The Impact of Hospital International Health Services on Medical Tourism: A Review of Private Lebanese Hospitals’ Online Services and its Readiness to be Part of a National Medical Tourism Plan

Background: The phenomenon of medical tourism, rooted in ancient traditions and thriving in the modern world, has transformed into a robust global industry. Lebanon's private healthcare sector has historically attracted international patients, but it faces challenges such as communication barriers and evolving economic landscapes. This research delves into Lebanon's private healthcare sector, aiming to identify obstacles and propose strategies for effective International Health Services (IHS). 

Methods: Employing a descriptive methodology, this study evaluates 44 private hospital websites in Lebanon across dimensions like accessibility, institutional credentials, and communication standards. Healthcare management experts conducted the assessment, leading to the categorization of websites into informative, communicative, collaborative, and empowered tiers. Statistical analysis ensured the reliability of the reviewers' ratings, revealing consistent findings. 

Results: The assessment highlighted varying approaches among Lebanese private hospitals in catering to medical tourists. While most websites emphasize medical services, crucial information such as staff credentials and cost-related details often remain undisclosed. The study uncovered gaps in services like medical record transfers and post-treatment care. However, some hospitals proactively engage international patients, showcasing specialized expertise.

Conclusion: This research not only evaluates private hospital websites in Lebanon but also proposes an innovative IHS framework. This framework envisions an independent department, an online platform for telemedicine and appointment booking, and tailored marketing strategies. Implementing these components can bolster Lebanon's position in global medical tourism, fostering economic growth, enhancing healthcare services, and strengthening diplomatic relations. Strategic collaborations and the adoption of these proposed strategies can elevate Lebanon's private hospitals, contributing significantly to the healthcare system and the economy.

Introduction

Throughout history, the pursuit of health and medical care has driven individuals to travel, seeking not only treatment but also opportunities for relaxation and wellness (Zhonget al., 2021). Today, this practice has evolved into a global phenomenon, with approximately 14 million people embarking on journeys for medical care annually, contributing to a multibillion-dollar industry (Qolipouret al., 2018).

As the demand for medical tourism grows, nations, hospitals, healthcare practitioners, and tourism facilitators are adapting to offer a diverse array of medical, health, and wellness tourism options (Turner, 2013). This trend is propelled by various factors, including the rise of international medical tourism, where individuals cross borders to access healthcare services at foreign hospitals and clinics (Ghasemiet al., 2022). Within this landscape, hospitals worldwide are increasingly establishing International Health Services (IHS) to cater to the needs of patients from different corners of the globe (Al-Aminet al., 2011).

Medical tourism can be categorized into two main types: mandatory and elective. Mandatory travel occurs when specific treatments are either inaccessible or illegal in the patient’s home country. In contrast, elective travel is driven by the patient’s preferences regarding timing and expenses, with the treatment often available locally (Zhonget al., 2021). The definition of medical tourists varies based on the healthcare system and funding mechanisms (Chen & Flood, 2013). Some are “consumers” who use their own funds or insurance to access various medical treatments, while others, especially in the European context, exercise citizenship rights to receive treatment in other European Union member states, seeking reimbursement from their home country’s healthcare system (Lunt & Carrera, 2011). Hospitals employ diverse marketing strategies to attract patients, including cost-based strategies that focus on affordability and differentiation strategies that emphasize unique, high-quality services (Al-Aminet al., 2011). Hospitals targeting patients from developing countries emphasize the uniqueness and quality of their medical procedures, while those targeting patients from developed countries strive to become low-cost destinations for high-quality medical care (Aulakhet al., 2000).

The concept of IHS departments within hospitals is intricately connected to the evolution of healthcare institutions, medical tourism, and global collaboration. An IHS department serves as a vital unit that extends healthcare services to international markets, which involve cross-border transactions (Maifrediet al., 2010). Although the precise historical roots of IHS departments remain somewhat elusive, they are undoubtedly intertwined with the broader history of hospitals and the emergence of medical tourism and international cooperation (Hensheret al., 2017). One of the pioneering institutions in the realm of IHS was the Mayo Clinic, founded in 1889 by Dr. William Worrall Mayo and his sons in Rochester, Minnesota (Mayo Clinic, n.d.). The Mayo Clinic rapidly gained international acclaim for its dedication to healthcare excellence and innovation.

