Student: Aleksandr Traskin; Student number: 403154
Supervisor: Kim Sørensen Ramus
Pre business plan investigation: Danish attitude towards
Lithuanian private health care services
Aarhus University
Business and Social Sciences
2012-05-01
1
Abstract
Aarhus School of Business and Social Sciences, Aarhus University, Business Administration
Author: Aleksandr Traskin
Title of Bachelor thesis: Pre business plan investigation: Danish attitude towards Lithuanian
private health care services
Supervisor: Kim Sørensen Ramus
Date of completion: 2012-05-01
Number of pages: 44 + 3 appendixes
The purpose of this study is to find out, how trustful are citizens of Denmark towards Lithuanian
private dental care and plastic surgery institutions and whether the image of the country plays a big
role in the formation of this trust. Perceived quality is another point to be researched, it is important
to know what people expect and what concerns they have. The last major research question is
associated with language issue and hence is aimed at finding out the proportion of those, who are not
confident in their knowledge if it comes to specific conversation in medical institution. It also
intends to find out whether it is possible to resolve the issue, by offering an alternative solution.
Some minor purposes exist as well, which are described throughout the report. This research is
conducted to become a part of future business plan. The research was initially determined to be
more practical rather than theoretical, hence theoretical part is mostly oriented at grounding the
research questions rather than at helping to solve them, except SERVQUAL model, which was used
to a minimal extent.
The questionnaire was distributed via the internet and manually, in March 2012. Hand written and
filled online copies amount to 150, which consist of 6 age groups. Unfortunately, mostly researchwise relevant age groups do not account sufficient number of respondents, hence the research gains
more of a scientific direction with descriptive character, rather than business-plan useful. In general,
the findings are such: there is no sufficient amount of distrust neither towards the country nor
towards health care institutions of interest, but some people are quite cautious while deciding
whether to go for plastic surgery or not. The expectations are not bad – respondents expect that
quality of services is at least medium in Lithuania (except rather small number of participants). As
to speaking English language in health care facilities, the majority states that it is not a problem for
them, as well as they do not have anything against being provided with a human translator. This is
the summary of the main findings.
Key words: trust, private health care institutions, dental care services, plastic surgery services,
expectations, English language, difficulty, translator, arbitrage, compatriots
1
Table of Contents
Abstract ............................................................................................................................................................... 0
1. Introduction.................................................................................................................................................... 1
1.1 Company ................................................................................................................................................... 1
1.1.1 Plastic surgery .................................................................................................................................... 1
1.1.2 Dental care ......................................................................................................................................... 2
1.1 Problem statement ................................................................................................................................... 3
1.2 Delimitations ............................................................................................................................................. 5
1.3 Research questions ................................................................................................................................... 5
1.4 Methodology ............................................................................................................................................. 5
2. Theoretical framework .................................................................................................................................... 6
2.1 Trust .......................................................................................................................................................... 6
2.1.1 Trust to compatriots ........................................................................................................................... 6
2.2 Exclusion of state health care facilities ..................................................................................................... 7
2.2 Perceived quality as part of customers’ satisfaction ..............................................................................11
2.3 Language issue ........................................................................................................................................14
2.4 Arbitrage..................................................................................................................................................15
3. Methodological part ......................................................................................................................................15
3.1 Questionnaire ..........................................................................................................................................15
3.2 Pre-test theory ........................................................................................................................................20
3.3 Pre-test results ........................................................................................................................................22
3.4 Survey completion period and obstacles ................................................................................................22
3.5 Comments analysis..................................................................................................................................23
3.6 Reliability and validity .............................................................................................................................25
3.6.1 Reliability ..........................................................................................................................................25
3.6.2 Validity..............................................................................................................................................26
3.7 The variables analysis ..............................................................................................................................27
3.7.1 Introduction of the variables ............................................................................................................28
3.7.2 Explanation of results .......................................................................................................................28
3.8 Application of theory...............................................................................................................................36
4. Conclusion .....................................................................................................................................................40
4.1 Summary of results .................................................................................................................................40
4.2 Future recommendations........................................................................................................................41
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5. Reference list .................................................................................................................................................42
Appendix A ........................................................................................................................................................45
Appendix B ........................................................................................................................................................48
Part I ..............................................................................................................................................................48
Part II .............................................................................................................................................................49
Part III ............................................................................................................................................................49
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1. Introduction
1.1 Company
“Amber Life” is going to be a Lithuania-based service company, which will be offering dental care
and plastic surgery in Lithuania while exploiting economic inequalities among Denmark and
Lithuania. The company will be offering individual packages, which will include health services,
travel expenditures, accommodation and optional leisure activities. Moreover, a consumer will have
a possibility to choose an advanced individual package, which might include local tourist travelling,
active entertainments, and cultural events.
Consumers will be able to access our service via the web site www.amberlife.dk. The web page will
contain the price list of the offered dental and plastic surgery services as well as prices of traveling,
accommodation and optional leisure activities. The consumer will be provided with 8/7 assistance,
which would help the customer to monitor their preferences in following service groups:
•
Traveling. The consumer will have an option to choose the traveling type - to travel by
plane, bus, train, ferry or individual transportation. The ticket booking and other
organizational activities will be adjusted to the individual needs.
•
Dental care and plastic surgery. Customers will be provided with a number of best
dental care and plastic surgery clinics in Lithuania to choose from. The professional
profiles, including accreditation and customers` feedback, will be available on the
website.
•
Accommodation. A customer will have a possibility to select the most suitable
accommodation, including quality requirements, the type of room, food preferences,
price, and location. Moreover, the customer will be able to choose across various SPA
procedures and other optional leisure activities.
1.1.1 Plastic surgery
According to one medical website based article1, the Danish society pays a lot of attention to health
and beauty, where plastic surgery is just one of the ways to contribute to it. The article says that
demand for plastic surgery in Denmark is growing and that at the moment about eighty per cent of
Danes have nothing against plastic surgeries. The statistics provide us with such numbers: nearly
1
http://ezinearticles.com/?Recent-Trends-in-Plastic-and-Cosmetic-Surgery-in-Denmark&id=390393
1
320 000 of Danes have been “under the knife”- that is about 8 per cent of total adult population in
Denmark. One of the important findings indicates that there would be 20 - 30 per cent projected
increase in plastic surgery services demand in the nearest future, which allows project the future as
the successful time for the development of this branch of business. The article states that, Danish
men count for a significant proportion of all plastic surgeries performed in the country - every third
Dane who has undergone or is contemplating cosmetic surgery is male. Nowadays, there is an
increasing trend among young Danish people to have a plastic surgery.
On the basis of the same article - the other factors, which influence market growth and market
attractiveness, are political and legal aspects. The increased demand for plastic surgeries in the
country is putting pressure on the Danish public health care system. The costs of certain plastic and
cosmetic surgeries necessary for the healthy functioning of the body, are being entirely or partly
paid by the public sector. Eyelid surgery, breast reduction and liposuction are interpreted by patients
to be necessary for the healthy functioning of the body, as opposed to being purely cosmetic.
According to Danish laws, all plastic and cosmetic surgeries have to be financed individually.
However, there can be a lot of interpretations what is a cosmetic surgery and what is essential for the
healthy functioning of the body. There is a considerable likelihood that the government will refuse
to pay for such “grey zone” surgeries and there will be an increasing demand for them in private
hospitals. As a result, there will be an increase in waiting periods for the plastic services. Since the
government could refuse financing all plastic or cosmetic surgeries, the prices might increase even
more. All in all, the data suggests that the prices might increase even more as the trends for plastic
and cosmetic services are going up in the future. However, there might be even bigger
dissatisfaction with the overpriced services and long waiting lines, which might create more
possibilities for the company to offer available and cheaper services.
