foreign
Ministry plans to extend visas for medical tourists to up to six
months, depending on their cases (Woodman, 2008; Sui, 2011).
In addition to medical-visa revisions for local hospitals, the
government is looking to invest in specialized medical zones
near the country’s international airports to attract even more
prospective medical tourists. Four of these zones are currently
in development and are projected to pull in 40,000 tourists per
annum once completed. Taiwan’s government is ultimately
banking on these facilities, together with the country’s state-
of-the-art health service technologies and low treatment costs,
to take business away from the likes of India and Thailand.
The Operation and Evaluation of Taiwan
Medical Tourism Policy Network
We interviewe d severa l ma nage rs at part ici pat ing hospi ta ls to
understand the outcomes of the policy network interaction. Our
findings were as follows: 1) consensus prevailed that interna-
tional medical services constituted a new opportunity for the
majority of medical service providers affected by this policy; 2)
the publication of the booklet “Patients beyond Borders: Tai-
wan Edition” to provide current information on 20 hospitals’
treatment specialties, accreditation levels, access by transporta-
tion, and communication; 3) participation in international
medical exhibitions and fairs can build and promote the medi-
cal image of Taiwan internationally; and 4) the number of for-
eign visitors to Taiwan is ever increasing, although people ar-
riving specifically to receive medical care is not as high as par-
ticipating hospitals expected. In 2008, approximately 5000
medical tourists traveled to Taiwan to receive health checkups
and cosmetic surgery. In 2009, this number had increased to
40,000 patients, who came mostly from China. TTFMT pre-
dicts that Taiwan may receive more than 100,000 medical tour-
ists annually.
Our study showed that representatives at different levels
hospitals held divergent opinions on policy implementation and
its outcome, although the government considered that the pol-
icy achieved its purpose. Our analysis was used to examine the
gaps based on the interview results from a policy network ap-
proach. First, the majority of hospital interviewees felt that the
government is responsible primarily for policy planning and
must provide the resources required to implement the policy,
based on the experiences of other countries. By contrast, the
relevant authorities felt that medical tourism services constitute
optional extra services that hospitals may elect to provide.
These government representatives were not heavily involved in
the medical tourism policy, and thought that the major task of
hospitals is to care for Taiwanese citizens’ health. However,
staff at private hospitals considered medical tourism services as
their blue ocean opportunities. As an industry or business, the
same hospitals aim to provide cost-effective services for pa-
tients, regardless of their social status, nationality, or race. The
directors of these hospitals thus feel that the government should
afford them increased resources.
Thus, TNHCA as a network manager has major responsibili-
ties to establish good communications and sufficient informa-
tion sharing among participants in the network.
Second, the implementation of medical tourism may be con-
sidered a cooperative process that requires actors to collaborate.
TNHCA must know more of the contribution of network actors
and their expectations for the policy network. Several of the
people we interviewed complained that actors were contribut-
ing unequally. Only a few hospitals eagerly participate in pro-
motional activities abroad and pay the related expenses them-
selves. The TNHCA has not succeeded in persuading all actors
Copyright © 2012 SciRes. 461
in the medical tourism policy network to contribute equal effort.
Several interviewees complained that hospitals that contribute
less still share equal benefits.
Third, because different levels of hospitals possess different
resources and operation strategies, they show different attitudes
and expectations in implementing the Flagship Program. One
public sector interviewee stated that foreigners seeking medical
services are frequently encountered at Taiwanese hospitals. By
contrast, hospital interviewees stated that they received rela-
tively few genuine medical tourists from abroad. Thus, policy
network managers should focus on their communicative role in
enhancing trust and consensus to improve network operations.
For example, one government interviewee said that the author-
ity had provided measures to open the market to foreign pa-
tients. However, staff at private hospitals expected government
to provide more active support for policy implementation and
stated that governments in other countries actively promote
such policies.
Fourth, hospitals which participated the Flagship Program
viewed network outcomes is not co-production result, their
efforts will depend on their gains. Respondents who felt that
network cooperation did not meet their expectations tended to
withdraw from the project. Finally, government representatives
were focused on fairness in implementing the policy, whereas
hospital staff emphasized the efficiency of service.
In the past, medical care was partly focused on providing
charitable care and nonprofit services. This approach conflicts
with the modern trend in which the medical industry is a busi-
ness. The government continues to regulate the advertising and
promotional activities of hospitals; for example, it does not
allow the prices of medical services to appear in brochures.
These regulations limit the promotional efforts of Taiwan’s
medical tourism services. The government regulations affect all
hospitals, even those not participating in the project. Hospital
directors who want to promote their organization’s service
quality and technology to attract more patients would prefer
that the government relax these marketing and promoting regu-
lations. However, the government continues to adopt a prudent
position and views the deregulation of medical advertising as a
serious issue.