The growth of medical tourism, characterized by individuals traveling across borders in pursuit of healthcare, has also played a significant role in shaping the development of IHS departments within hospitals. Medical tourism is motivated by factors such as cost savings, enhanced quality of care, reduced wait times, and access to specialized treatments (Darwazehet al., 2021). However, it presents hospitals with both challenges and opportunities related to quality, safety, regulation, ethics, and communication. IHS departments serve a crucial role in facilitating medical tourism by providing information, coordination, and support to international patients and their healthcare providers. Additionally, they foster international collaboration and knowledge exchange among healthcare professionals and institutions.

Patient advocacy groups contribute significantly to enhancing medical tourism through IHS by offering guidance and assistance to patients seeking treatment abroad (Hwanget al., 2018). They collaborate with hospitals to develop tailored international patient services, including language support, cultural orientation, and improved communication with healthcare providers (Hwanget al., 2018). The role of healthcare professionals in enhancing medical tourism is pivotal, as they provide high-quality care and ensure positive patient outcomes. A well-established physician network on an IHS website enables international patients to access information about physicians’ qualifications and expertise, fostering trust in the healthcare facility (Horowitzet al., 2007). Medical Travel Facilitators are key players in the medical travel industry, offering valuable information about destinations and healthcare providers while coordinating essential services such as passport and visa arrangements, travel logistics, and accommodations (Rydback, 2022).

Leading hospitals worldwide, including the Cleveland Clinic, Mayo Clinic, and Cedars Sinai, opt for international accreditation of their IHS due to its focus on best practices in medical tourism. This accreditation covers aspects such as leadership, patient experience, and continuous quality improvement (Ivet al., 2021), and it has seen rapid growth, increasing by approximately 20% annually (Global Healthcare Accreditation-GHA, n.d.). The insurance sector is increasingly involved in medical tourism, expanding its networks to include global physicians. In the coming decade, it is expected that major employer health plans will encompass offshore medical centers, necessitating effective communication between insurance providers and IHS to streamline the claims process and reduce administrative burdens (Horowitzet al., 2007).

The advent of Generation Z, a generation born between 1995 and 2012, who are digital natives comfortable with online platforms, underscores the importance of hospitals having well-designed IHS department websites to engage with international patients (Orneset al., 2014). The internet has become the primary medium for accessing medical information, with around 75%–80% of US internet users relying on it for healthcare information (Fox, 2008). Evaluations of healthcare websites have become a competitive advantage, with different levels of engagement, from basic information dissemination to real-time services (Tarcanet al., 2020). Amid financial challenges and competitive pressures in their domestic markets, hospitals can consider internationalizing their services to meet the demand for higher quality in developing countries and the cost-efficiency and shorter waiting times desired in developed nations (Al-Aminet al., 2011). This internationalization is often supported by government policies, including incentives for private healthcare providers and marketing of healthcare services abroad (Ministry of Public Health, n.d.).

However, one aspect that has received relatively little attention until now is the role and impact of web-based information in guiding medical tourism decisions (Horowitzet al., 2007). The internet serves as a vital bridge connecting patients with healthcare providers and facilitators, streamlining the treatment process (Cormany & Baloglu, 2011). Hospitals looking to attract international patients must cultivate a robust online presence, provide personalized services, maintain high medical standards, forge partnerships with medical facilitator companies, engage in medical tourism events, focus on specialized areas, and offer competitive pricing (Turner, 2007). Various digital platforms, from websites to social media, are employed to reach diverse customer niches and expand the medical travel market (Turner, 2013). While web-based information can bring about positive effects, such as increased healthcare access and improved hospital reputation, it also presents challenges like cultural differences and language barriers (Hanefeldet al., 2015). Striking the right balance is crucial for the success of medical tourism endeavors.

In light of these dynamics, this article proposes an innovative approach—an International Health Services (IHS) department within hospital settings, designed to be a vital component of a national medical tourism plan. This department aims to attract international patients, offering top-tier medical services, while simultaneously bolstering revenue for both the hospital and the country. The proposed business model prioritizes sustainability, efficiency, and customer satisfaction, ensuring that international patients have a positive experience while the hospital maintains a competitive edge in the global medical tourism landscape. The new IHS department will not only assist international patients with pre-travel planning, hotel bookings, and travel logistics but also provide pre-travel evaluations, care plans, cost estimates, timelines, complications management, follow-up, and discharge plans. Furthermore, it will focus on enhancing the cultural and social sensitivity of medical staff, recognizing the importance of these aspects in providing exceptional care to international patients. This article delves deeper into the concept of this innovative IHS department, exploring its potential benefits, challenges, and the role of web-based information in its implementation. In doing so, it seeks to contribute to the evolving field of medical tourism research and offer insights into the future of healthcare on a global scale.