These factors encourage to develop the idea of establishing intermediary services company, with
plastic surgery being one of the core areas.
1.1.2 Dental care
According to Annamari Nihtila’s report (2010, pp.14-17), the organization of the oral health care
system in Denmark is based on the Danish Health Act (Bekendtgørelse af Sundhedsloven nr 95 af
07, februar 2008) and the Government order of oral health care (Bekendtgørelse om tandpleje nr 727
2
af 15. juni 2007) that describes the overall structure of the oral health care programs and systems of
subsidies. The dental care system in Denmark is divided in two sectors - public and private. Public
sector provides oral health care programs for children (at age 0-18) which are free of charge and are
organized by the municipalities. Oral health care services for adults (18 years+) are provided by
private dentists or dental hygienists. The subsidies for adults oral care are described in Agreement
between the Danish Dental Association and the National Health Service (Overenskomst om
tandlægehjælp af 24.october 2006). The social security law directs the municipalities to give
subsidies for oral health care to people with low income, receiving social securities and pensioners.
Oral examination, scaling, individual prevention, treatment for dental caries and periodontal disease,
root canal treatment, extractions and oral surgery are subsidized and the refund rates vary from 30 to
65 per cent, depending on the patients age and the actual treatment. However, most services, like
orthodontics, crowns, bridges and removable prosthodontics are paid by the patients themselves.
Oral care industry recorded with retail value growth of 1 per cent in 2010 – a major improvement
upon the 3 per cent decline in sales recorded in 2009. The increase in sales was mainly stimulated by
strong promotional activities throughout the year. However, as a result of the economic downturn,
consumers reduced purchases of oral care products, sticking only to essential items and becoming
more price focused.
In response to this trend “Amber Life” is going to offer dental care services for significantly lower
prices. The bigger the scale of needed services is – the cheaper the whole package is.
1.1 Problem statement
The purpose of this project is to consider all possible obstacles and evaluate the degree of their
removability on the path to launching the product, gain deeper understanding of the market and
underlying processes on the way to success as well as to get you acknowledged with the product and
its’ specifications, point out its’ strong and weak points. The product is the company “Amber Life”,
which is to be established for the production of intermediary services – offering Lithuanian healthcare services in Denmark. First of all, Denmark and Lithuania have huge gap in prices for dental and
plastic services2. Secondly, it is assumed, that quality is quite the same – there exists no reason to
2
Plastic surgery : Lithuania - http://www.nordesthetics.com/en/plastic-surgery-lithuania?nocache=1 ; Denmark http://www.plasticsurgeon.dk/priser.html. Dental care services: Lithuania http://www.dentaltourismexpert.com/dental-care-in-lithuania.html; Denmark http://www.sdent.dk/priser/?gclid=CPPXg6mK268CFcjwzAodoQt-aQ
3
think that in Lithuania it can be worse, so assumed that it is at least on the same level as in Denmark.
Thirdly, “Amber Life” will be offering very comfortable way to book needed services – the
convenient website. It is going to be the website, with a design similar to travel agency website’s
design, with intention to make it as functional as possible. It will be continually re-mastered in order
to gain the best usability.
The company’s environmental basics can be defined as the dental care and plastic surgery market
for Danish consumers in Lithuania. The main company’s purpose will be to improve dental care and
plastic surgery planning services – create easy-to-use webpage with user friendly interface, which
will minimize the effort that has to be put in. The company will seek to be the most creative and
popular company, which would enhance consumers’ perceived value in Lithuania regarding health
care services. The company’s main challenge will be to be the leading organization which provides
the best arranged dental care and plastic surgery services in a customizable individual package.
The obstacle to overcome is peoples’ habit to believe that domestic products are the best or better
than foreign of the same kind, even if there is no evidence for that. We can easily add lack of trust to
foreign healthcare system, especially when it comes to surgeries, which are not the basic procedures,
but demand high level of skills and knowledge. The idea is to dig deep and to find out whether it is
possible to assure people that somewhere else they can find at least the same quality products.
Hence, the task is to come up with the solution that will be effective and will help to achieve the
targeted aim of making sure people use arbitrage without any pre-assumptions.
People tend to trust their nationals (trust to compatriots section) and one of the solutions would be
the establishment of the net, which would provide the references by Danish citizens. Of course it is
not the immediate measure because it takes to create trust-increasing database and to perform all
other procedures necessary for its’ successful launch and even more successful performance. The
report will produce some needed investigation whether such measure is useful.
The report will include theoretical part, where I will introduce you to every aspect of the services
and research part, where I will test whether the services will have demand and whether it is
favorable to launch it. In other words, I will find out how the potential customers perceive the
quality of the product.
4
1.2 Delimitations
Of course there exist some other organizational difficulties such as office vs. home-based model
consideration, ways of promoting the product and development of the website. It can be assumed
that these obstacles are minor to compare with the trust conquest campaign, because according to
Gefen (2000, p.1) “trust is major factor influencing the successful proliferation of E-commerce,
identified by major corporations, the Federal Administration and the Better Business Bureau, is
people's trust in Internet vendor.” They need only a bit of planning and budget adjustment to get
resolved. I do not say that they can be omitted or treated without necessary attention, but they do not
rely on the social aspect to that high extent. And social aspect includes public opinion, which is not
something completely stable or easy controllable. Hence I decided to delimitate this research in
order to gain better knowledge of the specific field such as perceived quality of services provided
and extent of trust to Lithuanian private medical health-care establishments which Danish
consumers possess.
1.3 Research questions
The research is aimed to give answers for three main questions:
a) How big is the amount of trust of society to foreign (in this case Lithuanian) health-care
facilities? It must be mentioned, that Lithuanian state institutions cannot be considered as
objects of interest, because firstly – they fall under national health-care system, secondly,
Amber Life is not interested in providing its’ intermediary services via state hospitals – that
does not fall into its’ business concept.
b) Perceived quality vs. objective quality. Positive or negative effect on the objective perception
of quality of services.
c) Language issues. Inability to communicate properly due to external reasons.
1.4 Methodology
The research will consist of data collection by mean of questionnaires. Quantitative research is
chosen due to the fact that the ideas are easy explainable – assumed that final course of actions can
be introduced to the audience and their clear understanding of subject is unavoidable; it is intended
to check whether at least partial consensus on the matter of perceived quality and trust to PFHCI3
can be reached between all groups of people. Among all respondents, older peoples’ opinions would
possess more value due to the fact that they are considered as more likely to need some medical
3
Private foreign health-care institution (by me)
5
interference, especially when it comes to dental care. But the purpose is to investigate whole
population starting from 18, because it is intended to find out all possible attitudes, despite the fact
that older people tend to make highest proportion of those who have health associated problems.
There is no intention to specialize on some certain age groups, for instance, because of plastic
surgeries and their popularity among all ages, with a bias towards “20-50 year old” range.
2. Theoretical framework
2.1 Trust
Since one of the main challenges of the report is to find out whether the trust issue can prevent
business project from successful implementation, hence most of theoretical part should be devoted
to developing the framework which will be used as a supportive material for the practical part of the
research. It is intended to find out whether Danish nationals possess necessary amount of trust to
Lithuania, especially to the specific area of interest within the state.