As shown by these findings, actors in both the public and
private sectors of the policy network hold differing beliefs on
the implementation and effectiveness of the policy. The nature
of resource dependencies that lie at the heart of policy networks
are the key variable in shaping policy outcomes, and coopera-
tion between the players could be improved by a network man-
ager. We found that different levels of hospitals were unaccus-
tomed to cooperating to provide services for foreign patients.
Thus, these organizations should become more willing to
jointly promote an excellent medical image for Taiwan interna-
tionally. The process of implementing the medical tourism
policy appears to be insufficiently oriented toward building
collective power. However, all networks involve collaborative
costs as well as benefits.
Conclusion and Policy Recommendations
This study found that medical tourism policy entails a
cross-domain complexity that was not merely dependent on
medical technology or equipment. The government must also
build the infrastructure and warm and friendly environment for
second language. The majority of our respondents recognized
the need for relevant authorities to improve the international
visibility of Taiwan’s medical services, and intentionally en-
gaged in interna tional medical service s. Hospital staff members
have begun to realize their positioning in the global market. A
number of respondents mentioned that cross-industry interac-
tion is necessary when serving medical tourists. Furthermore,
the respondents agreed that the government must provide policy
resources and require the participation of the relevant units.
Finally, the respondents mentioned the composition of the net-
work and the importance of organizing promotional teams to
travel to foreign countries and promote Taiwan’s medical im-
As mentioned, the numbers of international patients, differ-
ent levels of hospitals with different motivation, resources,
investment have a different evaluation opinion, although the
number of international patients is never too many. The major-
ity of hospital personnel felt that the number of international
patients should be increased in the future. Hospitals must be-
come involved in exhibition or investment activities organized
by the Foreign Trade Association. However, most respondents
who agreed that joining this organization would be helpful in
marketing international medical services did not think that this
would yield immediate results.
Our empirical analysis identified gaps between the expected
performance and real achievements. Several hospital personnel
were dissatisfied with the policy implementation and com-
plained of unfair contributions among the actors. Several re-
spondents complained that the provision of policy resources by
the government was limited. The findings also suggested that
network managers should play a more active communicative
role in improving the cooperation within the policy network.
Our findings thus indicated several barriers to the expansion of
the medical tourism market in Ta iwan.
Based on our findings, we recommend that the government
integrate the relevant authorities’ resources. For example, the
tourism industry could be linked more strongly to medical care
providers to offer medical tourism packages through Web sites
and brochures, a strategy employed actively by other countries.
The government should step into the role of regulator and fa-
cilitator of private investment in health care.
The management in policy network differs from one in hier-
archical structure. Public managers cannot command action in
networks, but they are still responsible for their outputs. Be-
cause there is no relationship between levels of control author-
ity, interactive specification is the only basis for maintaining
the network. Network managers attempt to build consensus and
promote a cooperation and communication platform. They also
strive to achieve fair and credible management to avoid hinder-
ing network cooperation. In other words, network managers
must have skills and knowledge sets to network as they do for
single organizations. For example, the management principles
of single organizations such as equal contribution, open com-
munication, shared responsibility, and mutual trust are still
essential and applicable to networks. As the use of networks in
public management increases, more questions regarding this
research arena must be answered.
The primary challenge for empirical research in public ad-
ministration is to separate how knowledge issues, problems,
and technologies are identified, brokered, and solved in net-
works. Apparently, policy network coordinator can facilitate
many political, bureaucratic, and resource deficiency issues.
Accountability in networks is defined and perceived differently
Copyright © 2012 SciRes.
than in single organizations. It is also necessary to know more
about the contribution of personal responsibility and respon-
siveness to network performance. The cohesion developed
through trust and a program rationale should also be measured
against the force of authority in hierarchies. The implementa-
tion of medical tourism services integrates different resources
and services, including medical resources, tourism services, and
transportation services, friendliness of the culture, and Tai-
wan’s international visibility and image. The research examines
cross-sector medical tourism policy by empirically analyzing
network interaction, network management and its effectiveness.
In deed, Taiwan is seeking to improve its international medical
image and publicity to obtain a leading edge in this area. This
study shows that medical tourism is a growing service, and
enjoys governmental support and active hospital involvement.
The medical tourism industry offers high potential for Tai-
wan primarily because of its inherent advantages in terms of
cost and quality. However the competition is getting heated up
and the success in future will largely be determined by devel-
opment and implementation of a joint strategy by various
syakeholders i n the industry.