Lebanon, with a significant presence of privately-owned hospitals, faces unique challenges due to a changing economic landscape and competition from Gulf countries in the medical tourism sector (Connell, 2006). The economic crisis, compounded by the COVID-19 pandemic and the Beirut port explosion in 2020, has strained private hospitals’ resources and led to a need for innovative strategies, including the development of IHS offerings, to ensure sustainability (Ministry of Public Health, n.d.).

The study aims to answer the following questions:

1. What are the available IHS in Lebanon?
2. Based on their websites, are the available IHS in Lebanese Hospitals aligned with the standards determined by the health industry in the areas of accessibility, content, and communication standards?
3. What are the prospective recommendations on practical framework for implementation to develop IHS in Lebanon?

Methodology

The methodology will involve an evaluation of the online content of Lebanese hospitals’ websites based on three standardized checklists that assess accessibility dimensions, credentials of the institution dimensions, and communication dimensions. The first step is to conduct a thorough search over IHS websites of Lebanese hospitals to collect relevant data. After collecting the data, the hospitals’ IHS websites will be classified into four levels: informative one-way communication, communicative two-way flow of communication, collaborative, and empowered. The primary objective of the assessment is to ascertain whether the selected hospitals have developed well-designed websites that are capable of effectively attracting international patients. The assessment seeks to validate the degree to which these websites adhere to the international recommendations identified in the literature review as vital for enhancing the medical tourism experience.

Research Type and Timeframe

The research is a descriptive study conducted between July and August 2023. It aims to gather data on hospital characteristics from the websites of private hospitals in Lebanon.

Research Population and Sampling

The research population consists of all active websites of private hospitals in Lebanon. The total number of private hospitals in Lebanon, according to the Ministry of Public Health, is 112. The sampling approach used was a comprehensive one, where all 112 private hospital websites were evaluated. No specific sampling was performed; all websites were included in the study. Out of the 112 private hospitals, 68 were excluded from the study due to website inactivity. This suggests that these 68 hospitals’ websites were not functional or regularly updated at the time of the study. The final sample size for the study was 44 private hospital websites. These 44 websites were selected from the initial pool of active websites after excluding the inactive ones.

Data Collection

The assessment employed a comprehensive questionnaire consisting of 44 items, meticulously crafted to cover a wide range of criteria related to website design, information accessibility, credential of institution quality, and communication standards. These dimensions have been thoughtfully categorized into three areas: accessibility Table I, credential of institution Table II, and communication standards Table III. The categorization ensures a structured approach to the assessment process, allowing for a thorough evaluation of each aspect. For each of the 44 dimensions within the accessibility, credential of institution, and communication standards categories, the independent experts will assign a score based on their assessment of the hospital’s website. They will review each dimension and determine whether it is present, and if so, they will assess its importance based on its optional, valuable, or essential nature.

Table I. Accessibility Dimensions with Score

Dimensions	Score if dimension exists
Website availability	3
IHS department	3
Multilingual options	3
Presentation of online medical services	3
Clear directions to reach the facility	3
Access to general health information	2
Possibility to obtain medical tests and record online	2
Information regarding the insurance acceptance	2
Possibility to make online payment	2
Transparent information about costs	1
Existence of financial assistance program	1
Availability of specific packages for international patients	1
Estimated payment method options	1
Information about attractions and accommodations existing nearby the facility	1
Total score	28

Table II. Credential of the Institution Dimensions with Score

Dimensions	Score if dimension exists
Existence of a guide for patients’ rights	3
Availability of online appointments	3
Existence of mission and vision supporting the international medical services	3
Clear commitment to maintain a workplace free from any kind of discrimination	2
Affiliation with reputable medical organization	2
Mentioning complications’ management	2
Guide for quality and patient safety including any international accreditation	2
Mentioning the international visitor statistics	2
Collaboration with outside organizers	2
Availability of online assessment	2
Availability of modern medical equipment	2
Availability of specialized units	2
Information about qualifications, expertise, and experience of professional staff	2
Information about patients’ satisfaction surveys	1
Announcement of awards and accomplishments	1
Total score	32

Table III. Communication Dimensions with Score

Dimensions	Score if dimension exists
Existence of links to social media accounts	3
Presence of email for international patients	3
Offering information on Visa requirements	2
Offering information on travel arrangement	2
Offering opportunities to make complaints and provide suggestions	2
Offering possibility for medical record transfers	2
Coordination for follow up care	2
Presence of mobile application template	2
Membership opportunities	2
Presence of telemedicine options	2
Presence of hotline service	2
Offering accommodation options	1
Announcement of press releases	1
Special features for disabled patients	1
Presenting patients testimonial and reviews	1
Total score	28

Scoring Scale Definition and Areas of Assessment

0: Dimension doesn’t exist on the website.