According to Sztompka (2000) trust is something that is oriented towards the other people and their
future contingent actions. Each nation possesses different amount of available trust to the others.
Some nations are more reserved and the others tend to be more trustful. The era of globalization
allows for international trade on a simplified level with plenty of possibilities to deliver goods all
around the world. At the same time it offers a wide range of different possibilities for arbitrage in
almost any category of goods. “This might lead consumers to reject foreign products because they
are not sufficiently familiar with the foreign products and firms or they need more information to
reduce uncertainty”(Gutierrez, Torres; 2007; pp. 1-2). The more people know about the homecountry of desired good, the more likely they will decide to buy it.
To show that absence of extra knowledge is not crucial for the project I intend to demonstrate, that
there is no need in profound knowledge of the home-country, when deciding whether to trust its’
healthcare system or not. Because it is not necessary medical interruption, but absolutely optional
for customer and also financially attractive for both parties, there should be no intention to violate
quality standard by service providers.
2.1.1 Trust to compatriots
The way to increase trust to the project would be to help Danes, who already used the services (does
not matter in which circumstances) share their opinions. Establishment of a network, with comments
6
on each facility/doctor as well as comments on organizational procedures, performed by Amber Life
would be kind. The writing4 by Russian scientists, suggests, that trust inside the nation is something
that can easily be explained and cannot be considered the other way than it is. When people have
precondition for trust, such as – same culture and values, experience of living under the same
political regime, having endured the same events (not necessary positive meaning), then they tend to
trust each other, because the probability of the same viewpoints between these people is much
higher. Hence, their service and all underlying aspects evaluation methods might easily be similar.
2.2 Exclusion of state health care facilities
There is not much that Denmark and Lithuania have in common. They compete in different
economical weight categories – Denmark is one of the wealthiest European countries, while
Lithuania is struggling and many people are leaving the country every year, people have different
level of national self-awareness – most of Danes tend to stay in their country and respect the way
things are going around, a minimum level of income in Denmark is much higher than in Lithuania.
Still, both parties can successfully communicate between. However, how does a Danish citizen
know, whether he/she can trust foreign health-care system and its’ services or not? Based on the
MSc research by Vaida Enevoldsen (2011), great majority of Danes have never been to that country
before and can’t boast they heard something really positive about it. The idea of going somewhere
else gets even less appealing to a person, who knows that according to the last ranking in 2009 Danish state health-care system is rated as one of the top health-care systems in Europe.
Copenhagen Capacity, Danish Capital Region’s official inward investment agency says: “within six
categories, covering 34 performance criteria, Denmark has 820 points out of 1,000 possible. In spite
of the impressive results and a climb of 7 in the index from 9th to 2nd position outstanding results
with regard to Patient rights and information as well as e-Health (and a leading position in Europe in
2008 for diabetes treatment) the Danish results can still be improved. The good Danish ranking is
primarily a result of new efforts within information communication and to a lesser extent better
results in the healthcare sector itself.” 5 Hence it is can be noticed, that when such ranking was
executed, quite high number of performance criteria’s was assessed. The assessment can be found
on pages 13-14 of Euro Health Consumer Index 2009: Report.
4
Internet based source
http://www.delorus.com/medialibrary/detail.php?ID=1896
5
http://www.copcap.com/content/us/quick_links/news/latest_news/2008/news_4th_quarter_2008/the_danish_healthcare
_system_ranks_number_2
7
The inequality of health-care systems might be the biggest negative point for the majority of people,
hence it can be considered as one of the major sources of suspicious attitude of Danes towards
“health tourism” in Lithuania. I provide direct comparisons of Lithuanian and Danish by Health
Consumer Powerhouse:
Figure 1. Comparison of DK and LT in the field of “Patient rights and information”. Based on
http://www.healthpowerhouse.com/files/Report-EHCI-2009-090925-final-with-cover.pdf p. 13-14
As it can be seen from the picture, most important difference in terms of patient rights and
information is that no-fault malpractice insurance practice is not as developed in Lithuania as in
Denmark yet, but according to the article, in Lithuania, the level of involvement of patient
organizations increased in past years to a level higher than the majority of the wealthiest countries in
the West. Hence, if insurance is made in Denmark, then there is absolutely no chance staying
without refund for experienced inconveniences, no matter due to whose fault.
8
Figure 2. Comparison of DK and LT in the field of “e-Health”. Based on
http://www.healthpowerhouse.com/files/Report-EHCI-2009-090925-final-with-cover.pdf p. 13-14
E-Health is more of a tool for citizens of the country, and has no connections with “Amber Life’s”
business idea.
Figure 3. Comparison of DK and LT in the field of “Waiting time for treatment”. Based on
http://www.healthpowerhouse.com/files/Report-EHCI-2009-090925-final-with-cover.pdf p. 13-14
Waiting time for treatment is quite similar in both countries and is suited only for state medical
facilities, because private institutions have their own standards for waiting lines.
9
Figure 4. Comparison of DK and LT in the field of “Outcomes”. Based on
http://www.healthpowerhouse.com/files/Report-EHCI-2009-090925-final-with-cover.pdf p. 13-14
These differences are all probably irrelevant for one who visits the country for plastic surgery or
dental care services.
Figure 5. Comparison of DK and LT in the field of “Range and reach of services provided”. Based on
http://www.healthpowerhouse.com/files/Report-EHCI-2009-090925-final-with-cover.pdf p. 13-14
The only aspect of interest might be 5.7, though in private facilities you pay for each procedure,
hence, the doctor is an interested person in a positive outcome and is motivated to do as well as
possible to meet the expectations and quality standard.
10
Figure 6. Comparison of DK and LT in the field of “Pharmaceuticals”. Based on
http://www.healthpowerhouse.com/files/Report-EHCI-2009-090925-final-with-cover.pdf p. 13-14
This table considers subsidies for citizens, who pay tax or drugs for other diseases, not related to
plastic surgery or dental care.
From the tables it can be easily noticed that the gap between health-care systems is quite visible, that
statement can be supported with numerical evidence (sum of attributes, which is part of the overall
rating).
I explained all of these tables to prove that “Amber Life’s” offerings will have nothing in common
with state health-care system. Based on the direct relation of these parameters to national state
health-care system and its’ provided services it can be concluded that they are irrelevant in the
report, due to the fact that business idea does not take into consideration the use of Lithuanian state
health-care facilities, only private institutions and clinics.
2.2 Perceived quality as part of customers’ satisfaction
If you do not manage to match your customer’s expectations – you are on your way to lose him/her,
unless you remain competitive on all fronts. The attractive way to maintain competitive advantage,
create a good name for your brand/company, keep satisfied customers using your services – is to
keep quality standards up to the highest possible level (if assumed that due to some obstacles you
can’t do that – then the maximum has to be squeezed out of possible resources). Yoo and Park
(2007, p. 4), in their work write: “The firm’s ability to create and provide a high level of service
quality is a key to sustaining competitive advantages amid severe competition. The intangibility
nature of service, however, makes it hard to set standards.” In spite of the difficulties, Parasuraman
et al. (1988) present five sub-dimensions of service quality – reliability, tangibles, responsiveness,
11
assurance, and empathy. According to Ravichandran, Arun Kumar and Prabhakaran (2010, p. 118),
the SERVQUAL model is based on the perception gap between the received service quality and the
expected service quality, and has been widely adopted for explaining consumer perception of service
quality.