Though empirical analysis, there exists some gaps between
expected performance and real one. This study found that some
of hospitals are dissatisfied with the policy implementation,
especially fairness of contributions among actors. Some of
them complaint that the government afford policy resources is
limited. Also, the study found that network manager should
play a more active communicative role in improving the coop-
eration inside policy network. Thus, this study shows that there
are still barriers to the expansion of the medical tourism market.
Based on the findings above, this study recommends the fol-
lowing: the government should integrate the relevant policy
resources. For example, the government integrates the tourism
industries with medical care providers to offer medical tourism
packages through websites and brochures, a strategy actively
employed by other countries. The government should step in
the role of a steering facilitator in the developing healthcare
The study suggests that the network coordinator from the in-
teractive process of open, consensus process, the legitimacy or
effectiveness of the support and learning opportunities for
growth, so that actions to understand the interaction as the basis
for maintaining network integrity. Finally, effective leadership
and coordination is one of the most important factors influenc-
ing the performance of a policy network. The medical tourism
industry has become competitive business among nations, but
this has led the effectiveness of other related activities. It is
recommended by the authority or officer responsible for a
higher level than the Department of Health to play a more ac-
tive role in a coordinated medical tourism effort.
The author would like to thank National Science Council in
Taiwan for financially supporting this research under the Grant
NSC 99-2410-H-155-052.
Agranoff, R., & McGuire, M. (2001). Big questions in public network
management research. Journal of Public Administration Research
and Theory, 11, 295-326. doi:10.1093/oxfordjournals.jpart.a003504
Agranoff, R., & McGuire, M. (2003). Collaborative public management:
New strategies for local governments. Washington DC: Georgetown
University Press.
Aizura, A. (2009). Where health and beauty meet: Femininity and radi-
calization in Thai cosmetic surgery clinics. Asian Studies Review, 33,
303-317. doi:10.1080/10357820903153707
Altin, M. M., Singal, M., & Kara, D. (2011). Virginia polytechnic con-
sumer decision components for medical tourism: A stakeholder ap-
proach. Proceedings of 16th graduate students research conference,
http://scholar works.umass .ed u/cgi/viewcontent.cgi?article=1286&co
Balaban, V., & Marano, C. (2010). Medical tourism research: A syste-
matic review. International Journal of Infectious Diseases, 14, e135-
e135. doi:10.1016/j.ijid.2010.02.1784
Bevir, M., & Rhodes, R. A. W. (2003). Interpreting british governance.
London: Routledge. doi:10.4324/9780203352311
Bies, W., & Zacharia, L. (2007). Medical tourism: Outsourcing surgery.
Mathematical and Computer Modelling, 46, 1144-1159.
Bookman, M. Z.,& Bookman, K. R. (2007). Medical tourism in devel-
oping countries. New York: Palgrave Macmillan.
Brass, D., Galaskiewicz, J., Greve, H., & Tsai, W. (2004). Taking stock
of networks and organizations: A multilevel perspective. Academy of
Management Journal, 47, 795-817. doi:10.2307/20159624
Burkett, L. (2007). Medical tourism. Journal of Legal Medicine, 28,
223-245. doi:10.1080/01947640701357763
Carrera, P. M., & Bridges, F. P. (2006). Globalization and healthcare:
Understanding health care and medical tourism. Expert Review of
Pharmacoeconomics and Outcomes Research, 6, 447-454.
Cetron, M., Micco, F. D., & Davies, O. (2006). Hospitality 2010: The
future of hospitality and travel. Upper Saddle River, NJ: Prentice
Chang, H. J. (2005). Taiwan’s national health insurance: Current de-
velopment and performance. Proceeding for international sympo-
sium: Toward an equitable, efficient, and high quality national
health insurance, Taipei.
Chee, H. L. (2007). Medical tourism in Malaysia: International move-
ment of healthcare consumers and the commodification of healthcare.
URL (last checked 15 May 2011).
Cheng, P. W. H., & Chu, T. M. (2007). Health care insurance in Tai-
wan. Asian Studies R e v ie w, 33, 303-317.
Das, B., & Gupta, J. (2005). Medical tourism: Myth or reality? Express
Healthcare Management.
De Arellano, A. B. R. (2007). Patients without borders: The emergence
of medical tourism. International Journal of Health Services, 37,
193-198. doi:10.2190/4857-468G-2325-47UU
Forgione, D. A., & Smith, P. C. (2007). Medical tourism and its impact
on the US health care system. Journal of Health Care Finance, 34,
Goldsmith, S., & Eggers, W. D. (2004). Governing by network: The
new shape of the public sector. Washington DC: Brookings Institu-
tion Press.