1: Dimension exists but is optional, providing limited value to international patients.

2: Dimension exists and is valuable, enhancing the international patient experience.

3: Dimension exists and is essential, significantly contributing to the effectiveness of the website in attracting international patients.

Independent Expert Review

To ensure objectivity and reliability, the assessment was conducted by three independent experts in healthcare management. These experts possess the necessary knowledge and experience to critically evaluate the dimensions outlined in the questionnaire. Their diverse perspectives and expertise contribute to a comprehensive evaluation process that considers various nuances and intricacies of website design and usability.

Procedure

The experts conducted their assessments by performing Google engine searches for each selected hospital. The experts collected data based on their observations and evaluations of the hospital websites. This approach mimics the behavior of potential international patients who typically search for hospitals online.

Scoring

For each of the 44 dimensions within the accessibility, credential of the institution, and communication standards categories, the independent experts assigned a score based on their assessment of the hospital’s website. Once all dimensions have been assessed and scored for each hospital, the total score for each category (accessibility, credential of the institution, communication standards) was calculated and for the overall assessment of the website. Summing up the scores for each dimension within a category provides a quantifiable measure of how well the hospital’s website performs in that specific area. To institute a comprehensive and systematic scoring framework, we employed the norm-referenced method, which played a pivotal role in categorizing websites across four distinct performance tiers. This method was underpinned by a calculated benchmark derived from the desired percentile rank, expressed by the formula: (1)Cutoffscore=Desiredpercentilerank100×(N+1)

where N is the total number of scores in the distribution. Accordingly, for the 25% percentile the cut off is 25% × (87 + 1) = 22. If the mean scores of three evaluators were smaller than 22, the website is called informative website. It is more of a one-way flow of information. If the mean scores of three evaluators were between 22 and 44, the website is called communicative website. It is a two-way flow of information. If the mean scores of three evaluators were between 44 and 66, the website is called collaborative website. And finally, if the mean scores of three evaluators were between 66 and 87, the website is called empowered website. It is a website that has all the features of the previous websites in addition to sophisticated technology that provides services in near real time.

Data Analysis

Statistical analysis was performed using IBM SPSS software v20. A comparative analysis of the reviewers was conducted to identify any discrepancies or areas where the scoring system may need adjustment. The Intraclass Correlation Coefficient (ICC) was used to quantify the extent the ratings made by the three raters are consistent or reliable. ICC values range between 0 and 1. A higher ICC indicates greater agreement among the reviewers. As a general guideline:

• ICC < 0.5: Poor to moderate agreement.
• 0.5 ≤ ICC < 0.75: Moderate to good agreement.
• ICC ≥ 0.75: Good to excellent agreement.

This iterative process helps ensure that the scoring system accurately captures the effectiveness of hospital websites in attracting international patients. Adjustments based on the results of the validity check can enhance the reliability and applicability of our scoring system for future assessments. Then mean hospitals total and dimensions scores were calculated. Data was expressed in frequencies, mean and percentages. Based on the assessment scores, we can provide recommendations to hospitals for improving their websites.

Results

In the evaluation of 44 private hospital websites, a high level of agreement among three reviewers was observed, with an exceptional Intra-class Correlation Coefficient (ICC) value of 0.991. This remarkable agreement underscores the reliability of the assessment process Table IV.

Table IV. Inter-Rater Reliability (ICC) among Three Reviewers for Private Hospital Website Assessments

	Intraclass correlation coefficient(ICC)	95% Confidence interval
		Lower bound	Higher bound
Accessibility	0.974	0.957	0.985
Credential of institution	0.992	0.986	0.995
Communication	0.982	0.970	0.989
Total score	0.991	0.985	0.995

Regarding the types of websites, 57% of the hospitals had “informing websites” primarily offering one-way information, including services available, directions, patients’ rights, online appointments, and social media links. 25% had “communicative websites,” which added two-way communication, including medical test results, insurance information, and patient feedback options.

Only 16% had “collaborative websites” offering financial assistance, special packages, online payments, travel info, and medical record transfer. Remarkably, only one website reached the “empowered” level, approaching a collaborative website (Fig. 1).

Fig. 1. Distribution of website categories.