Table 7. SERVQUAL or Gaps Model by Zeithaml, Parasuraman, Berry
SERVQUAL, developed and tested by Parasuraman (1988) in his scientific works is a widely used
measure for service quality. It was chosen to become a subject of reports by a number of scientists.
The underlying idea is that objective quality and perceived quality are two different things. As
uninterested side, scientists can evaluate objective quality based on the model, consumers will
perceive the quality through their own expectations and standards. According to Holbrook and
Corfman (1985), mechanistic and humanistic qualities directly refer to objective and perceived –
they are synonymous. Some of them proved the applicability of the model, hence showed its’
usefulness. According to Yoo and Park (2007, p.5), the reliability of Parasuraman’s theory was
showed by Bolton and Drew, 1991 6 ; Cronin and Taylor, 1992 7 ; etc. On the other hand, some
scientists showed that there is always room for improvement and SERVQUAL isn’t the exception.
In their work, Reeves and Bednar (1994, p. 434) state that the higher are initial expectations of the
quality – the higher will be overall satisfaction, despite the fact, that objective quality is worse than
perceived. They also characterize quality in their own way, including such dimensions as excellence,
6
7
http://www.ruthnbolton.com/Publications/LongitudinalAnalysisofServiceChangesonAttitudes.pdf
http://www.jstor.org/stable/1252296
12
value, conformance to specifications, and meeting/exceeding expectations. A number of scientists
provide slightly different definitions of service quality, but all they agree with the emphasis on
customers. Kim and Lee (2000, p. 238) view service quality as a set of sub-dimensions such as
reliability and responsiveness that precede customer satisfaction. This research defines perceived
service quality as the extent to which a firm successfully serves the purpose of customers.
Most of criticism found was provided by Francis Buttle (1994, p. 10). Here I intend to highlight
ones’, which are most relevant for the report:
Theoretical:
• Gaps model: there is little evidence that customers assess service quality in terms of P – E gaps.
• Process orientation: SERVQUAL focuses on the process of service delivery, not the outcomes of
the service encounter.
• Dimensionality: SERVQUAL’s five dimensions are not universals; the number of dimensions
comprising SQ is contextualized; items do not always load on to the factors which one would a
priori expect.
Operational:
• Expectations: the term expectation is polysemic; consumers use standards other than expectations
to evaluate SQ; and SERVQUAL fails to measure absolute SQ expectations.
• Item composition: four or five items cannot capture the variability within each SQ dimension.
Despite these critics, the model will be used in the research part of this report though, these points
will be taken into consideration in order to avoid polysemic conclusions regarding same questions.
Since the company has not been offering its’ services yet, it is impossible to find out the perceived
quality. To deal with this problem I assume, that perceived quality level allows for successful
exploitation of such business model, that it is similar to the level which Danish dental/plastic
services achieve in consumers’ eyes. I am also planning to keep gaps 2, 3, 4 as non-existing (having
no sufficient differences between values proposed in the model). Having this data as given, by mean
of questionnaire I will gather the other data which will allow me to run SERVQUAL test. To do this
I need to find out whether my understanding of expectations is similar to consumers’.
13
2.3 Language issue
One of the underlying issues of customer satisfaction is the ability to talk the same language and to
be understood. According to statistics of 20088, only 26 per cent of Lithuanians speak English, and
that is a miserable amount to compare to Denmark, where most of the population masters this
language at least on acceptable level. According to Eurobarometer (2006, p. 13), supervised by
European Comission, 86 per cent of Danes speak English. To make things even worse, only 5 per
cent of Lithuanian undergraduates get the necessary result from IELTS (international English
language test) from the first time. This means, that even youth has difficulties with foreign
languages – what to say about older people, who probably will make the highest impact on the
foreigners while on medical tour. All of that is written to consider describe the extent of
inconvenience which might be faced by Danish tourists while in Lithuania.
That is worth
mentioning that elderly Danes are considered as potential customers and there is no evidence that
they speak English. According to the data provided by Index Mundi9, 17,1 per cent of population
consist of elderly people – 65 year-old and older. Though, that is more than 14 per cent of nonenglish-speakers, and if even to assume that all these 14 per cent are somewhere among 65+ age
group and that only they don’t speak English language, still approximately 20 per cent of “65 and
older” population manage to speak English.
On the other hand, the 2011 data suggests that the amount of English language speakers is growing,
and it is up to 32 per cent of population by now. Private doctors and their assistants usually possess
some English language knowledge, at least in their field, due to the fact that most of them were
studying abroad, to get better education than offered by Lithuanian national educational system. In
case they do not, the company intends to deal with the language issue by providing translating
services at its own expense (Lithuanian – Danish / English - Danish). The translators duty is to keep
confidentiality same as the doctors. However, it’s up to a customers’ own beliefs, whether to trust
his/her medical data to someone else or not. It can be assumed, that medical tourists are not familiar
with specific terminology in English, even in their native language, perhaps. Then they probably are
very anxious and unsure about visiting another country, explaining their situation and trying to
understand the response. The study is aiming to find out the percent of people, comfortable with
having health care procedures in English, as well as, the percent of those, comfortable using the
translator.
8
http://www.kalba.lt/kiek-uzsienio-kalbu-privalome-ismokyti-savo-vaikus.html
9
http://www.indexmundi.com/denmark/age_structure.html
14
2.4 Arbitrage
This business idea is to a high extent based on consumers’ arbitrage, what allows adjusting prices
and other valuables to the level which allows maintaining competitive and attractive position. It is
obvious, that “Amber Life” cannot affect institutions pricing policies, but can do its’ best to exclude
clients’ unnecessary spending, so that the only extra amount of money spent would be a markup
(company’s share for its’ provided services).
It is intended to create the conditions for arbitrage to become a useful tool for clients as well as for
the company. When it comes to the consumer – the willingness to save money sometimes
overcomes other instincts. According to *see footnote*10 money might be either a source of security
or freedom, or a measure of self-esteem as well as a cause of anxiety or dependence. It depends on
the amounts of money in disposal. Following the authors idea, there are different categories of
people if to take spending power into consideration – from miser to over-spender. Following the
idea of arbitrage, it might be assumed, that knowing about the existence of similar value possessing
goods, but preferring the more expensive ones – is considered as overspending. One of the study
aims is to find out whether Danish people tend to spend more than could be and whether it has
connection to trust issue, given that savings might be of a reasonable size.
3. Methodological part
3.1 Questionnaire
The chosen type of questionnaire is structured -undisguised questionnaire:
• Questions are listed in a pre-arranged order; - the way of adhering some certain order is chosen in
order to keep references from one to another legit (the chains of questions, where some have to be
answered only in order the previous questions were answered). It also prevents respondents from
switching from one sub-topic of the questionnaire to another, because that might cause a loose of
attention and due to this fact answers might be inconsistent – it can be assumed, that respondents
10
While writing this part, only link to the page was saved, and whole reference was planned to make in the end.
Unfortunately the link is not responding properly, hence I cannot find out the author and other details. Text is not cited,
that is why the task is impossible to complete.
http://web.ebscohost.com.ez.statsbiblioteket.dk:2048/ehost/pdfviewer/pdfviewer?vid=2&hid=106&sid=ccdfe347-512a4256-ba99-98abaa9cd60e%40sessionmgr15
15
have to start thinking one way to answer some chains of questions and interrupting the “out of the
box” thinking process might react with some sort of not the best outcomes. I do not intend to state
that my questionnaire demands such thinking effort, however, in order to avoid any possible risks I
arranged it the way, that all questions of the same specifics follow each other.