Hajer, M., & Versteeg, W. (2005). Performing governance through
networks. European Political Science, 4, 340-347.
Heung, V. C. S., Kucukusta, D., & Song, H. (2010). A conceptual
model of medical tourism: Implications for future research. Journal
of Travel & Tourism Marketing, 27, 236-251.
Huxham, C., & Vangen, S. (2005). Managing to collaborate: The the-
ory and practice of collaborative advantage. London: Routledge.
Kenis, P. N., & Schneider, V. (1991). Policy networks and policy
analysis: Scrutinizing a new analytical toolbox. In B. Marin, & R.
Mayntz (Eds.), Policy networks: Empirical evidence and theoretical
considerations (pp. 25-59). Boulder, CO: Westview Press.
Copyright © 2012 SciRes. 463
Copyright © 2012 SciRes.
Klijn, E. H., & Teisman, G. R. (1997). Strategies and games in net-
works. In W. J. M. Kickert, E.-H. Klijn, & J. F. M. Koppenjan (Eds.),
Managing complex networks: Strategies for the public sector (pp.
50-54). London: Sa ge P ublication. doi:10.4135/9781446217658.n6
Krugman, P. (2005). Pride, prejudice, insurance. URL (last checked 15
November 2010).
Marin, B., & Mayntz, R. (1991). Policy networks: Empirical evidence
and theoretical considerations. Boulder, CO: Westview Press.
Marius (2012). China’s Medical Tourists Heading to Taiwan Interna-
tional Insurance and Healthcare Industry News. January 16, 2012.
McGuire, M. (2002). Managing networks: Propositions on what ma-
nagers do and why they do it. Public Administration Review, 62,
599-609. doi:10.1111/1540-6210.00240
Member of Medical Tourism Association (2007). Top 10 reasons why
medical tourism is popular? URL (last checked 10 Novem ber 2010).
Mitra, S. (2005). Medical tourism and the healthcare services industry:
A look at Singapore. URL (last checked 10 May 2009).
Mueller, H., & Kaufmann, E. L. (2001). Wellness tourism: Market
analysis of a special health tourism segment and implications for the
hotel industry. Journal of Vacation Marketing, 7, 5-17.
Peterson, J., & O’Toole Jr., L. J. (2001). Federal governance in the US
and the EU: A policy network perspective. In K. Nicolaidis, & R.
Howse (Eds.), The federal vision (pp. 300-334). Oxford: Oxford
University Press. doi:10.1093/0199245002.003.0012
Provan, K. G., & Milward, H. B. (1995). A preliminary theory of net-
work effectiveness: A comparative study of four community mental
health systems. Administrative Science Quarterly, 40, 1-33.
Rhodes, R. A. W. (1997). Understanding governance: Policy networks,
governance and accountability. Buckingham: Open University Press.
Richards, D. & Smith, M. J. (2002). Governance and public policy in
the UK. Oxford: Oxford University Press.
Richardson, J. J., & Jordan, A. G. (1979). Governing under pressure.
Oxford: Martin Robertson.
Sara, C. D., & Mugomba, C. (2006). Medical tourism and its entrepre-
neurial opportunities—A conceptual framework for entry into the
Industry. Master Thesis, Swedish: Gothenburg University.
Sharpe, L. J. (1985). Central coordination and the policy network. Po-
litical Studies, 33, 361-381. doi:10.1111/j.1467-9248.1985.tb01150.x
Sui, C. (2011). Taiwan taps China for lucrative medical Tourism Mar-
ket. BBC News.
Taiwan Nongovernmental Hospitals & Clinics Association Taiwan
Task Force for Medical Travel (2009). Comparative advantages.
URL (last checked 10 May 2010).
Taiwan Today News (2009). Local medical group signs contract to
push services in PRC. URL (last checked 10 November 2010).
Teh, I. (2007). Healthcare tourism in Thailand: Path ahead? Environ-
mental challenges and visions of sustainable health care. URL (last
checked 10 November 2010).
Teh, I., & Chug, C. (2005). Supplementing growth with medical tour-
ism. Asia Pacific Business Network, 9, 306-311.
Turner, L. (2007). First world health care at third world prices: Global-
ization, bioethics and m edical tourism. BioSoci et ie s , 2, 303-325.
Van Demark, D. C. (2007). How will the medical tourism industry in
the United States develop? URL (last checked 14 No v ember 2010).
Woodman, J. (2008). Patients beyond borders. New York: A Healthy
Travel Publication.
Yeoman, I. (2007). Tomorrow’s world consumer and tourist. Visit
Scotland, 2, 1-28.