A minority of hospitals explicitly mentioned support for international medical services in their mission and vision statements (20%), and a mere 16% presented an IHS department. Regarding marketing strategies, 6% of hospitals actively promoted their health services internationally, focusing on expertise in specific medical fields and advanced technology. Some targeted price-sensitive medical tourists (9%) with cost-effective options, while others aimed at luxury travelers (9%), offering comprehensive travel experiences. Patient feedback utilization was limited, with less than 5% of hospitals announcing patient satisfaction survey results and only 7% posting patient testimonials.

Collaborations with external medical organizers were rare (less than 5%), and information about visa requirements was provided by just 2% of the hospitals. Guidance on travel arrangements (less than 10%) and accommodation options (less than 7%) was infrequently offered. None of the hospitals had organized membership programs for international patients. Language accessibility was prioritized, as all websites were in English. Additionally, 11% of the websites were bilingual (French and English), and some offered multilingual options (less than 5%). Limited hospitals confirmed the availability of interpreters and English-speaking staff. Approximately 20% of hospitals were committed to maintaining a discrimination-free workplace, emphasizing inclusivity and non-discrimination.

The majority of hospitals (95%) provided information about the medical services they offer. Roughly 41% shared general health tips, and nearly 30% presented information about their medical staff’s qualifications and expertise. However, specific details, such as certifications and publications, were often missing.

Remarkably, none of the hospitals provided information about the cost-effectiveness of their health services. Cost estimates were available only upon request (less than 10%), and insurance coverage details were provided by 34% of the hospitals. Some hospitals offered financial assistance services (16%), while 9% focused on targeting price-sensitive medical tourists. Luxury travelers were also considered (9%) by providing comprehensive travel experiences.

Online appointment availability was offered by 48% of hospitals, but online assessments were limited to 11%. Approximately 27% of hospitals emphasized their advanced technology and diagnostic capabilities, while 45% had specialized units. Awards and accomplishments were highlighted by 32% of hospitals, and 34% had obtained national and international accreditation. Affiliations with reputable medical organizations were seen in 25% of hospitals. Press releases related to medical services were provided by 52% of hospitals. Information about potential complications post-treatment was missing. Only 10% of hospitals offered medical record transfer, and 2% explicitly announced their ability to provide follow-up care. Telemedicine services were offered by 9% of hospitals, while hotline services were available at 18%. Email addresses for international patients were provided by 11% of hospitals. Mobile application templates were presented by 7% of hospitals. Encouragingly, 66% of hospitals facilitated online complaints and suggestions.

Around 70% offered a guide to patients’ rights, and 73% provided links to their social media accounts. Access to medical test results online (30%) and online payment options (11%) were still limited Table V. Finally, 80% of hospitals posted clear directions to reach their facilities through Google Maps. In summary, the study revealed varying levels of readiness among Lebanese private hospitals to participate in medical tourism. While some hospitals actively engage with international patients, offer comprehensive services, and prioritize online presence, many areas, such as cost transparency, complication management, and follow-up care, require improvement to enhance their appeal to medical tourists.