• Respondents are told about the purpose of conducting survey; - I decided not to ignore the
willingness of respondents to know the purpose of this survey. According to Plant and Miller (1997,
pp. 21-24), undisguised survey brings out more or less honest way of answering it, even if it is
something that a person can easily get ashamed of - alcohol consumption survey. I can promise is
confidentiality as well as the use of results only for this reports purpose. I absolutely reject the
possibility of abuse of data and any sort of harm provoked by answering the survey – it is absolutely
anonymous and not mandatory.
The questions have to fulfill their aim – they must be suitable for the research (no unnecessary
questions; answers should be available for being analyzed with respect to the theories, stated in the
theoretical part), they have to be understandable and possess one specific explanation (no
misinterpretations allowed).
1) Please state your age:
Respondents will state their age by inputting it manually. Numerous conclusions should be
available to be drawn, knowing the distribution of this parameter. It is an unavoidable part of
nearly all surveys.
2) What is your gender?
Amber Life offers two different types of services (dental care and plastic surgery services), it
can be assumed that each of types is not equally demanded by men and women (especially
plastic surgery). The knowledge of gender allows for including more specifics into tests.
3) Have you ever been using private dental-care services in Denmark?
16
This question is targeted at finding out the proportion of population that has encountered
dental-care services in Denmark’s private institutions. The more respondents had, the more
efficient is the survey, because experienced respondents give the degree of objectivity to this
survey.
4) Have you ever been using private plastic surgery services in Denmark?
5) (For those who said “YES” in 3) How would you evaluate this experience in terms of
price/quality relations?
Here the rating scale has been chosen, with five possibilities from “Absolutely unsatisfying”
to “Absolutely satisfying”. It should be considered that there might be a number of
respondents who just had their tooth sealed or other simple procedure completed, which does
not demand especially high competencies. However, this question results can give an
overview of consumer attitude towards domestic private services price/quality relationship.
6) (For those who said “YES” in 4) How would you evaluate this experience in terms of
price/quality relations?
7) Are you informed about the price-level for different plastic surgery services in Denmark?
The question is aimed at finding out the proportion of respondents, who are fully or to some
other extent informed about pricing level for plastic surgery. Possible answers are:
yes/partially/no
8) (For those who said “Yes”/”Partially” in 7) Rate your satisfaction with price-level for
plastic surgery services in Denmark?
The question assumes answering by picking one of five possibilities, from “Absolutely
unsatisfying” to “Absolutely satisfying”.
9) Are you informed about the price-level for different dental care services in Denmark?
17
10) (For those who said “Yes”/”Partially” in 9) Are you satisfied with price-level for dental
care services in Denmark?
11) Rate your satisfaction with the quality of plastic surgery services in Denmark? (Answer if
you have your opinion on this matter)
The question is aimed at finding out the level of satisfaction of respondents, who have their
opinion on the matter of quality of particular services. The opinion could have been formed
after personal use of services, by stories of other people to whom the degree of trust is quite
high or by observing the outcomes of use of these services by other people. There might
exist other factors influencing the opinion.
12) Rate your satisfaction with the quality of dental care services in Denmark? (Answer if you
have your opinion on this matter)
13) Would you agree to have dental care services performed in private institution abroad,
given the quality is the same level as in Denmark?
This question is supposed to find out the proportion of surveyed population, who in general
would agree to leave home-country and go on tour to resolve their health problems. It is
expected that without specification of incentives, the results might be different.
14) Would you agree to have plastic surgery services performed in private institution abroad,
given the quality is the same level as in Denmark?
15) Please rate your expectations of quality of dental care services at private institutions
abroad?
Five possible choices are offered to respondents, allowing them to pick one, from “Low” to
“High”. It is intended to find out whether expectations of the quality abroad will be similar to
expectations in Lithuania. That could allow see whether expectations are biased or not.
16) Please rate your expectations of quality of plastic surgery services at private institutions
abroad?
18
17) Please rate your expectations of quality of dental care services at private institutions in
Lithuania?
18) Please rate your expectations of quality of plastic surgery services at private institutions in
Lithuania?
19) Would you agree to have dental care services performed in Lithuanian private institution,
in case it could lower your bill by 40-70% and given that the quality is the same level as in
Denmark?
This question aims at finding out the proportion of respondents, willing to use Amber Life’s
services, given they will be rewarded with sufficient savings.
20) Would you agree to have plastic surgery services performed in Lithuanian private
institution, in case it could lower your bill by 40-70% and given that the quality is the same
level as in Denmark?
21) If “No” in 19 and 20. Have you ever been in Lithuania?
The respondents, who answered “No” to previous question should answer this one, because
the aim of this question is to test the assumption that negative answer might be a reaction to
a previous contact with Lithuania/ Lithuanian culture.
22) If “No” in 19 and 20. Do you have a negative image of Lithuania?
The question is targeted at further finding out the reason for answer “No” in question 16.
Answers “Yes” and “Maybe” mean that respondent has negative image of the country.
23) If “No” in 19 and 20. Please state the reason, why would you prefer not to have dental
care services and/or plastic surgery services in Lithuania.
19
This question demands a hand-typed answer, which will be a supplementary material for
analysis. Different answers are expected to be handed in, hence a number of statements will
be available to make. It is assumed, that there will be answers, that possess the same
meaning – the most popular among respondents will be considered as the key issues.
24) Would positive responses of your compatriots affect your decision to use one or another
service in Lithuania?
The purpose of this question is to find out the extent of sampled population, who rely on
their compatriots’ opinions, as well as to test whether the establishment of feedback channel
would be a sensible action.
25) Would you have difficulties speaking English in foreign health-care facilities? (Keep in
mind, that it is not a friendly talk, but a serious conversation, with a use of medical
terminology)
The question aims at uncovering respondents’ opinion on their own English language oral
capabilities. The respondents must assume that some specific terminology might be used by
doctors, though could be explained easily in simplified words.
26) Would you be against being provided with a translator, who would have to be into all
details of your conversation with specialist(s) and would have to keep confidentiality? (In
case you are not a fluent English speaker or vice-versa)
This question is targeted at finding out the ratio of those who would like to use translator and
those who would not.
3.2 Pre-test theory
After all of the questions are written down and the scales for answering are chosen, the pre-test of
the survey is started. According to Iarossi (2006, p.89), the pre-test functions is to evaluate the
competency of the questions, to estimate the length of the survey (time that it takes to answer the
20
survey) and to check overall quality of the surveyor. According to the source11, which was helping
me throughout the stage of questionnaire development, pre-test first serves as the initial “live” test of
the survey, and secondly it is the last step in finalizing the survey questions and form. The source
author considers the pre-test to be possibly one of the most critical steps in administering a survey.
In this project, the idea is to test the pre-survey text – a couple of rows, just to introduce the purpose
of the survey and some details about Amber Life, as well as to test the questionnaire (for the reasons
mentioned above). The pre-test participants will amount to twenty respondents, whose purpose will
be to read the survey and pre-survey text, to fill it in and to answer a number of questions which are
aimed at finding out whether:
• Do the respondents understand the survey’s objective?
• Do the respondents feel comfortable answering the questions?
• Is the wording of the survey clear?
• Is the time reference clear to the respondents?
• Are the answer choices compatible with the respondents’ experience in the matter?