Table V. Reviewers Evaluations of Private Hospital Website Characteristics

Hospital name	Reviewer 1	Reviewer 2	Reviewer 3	Mean total score
Abou Jaude Hospital-Metn	30	30	29	29.7
Akkar-Rahal Hospital-North	19	20	19	19.3
Al Hayat Hospital-Beirut	6	11	6	7.7
Al Koura Hospital-North	20	19	20	19.7
Al Makassed Hospital-Beirut	17	14	17	16.0
Al Rassoul Al Aazam Hospital-Beirut	15	14	16	15.0
Al-Mazloum Hospital-North	21	20	21	20.7
American University of Beirut Medical Center–Beirut	61	68	68	65.7
Beit Chabab Hospital-Metn	18	18	18	18.0
Bellevue Medical Center-Metn	57	51	57	55.0
Bikhazi Medical Group-Beirut	25	25	38	29.3
Centre Hospitalier Universitaire Notre Dame des Secours–Byblos	29	29	29	29.0
Clemenceau Medical Center-Beirut	63	60	64	62.3
Clinique du Levant-Metn	51	52	52	51.7
Dallaa Hospital-South	21	15	18	18.0
Dar El Amal University Hospital-Baalbek	21	23	21	21.7
El Yousef Hospital-North	22	25	16	21.0
Eye & Ear Hospital-Metn	50	50	49	49.7
Gharios / Mount Lebanon Hospital-Metn	38	37	38	37.7
Hammoud Hospital University Medical Center–Saida	21	24	21	22.0
Hopital Des Soeurs Du Rosaire-Beirut	18	18	18	18.0
Hôpital Libanais Geitaoui-Beirut	25	23	25	24.3
Hôpital Libano Francais-Zahlé	19	19	19	19.0
Hopital Psychiatrique de la croix-Metn	14	14	14	14.0
Hôpital Serhal–Metn	20	20	21	20.3
Hôtel-Dieu de France-Beirut	67	66	67	66.7
Islami Private Hospital-North	17	17	17	17.0
Kassab Hospital-	24	24	24	24.0
Khoury General Hospital-Zahle	9	12	9	10.0
Labib Medical Center-South	30	24	24	26.0
LAU Medical Center-Rizk Hospital-Beirut.	35	38	51	41.3
Middle East Institute of Health-Metn	23	20	21	21.3
Monla Hospital–North	24	24	21	23.0
Monzer El Hajj Hospital-North	18	21	18	19.0
Nini Hospital–North	22	24	19	21.7
Notre Dame Hospital-Keserwan	4	12	3	6.3
Notre Dame Maritime hospital-Byblos	18	14	18	16.7
Raee Hospital-South	18	18	18	18.0
Rayak Hospital-Bekaa	23	20	20	21.0
Sahel Hospital–Beirut	33	33	40	35.3
Saint George Hospital-Roum-Beirut	50	52	50	50.7
Saint Georges Hospital-Keserwan	24	24	24	24.0
Saint Joseph Hospital-Metn	21	21	21	21.0
Trad Hospital–Beirut	52	54	52	52.7

Discussion

In an era characterized by global mobility and the pursuit of high-quality healthcare solutions, the evaluation of private hospital websites in Lebanon, undertaken in the context of their readiness to participate in the national tourism plan, has unearthed a series of vital revelations. These findings underscore the essential components that shape the landscape of medical tourism, both from the perspective of potential international patients and the healthcare institutions themselves. As the pursuit of cross-border medical services gains prominence, the imperative for hospitals to foster transparency, efficacy, and patient-centered care becomes all the more critical. This research sheds light on the multifaceted intricacies of hospital readiness for medical tourism and presents a comprehensive blueprint for the creation of an International Health Services (IHS) Department within hospitals seeking to embrace the national medical tourism plan. By addressing the identified gaps and aligning with international health service department guidelines, hospitals can cultivate an environment of excellence, both in catering to the needs of global patients and in elevating the overall healthcare standards within the nation. This discussion serves as the cornerstone for a meticulously designed framework that endeavors to establish the IHS Department as a beacon of assurance, collaboration, and holistic patient care within Lebanon’s medical tourism landscape. Designing a framework for an IHS department within the Lebanese private hospitals to enhance medical tourism services can be a complex undertaking. IHS framework can elevate Lebanon’s reputation for world-class healthcare. This approach not only attracts diverse patient segments but also fosters economic growth through increased revenue, foreign exchange inflow, job creation, and investment opportunities. The emphasis on patient-centered care, cultural sensitivity, and sustainability can lead to improved patient experiences, strengthened healthcare infrastructure, and positive diplomatic relations. Ultimately, this comprehensive approach aligns with global healthcare trends, positioning Lebanon as a competitive and responsible destination for medical tourism while contributing to broader economic and healthcare system development.

PESTLE Analysis of the IHS Framework

Based on the results of the survey conducted on private hospitals’ websites in Lebanon and considering the PESTLE analysis framework (Political, Economic, Sociological, Technological, Legal, Environmental), we will detail the IHS framework suggested (see Fig. 2).

Fig. 2. PESTEL analysis.

Political Factors

Licensing and Accreditation

The Ministry of Public Health (MOPH) in Lebanon plays a pivotal role in ensuring the quality and standardization of healthcare services in Lebanon. As part of its accreditation survey, the evaluation of the IHS Department within hospital settings is of paramount importance. The MOPH shall collaborate with recognized national and international healthcare accreditation bodies to ensure the Lebanese hospitals meet and maintain the required standards. The MOPH survey shall evaluate whether the IHS Department adheres to national and international regulations, including patient rights, legal requirements, and privacy standards.

Visa and Documentation

Collaborate with relevant authorities to facilitate the visa application process for international patients seeking medical treatment in Lebanon. This can include medical certificates, treatment plans, and supporting letters. Engage with relevant government agencies to advocate for policies that support medical tourism, including streamlined visa processes and incentives for international patients.

Economic Factors

Pricing Transparency

Develop an online pricing calculator that enables patients to estimate costs for various treatments and procedures. Include breakdowns of medical, accommodation, and other associated costs.

Insurance Coordination

Create partnerships with international insurance providers and offer comprehensive information on accepted insurance plans, coverage limits, and reimbursement processes.

Local Currency Payment

Implement solutions for patients to pay in foreign currencies, providing options to mitigate the effects of the currency devaluation and making payments more manageable.

Sociological Factors

Cultural Sensitivity Training

Develop cultural sensitivity training programs for staff to ensure respectful and empathetic interactions with patients from different cultural backgrounds.

Language Services

Invest in professional interpreters and offer translation services for patient documents, medical records, and educational materials in multiple languages.

Inclusive Environment

Implement diversity and inclusion initiatives that extend beyond patients to ensure that staff from diverse backgrounds feel valued and included.

Technological Factors

Online Services

Enhance the hospital’s website to offer user-friendly interfaces for online appointment scheduling, telemedicine consultations, and access to medical test results securely.

Telemedicine Expansion

Launch comprehensive telemedicine platforms that allow patients to consult with specialists remotely, share medical histories, and receive preliminary medical advice.

Digital Payment

Partner with reputable online payment gateways to offer secure and convenient payment options for international patients, reducing the need for in-person transactions.

Legal Factors

Legal Compliance

Work closely with legal advisors to ensure that international patient services are compliant with local and international regulations, including data protection laws and patient rights.

Contracts and Agreements

Develop clear and transparent contracts outlining services, costs, and expectations for both medical organizers and international patients, reducing potential misunderstandings.

Environmental Factors

Targeted Marketing Campaigns

Create marketing campaigns targeting each identified segment of medical tourists (specialized care seekers, cost-conscious patients, luxury travelers). Tailor messages to their specific needs and preferences.

International Partnerships

Establish partnerships with medical travel agencies, international medical conferences, and reputable medical organizations to expand the hospital’s global network.

Comprehensive Information

Ensure the hospital’s website offers detailed information on medical services, packages, accommodations, local attractions, and travel arrangements, making it a one-stop resource for international patients.

Quality Assurance

Utilize patient satisfaction surveys to gather feedback and continuously improve services. Highlight success stories and positive testimonials on the website to build trust.

Feedback Mechanisms

Implement an online feedback portal where patients can submit complaints, suggestions, and reviews. Regularly assess feedback to identify areas for improvement.

Social Media Engagement

Establish active social media accounts to share success stories, patient experiences, and healthcare updates. Respond promptly to inquiries and engage with the online community.

The IHS Framework

Implementing these strategies within the framework can create a comprehensive and effective IHS department that caters to the unique needs and preferences of medical tourists. By addressing each factor in the PESTLE analysis and building upon the survey results, Lebanese private hospitals can position themselves as premier destinations for international patients seeking high-quality medical care. Accordingly, the IHS framework shall be based on three components: Independent department, online platform, and marketing strategies (see Fig. 3).

Fig. 3. Three components of the IHS framework.

Independent Department

IHS involves establishing a dedicated department within a hospital focused on catering to the unique needs of international patients. This specialized unit serves as a central point of contact, offering personalized assistance to foreign patients from the initial inquiry through post-treatment follow-up. It provides support in areas such as language interpretation, cultural sensitivity, logistical arrangements, and medical appointment coordination, ensuring a smooth and comfortable medical journey.

Online Platform

To enhance accessibility and engagement, IHS departments should develop an online platform connected to a network of physicians who can provide real-time telemedicine and teleconsultation services. This platform caters to the preferences of tech-savvy international patients, enabling easy appointment booking, medical record access, and communication with medical staff.

Marketing Strategies

IHS departments should implement tailored marketing strategies that highlight the hospital’s high-quality services at competitive costs. These strategies should emphasize the hospital’s medical expertise, advanced facilities, and reputation for top-tier healthcare. Targeted advertising and promotional campaigns should be used to reach potential international patients in key markets, promoting the hospital as a preferred destination for medical treatment.

In addition to the three components mentioned earlier, the IHS department should also offer the following services to enhance the medical tourism experience, multilingual services, general health information, transparent information about costs with specific packages, in addition to the possibility of making online appointments, assessment, coordination of follow up care and treatment plan of possible complications. Interoperability of electronic health record (EHR) systems is crucial for efficient medical record transfers. Hospitals should adopt international standards for health data exchange, such as HL7 (Health Level Seven) and FHIR (Fast Healthcare Interoperability Resources), to facilitate smooth data sharing with other healthcare providers (see Fig. 4).