• Do any of the items require the respondent to think too long or hard before responding? Which
ones?
• Which items produce irritation, embarrassment, or confusion?
• Do any of the questions generate response bias? Which ones?
• Do the answers collected reflect what you want in regards to the purpose of the survey?
• Is there enough diversity in the answers received?
• Is the survey too long?
• According to your test audience, have any other important issues been overlooked?
11
http://s3.amazonaws.com/SurveyMonkeyFiles/SmartSurvey.pdf
21
Iarossi proposes taking into consideration these aspects when checking the surveys’ sufficiency. All
of them are targeting the specific area of the survey creation, and respondents’ answers might make
it easier to understand the mistakes and to correct them.
3.3 Pre-test results
First of all, respondents found questions 15 and 16 quite inconvenient for answering, due to the vast
possibilities of different “abroad(s)” available to choose. The idea of finding expectations for an
“average abroad” seems to be impossible to carry out in just one question. Hence, it will be given up
and these two questions will be excluded from the questionnaire.
Secondly, question number 21 is open-ended and most of respondents did not tend to answer it
mostly because of inability to formulate the issue for which they would prefer not using Amber
Life’s services (not going to Lithuania for one of/both particular purposes). After they attempted
answering the survey, some sort of discussion was held, where I was suggested formulating a couple
of negative statements about Lithuania, which in fact can be already existing stereotypes as well as
some innovations, to make things a little bit more complicated for respondents. The new version of
the question is:
Please rate the following statements:

Lithuanians possess mostly negative traits of character

Lithuania seems to be not a safe place to travel to

Lithuanian political regime seems not appealing

Lithuanian doctors are not competent
This question aims at finding out the extent of influence of each of these aspects in the process of
neglecting the possibility of going to Lithuania.
As to other Iarossi’s proposed points, they seem to be satisfied, and respondents in general did not
express any other dissatisfaction.
3.4 Survey completion period and obstacles
The web-survey was available for answering for approximately two weeks, on the resource
www.pollmill.com, and during that time only about eighty answers were gathered. That is
approximately a half of the required minimum answers number for the survey, hence some other
22
measures were taken to increase the amount of answered surveys. Approximately one hundred of
copies were printed out and distributed among:
a) the Aarhus School of Business and Social Sciences staff members
b) fellow-students
c) random people from the street
The distribution among fellow students created a bias towards “eighteen – twenty five” years age
group to be dominant among the other groups, hence I tried to correct that with rather intense
distribution of surveys among people that do not fall into this age group.
In the process of gathering answers for the survey it was found out, that personal distribution of
surveys gives bigger gains – only five persons of seventy eight refused to fill the survey, when I
handed it requested them to do this. It was expected to face high completion rate while distributing
the survey through the internet, though expectations did not match reality. The survey was posted on
www.dindebat.dk and www.facebook.com account, which cumulatively gave only seventy eight
answers, including the fact that the survey was shared by my “facebook” contacts among their
contacts.
The other obstacle was my own mistake – the word “private” is for sure an odd word in the question
“Have you ever been using private dental-care services in Denmark?” Such formulation made
respondents feel inconvenient and made them to hesitate which answer to choose (yes/no). There is
only one type of dental care institutions in Denmark, and dental care is partially/fully refunded
before the age of 18 and in some cases after 18. Hence, some respondents on the internet ticked
“No” in the question, instead of “Yes”, due to my misinterpretation of question. While distributing
the survey papers manually, I always made the respondents aware of the error in question 1.
According to respondents, the survey was rather easy to fill in – no formulations made them hesitate
(except question 1 for internet participants), the average time among internet respondents was 180
seconds, and the average time among others was not more than 4 minutes (according to my own
observations).
3.5 Comments analysis
Some of respondents left their comments about the survey, which appeared to be very useful,
because it gives a bit of qualitative data for my consideration. Comments mostly make emphasis on
the aspects, which I did not mention in the survey, but which would definitely take place in the
23
actual business plan. The comments will be presented without any changes/corrections made to them
and discussed below:
1) “It is definetelly to expensive to travel all the way to Lithuania just to go to a dentist : ) In
case of a more expensive treatment (crowns, bridges) several visits to a dentis are nesessary,
therefor it is not possible to be done abroad. I guess the same relates to plastic surgery.”
Such comment is a representation of my failure to make respondents aware of all details, which
might affect their opinion. That happened due to my full concentration on the respondents’
perceptions of Lithuania and the difference between the countries in terms of price/quality. The
questionnaire was not broad enough to introduce all aspects of business plan to potential customers.
Consequently, people are not aware of all “existing” detail, hence recognize them as missing. That
has sort of negative effect on their willingness to go there.
2) “Don´t want to travel that far for any medical care, when they are god enougth where I am.”
This comment is not obvious enough to be analyzed, because “good enough” might include both
“good quality” and “good price” (be fully accepted by consumer) as well as one or another alone. In
general, the person seems satisfied with local medical care and is not willing to travel abroad for it.
On the other hand, there exists a possibility that the person might had not taken into the
consideration the fact, that prices are significantly lower in Lithuania, while the quality is at least
same level as in Denmark.
3) “My concerns with having healthcare performed outside my own country are mostly founded
in the fact that not only language but also culture is a big factor in how well citizens of
different countries understand each other. Also, if problems were to arise, it would seem
almost impossible to file a formal complaint.”
Concerns of this respondent seem appropriate and have to be discussed. First of all, cultural
differences definitely can be considered as an obstacle in communication and partnership, on the
other hand, author of the business plan does not see this issue preventing the main objective of the
travel from being fulfilled. Doctors and medical personnel are fully professional and do not allow
themselves unnecessary interruptions of customers. They follow their professional ethics and seek
24
consumer’ satisfaction. Secondly, the formal complaint issue is not to be considered it this paper,
though it is something, that can definitely be done if needed, depends on the circumstances and on
the type of medical insurance the person has.
4) “I do not question that doctors can be equally good from coutry to coutry. My main concern
in regards to having plastic surgery or dental work done abroard is a fear og not being
coveret by Danish guarantees and the Danish consumer legislation etc. in case of
complications.”
These concerns seem to be legit, and quite of an issue, unless you have an international medical
insurance. Denmark has one of the best medical insurance systems in Europe, based on materials
disposed on page 9. The customers of Amber Life would have been provided with all necessary
information on this matter via the internet website.
5) “Regarding #18: I do not have a negative image of Lithuania in general, but I have doubts
about the medical care quality there.”
This comment might be the one, which almost every respondent had on his mind. The person, that
has never undergone medical care in Lithuania, will definitely have some doubts about the quality,
which could be faded away by a couple of measures:
a) By making a person acknowledged with the opinions of experts in the field
b) By making a person hear/read/listen to the opinion of persons, that are trusted by this person
c) By showing the results of comparisons with “top” developed countries (in terms of needed
specifications)
3.6 Reliability and validity
3.6.1 Reliability
According to Miller (p.1), reliability is defined as the extent to which a questionnaire, test,
observation or any measurement procedure produces the same results on repeated trials. In short, it
is the stability or consistency of scores over time or across raters. Keep in mind that reliability
pertains to scores not people. There are three aspects of reliability, namely: equivalence, stability
and internal consistency (homogeneity). Equivalence is measured through a parallel forms procedure
25
in which one administers alternative forms of the same measure to either the same group or different
group of respondents. Stability is assessed through a test-retest procedure that involves
administering the same measurement instrument to the same individuals under the same conditions
after some period of time. The general convention in research has been prescribed by Nunnally and
Bernstein (1994) who state that one should strive for reliability values of .70 or higher.