Fig. 4. Additional services of IHS.

By offering these additional services, the IHS department within hospitals can enhance the medical tourism experience and establish a reputation for providing world-class medical services to patients from different parts of the world.

Conclusion

The evaluation of private hospital websites in Lebanon for their readiness to participate in the national tourist plan revealed notable gaps in essential information provision, particularly in cost transparency and medical staff qualifications. On a positive note, some hospitals demonstrated efforts to attract medical tourists through insurance coverage information and tailored packages. However, there’s room for improvement in areas such as language accessibility, comprehensive patient support, and adherence to international guidelines. Addressing these shortcomings will enhance the appeal of Lebanese private hospitals to international patients and elevate healthcare services in the country.

Recommendations

Overall, based on the findings and discussions regarding the evaluation of private hospital websites in Lebanon and their readiness to participate in the national tourist plan, here are prospective recommendations for a practical framework to develop international healthcare services in Lebanon:

1. Enhance Online Presence: Develop and implement a comprehensive online marketing strategy for Lebanese private hospitals targeting international patients. This should include creating informative, user-friendly, and multilingual websites that provide detailed information about medical services, cost estimation, insurance coverage, travel arrangements, and accommodation options.
2. Collaborate with International Medical Organizers: Actively engage with international medical organizations and agencies to promote Lebanese hospitals as attractive destinations for medical tourists. Establish partnerships to expand the reach and visibility of healthcare services.
3. Develop Specialized Membership Programs: Create membership programs specifically tailored for international patients. Offer specialized services, benefits, and privileges to attract medical tourists and build long-term relationships with them.
4. Offer Comprehensive Services and Packages: Design comprehensive medical packages for international patients that include not only healthcare services but also travel arrangements, accommodation, and sightseeing opportunities. This will provide a complete travel experience for medical tourists seeking high-quality healthcare and leisure activities.
5. Transparent Information and Cost Estimation: Ensure transparency in pricing and cost estimation for medical services. Provide clear and detailed information about the cost-effectiveness of treatments and financial assistance options for patients.
6. Showcase Medical Staff Qualifications: Present detailed information about the qualifications, certifications, publications, and experience of medical staff on hospital websites. This will build trust and confidence in the expertise of healthcare professionals.
7. Focus on Post-Treatment Care and Follow-up: Develop protocols and information materials for managing possible post-treatment complications. Establish a streamlined process for medical record transfer and provide ongoing follow-up care for international patients.
8. Expand Telemedicine Services: Invest in telemedicine infrastructure to offer remote consultations and online assessments for international patients. This will enhance accessibility to healthcare services and facilitate pre-treatment evaluations.
9. Improve Language Accessibility: Offer website content in multiple languages beyond English and French, catering to the specific needs of different international patient groups.
10. Promote Workplace Inclusivity: Emphasize workplace non-discrimination and create an inclusive environment for both staff and international patients. Provide language interpreters and English-speaking staff to facilitate communication.
11. Leverage Patient Feedback: Actively collect and showcase patient feedback, satisfaction survey results, and testimonials to demonstrate the quality of care and build trust among potential international patients.
12. Compliance with International Guidelines: Align hospital services and websites with international health service department guidelines to enhance credibility and attract a broader international patient base.
13. Collaboration with Government Initiatives: Collaborate with government authorities and participate in national tourist plans to promote Lebanon as a preferred destination for medical tourism. Seek support from relevant government bodies to facilitate the implementation of international healthcare services. Ask MOPH to include the IHS department evaluation in the national hospital accreditation system survey.

By implementing these recommendations, Lebanese private hospitals can develop a practical framework to enhance their international healthcare services and establish themselves as competitive players in the global medical tourism industry. A strong focus on transparency, accessibility, and comprehensive services will attract international patients seeking high-quality healthcare in Lebanon, ultimately benefiting the healthcare sector and the country’s economy. This research is limited by the private hospitals in Lebanon. Public hospitals were outside the sphere of study frame. The study focused solely on the evaluation of hospital websites. It did not consider other factors such as marketing campaigns, partnerships, or on-ground services offered to international patients. The findings and recommendations of the thesis may be specific to the context of Lebanon, but the checklists created might be used to evaluate the hospitals of other countries. Future research could compare the marketing strategies and services offered by private hospitals in Lebanon with those in neighboring countries or regions to identify strengths and weaknesses. Conducting patient satisfaction studies can provide deeper insights into the quality of care provided by Lebanese private hospitals and identify areas for improvement.