SPSS possesses the option, which allows obtaining the direct reliability coefficient, so called
Cronbach’s Alpha. Hence, I will not be performing these 3 analyses one after another, but just the
one universal analysis. For that reason I am going to spread my 150 sample into two samples of 75.
Generally, it is suggested to have another 150 respondents or the same respondents questioned again
later. I am not capable of doing the procedure duo to its’ complicatedness in terms of time
consumption, hence I will test reliability the way described earlier.
The SPSS calculated Cronbach’s Alpha12 does not reach 0.7 in almost all of the tests performed –
one test per variable. It possesses either negative meaning or is not big enough. If to spread 150 into
three samples of 50 respondents, then Cronbach’s Alpha obtains the value of 0.7 or something very
similar to it, for the majority of variables. The outcomes, which I get using two samples of 75 occurs
probably due to the high concentration of similar answers in one of the samples.
I also performed this operation for the variables with the same scales, for instance – if there were
two answering possibilities “yes” and “no”, then I took all variables which included such and ran the
test with them. The outcomes were mostly between 0 and 0.7, but some of the cases were excluded
probably due to the fact that some of variables consisted of less than 150 answers.
Generally, if 0.7 is the minimum score to be counted as reliable, than hardly any of the question s
possesses reliable answers in my survey. On the other hand, I might have been unable to conduct the
test fully properly or have misunderstood its’ idea.
3.6.2 Validity
According to mufmufmuf, validity is defined as the extent to which the instrument measures what it
purports to measure. There exist many types of validity, such as content validity, face validity,
criterion-related validity (or predictive validity), construct validity, factorial validity, concurrent
validity, convergent validity and divergent (or discriminant validity). The other source 13 unveils
12
13
http://www.ats.ucla.edu/stat/spss/faq/alpha.html
http://relevantinsights.com/validity-and-reliability
26
slightly different formulation of validity – the one which absolutely fits my needs, because it does
not provide too broad definitions while concentrates on the core meaning. It covers:
• Content validity: This is related to our ability to create questions that reflect the issue we are
researching and make sure that key related subjects are not excluded.
As to content validity of my questionnaire, I believe that it possesses the necessary amount of one,
because quite many questions are aimed at uncovering the same issue all the time. Still, after having
results on hand and matching them to my expectations, I realized that some aspects could have been
unveiled to a broader extent – one-two extra questions could have been of use in order to get some
specific, less general data.
• Internal validity: This asks whether the questions we pose can really explain the outcome we want
to research.
Nearly all of the questions contribute to extracting data, necessary to answer the main research
question. Some of them serve more supportive role, while others expect direct answers for the
research questions. For instance, question aimed at finding out whether people think they would
have difficulty to speak English in private health care institutions, expects direct answer, like
“yes”/”no”/”maybe”. Probably, such question possesses great internal validity. On the other hand,
there is a number of questions, which are aimed at finding out some specific details, which
combined allow for some generalizations to be made.
• External validity: This refers to the extent in which the results can be generalized to the target
population the survey sample is representing.
In my case, the results can be generalized probably to all population members, bellow the age of 55,
due to the fact that I did not gather enough respondents of this age.
3.7 The variables analysis
After having all 150 survey answers transformed into SPSS dataset, 27 variables were obtained.
These variables will undergo some SPSS analyses, in order to be available for explanation and to
provide some graphical output (mostly tables). The explained variables shall be able to be used for
main research questions answering as well as for drawing some minor conclusions based on other
observations. Such SPSS technique as descriptive statistics (frequencies analysis) will be used,
because it provides output which is comfortable to work with as well as fits mostly all of my needs.
27
3.7.1 Introduction of the variables
Appendix A provides the screenshots of the questionnaire, taken from the web-survey, hence
Appendix B represents the SPSS view of the variables. Each of the variables is based on one of the
questions.
Variables:
dental_care_denmark
(q1);
price_quality_plastic
(q4);
price_level_dental_dk
quality_sat_dental
plastic_surgery_denmark
price_level_plastic_dk
(q7);
(q10);
(q2);
(q5);
price_level_sat_dental
dental_care_abroad
price_quality_dental
price_level_sat_plastic
(q8);
(q11);
quality_sat_plastic
plastic_surgery_abroad
(q3);
(q6);
(q9);
(q12);
expectations_dental_LT (q13); expectations_plastic_LT (q14); willingness_dental_LT (q15);
willingness_plastic_LT
(q16);
negative_traits_character
(q19/1);
not_competent_doctors
(q19/4);
been_to_LT
(q17);
not_safe_place
negative_image_LT
(q18);
political_regime
(q19/3);
(q19/2);
compatriots_responses
(q20);
difficulties_english
(q21);
against_translator (q22); age_group (q23); gender (q24).
Appendix B/ Part II gives an explanation of what each of variables contain in itself. Q(n) shows
which question’s data was used to create a variable.
3.7.2 Explanation of results
All tables, discussed under this topic, can be found in Appendix B/Part III.
150 respondents took part in filling of this survey. 55 respondents belong to “18-25” age group, 40
respondents belong to “26-35” age group, 28 respondents belong to “36-45” age group, 22
respondents belong to “46-55” age group, 3 respondents belong to “56-65” age group and 2
respondents belong to “66+” age group. It must be mentioned, that the proportion of people, aged 56
and older, is not satisfying my initial demands, due to the fact that people of these age and their
opinion is extremely important for the research as well as for development of Amber Life’s business
strategy. Older people are vital part of it, and having 5 representatives of these groups out of 150
respondents is extremely unsatisfying. Hence, now the research becomes more of a general, willing
to find the overall attitude of population towards the matters.
70 respondents out of 150 are female, another 80 – male.
28
Firstly, I analyze variable dental_care_dk based on age group. More than 33 per cent of
respondents felt into “18-25” age group (55 respondents). Half of them (28 respondents) said that
they have not ever used private dental care services. That is 65 per cent of all respondents, who
answered “no” in question 1. The second biggest group is ”26-35” with 40 respondents, only 7 of
whom answered “no” to this question. Next group “36-45” consists of 28 respondents, and only 4 of
them answered “no” to this question. It can be assumed, that people in groups “26-35” and “36-45”
misunderstood the question, because their age contributes to visiting dentist or any other dental
specialist at least a couple of times. The next group “46-55” consists of 22 respondents, 3 of whom
answered “no”. The last “no” answer can be found in “56-65” group, which consists only of 3
respondents. According to dental care survey (2007, p.30), conducted in New York State, only 4.3
per cnet of questioned population has not ever been to a dentist. Their sample consisted of 1,799
people of different ages (from children to adults). I admit that these are two different cultures, which
possess some differences, which might have some influence on condition of teeth. But in general,
both countries consist of mostly educated population, aware of ways to take care of their teeth. That
is why the reliability of these answers can be questioned. Such response bias occurred either because
of the wrong wording of question, which could be misunderstood by people, or because most of
young people have good teeth and did not need any interference from the medical side. There is also
a possibility of survey been filled by not citizens of Denmark, who have never experienced dental
care services in Denmark or by new citizens, who have not been to dental care institution during
their spell in Denmark, necessary to gain citizenship.
The second variable analyzed is plastic_surgery_dk. 5 respondents of the youngest group answered
that they have undergone plastic surgery. 4 respondents from “26-35” group also said “yes” in this
question, while 1 respondent avoided answering this question due to unknown reasons. 4
respondents from the following group also answered “yes”. 5 respondents from “46-55” group used
plastic surgery services and 1 person avoided answering this question. In general, 18 respondents out
of 148 (those who answered this question) had undergone plastic surgery, what amounts as 12 per
cent.
From these results it can be seen, that dental care services are always demanded – minimum 67% of
surveyed population at least once were to visit this healthcare institution. Plastic surgery industry is
not as popular yet, hopefully it will gain more desirability and popularity among consumers in the
29
nearest future. That would make Amber Life dependent not on one type of provided services, but
would allow to more or less equally depend on both spheres.
Price_quality_dental_dk analysis shows that respondents were mostly either partially unsatisfied
or partially satisfied with price to quality relation of dental care services. Each scored 35 voices. 18
respondents stated they are neutral to this. At the same time 12 respondents are absolutely
unsatisfied and 7 are absolutely satisfied. 107 answers were obtained, due to the fact that this
question had to be answered only by those who said “yes” in question 1. It can be concluded that
almost half of respondents left unsatisfied to different extent (47 per cent), which is quite a number
to suggest new option for them.
The results of price_quality_plastic_dk are extremely equally distributed, if not to take category
“absolutely unsatisfied” into consideration. “Neutral”, “absolutely satisfied” and “partially satisfied”
all scored 6 voices each. Only one person is absolutely unsatisfied and five respondents are partially
unsatisfied. The question was supposed to be answered by 22 respondents but occasionally two
more persons answered it.
Awareness about price level of dental care services (price_level_dental_DK) is quite high –
answers “yes” and “partially” gained 128 out of 149 answers, with 65 and 63 respectively. Only 21
respondent thinks that he/she is not aware of price level for the services. 1 respondent avoided to
answer this question.
Most of respondents are not satisfied with price level for dental care services – 38 absolutely and 55
partially, while 20 remain neutral. That statistics definitely supports the ideal of Amber Life.
On the contrary, awareness about price level for plastic surgeries (price_level_plastic_DK) is not
that big. 99 respondents are not informed about it at all. 17 respondents answered that they are aware
about it and 34 respondents stated that they are partially aware.
The satisfaction levels are distributed quite equally from the center (Neutral), leaving it to be the
most popular answer among respondents. 28 persons stated they were not either satisfied or
dissatisfied with price level for plastic surgeries. That confirms the fact that there is no strong
evidence that plastic surgeries would be a desired product to be outsourced.
Quality_sat_dental_dk gained mostly positive answers – only 23 respondents are not satisfied with
the quality of dental services in Denmark. Probably they had experienced some complications or
30
medical error. 7 of respondents are absolutely unsatisfied, while 16 are only partially unsatisfied. At
the same time 35 respondents stated they are neutral – do not have any specific feelings about it. 39
respondents are partially satisfied with the quality and 27 are absolutely satisfied. 26 votes are
missing, but since the question was optional to answer, that is not a problem. In general, I have 19%
of sampled population unsatisfied versus 53 per cent satisfied. That is quite well supported by the
fact that Denmark has one of the best health-care systems in Europe, hence quality is at the top level.
54 respondents answered the question about plastic surgery quality satisfaction, and only 2 persons
appear
to
be
unsatisfied
with
it.
They
distributed
equally
among
two
groups.
quality_sat_plastic_dk contains of 26 “neutral” voters and 26 satisfied respondents. 12 of them are
partially satisfied and 14 are absolutely satisfied with the quality of particular services. The
interesting thing is that 15 of all “neutrals” are among “18-25” age group, and amount to 28 per cent
of those, who answered this question. Generally, 25 of 54 respondents belong to that group, which is
46 per cent. Except the fact, that they account as the biggest group in the sample, based on observed
results, it can be assumed, that plastic surgery is more popular among young people rather than
among other groups.
Questioned, whether they would agree to go abroad for medical services (dental care), 67
respondents, which amounts to 44.7 ~ 48 per cent of surveyed population, answered that they would.
Only 17 respondents stayed absolutely loyal to Denmark’s state institutions. Another 66 respondents
did not give direct answer, but said that maybe they would go. “Maybe” can be interpreted as “yes”,
if specific conditions are satisfied. It is not 100 per cent “yes”, but in this context “maybe” sounds a
bit like “probably”, hence I assume that 48 per cent is the minimum of what could be achieved. The
other important fact is that 33 respondents of those who answered “yes” fall into “18-25” age group.
dental_care_abroad
Cumulative
Frequency
Valid
Percent
Valid Percent
Percent
yes
67
44.7
44.7
44.7
no
17
11.3
11.3
56.0
maybe
66
44.0
44.0
100.0
150
100.0
100.0
Total
Figure 8. Distribution of answers to question “Would you go for dental care services abroad, given that quality is same
as in Denmark?”
31
As to plastic surgery abroad, the proportion is quite different from the previously analyzed one.
Quite many respondents are against going abroad for this kind of purpose – whole 27.8 per cent. The
number of those, who agree to head to another country for plastic surgery is not very different from
those who would not do that. It is 44 respondents , which amounts to 30.6 per cent of the sample
size. It must be mentioned, that 6 persons avoided answering to this question due to unknown
reasons. Again, more than 40 per cent answered “maybe”, which I would prefer not to count as “no”
or “yes”, but depends on particular circumstances. The interesting moment, is that only respondents
who represent the youngest age group had more “yes” than “no” answers.
plastic_surgery_abroad
Cumulative
Frequency
Valid
Valid Percent
Percent
yes
44
29.3
30.6
30.6
no
40
26.7
27.8
58.3
maybe
60
40.0
41.7
100.0
144
96.0
100.0
6
4.0
150
100.0
Total
Missing
Percent
System
Total
Figure 9. Distribution of answers to question “Would you go for plastic surgery services abroad, given that quality is
same as in Denmark?”
expectations_dental_lt analysis showed, that respondents tend to expect medium quality of services
in Lithuania. That is quite a predictable answer, because the vast majority of respondents have never
undergone these services and were never informed about their quality. Hence, 84 respondents
chosen “medium” answer and that amounts to 56 per cent of responses to this question. “Low” and
“very low” expectations on quality make the least part of the sample, at the same time “high” is the
second largest group. It must be mentioned that 6 persons ignored the question.
When analyzed, expectations_plastic_lt appeared to be normally distributed, with the central
meaning equal to 82 respondents (“medium”) and nearly equally going down both sides, with 7
(“very low”), 26 (“low”), 22 (“high”) and 7 (“very high”). Hence, 54.7 ~ 55 per cent of responses
cover the “middle” option.
Now one of the most important results to be described: when variable willingness_dental_lt was
analyzed, some encouraging results were observed. First of all, 86 respondents, which accounts as
32
57 per cent of sample size, said they would go to Lithuania for dental care services, while only 22
(~15%) refused to. 42 respondents are hesitating or expect some certain circumstances, hence they
answered “maybe”, which is not “no” or “yes” yet, as mentioned above. If to study the table based
in the Appendix, it can be noticed that almost in every group, majority answered “yes” and gap
between “yes”/”no” respondents is quite huge.
willingness_dental_LT
Cumulative
Frequency
Valid
Percent
Valid Percent
Percent
yes
86
57.3
57.3
57.3
no
22
14.7
14.7
72.0
maybe
42
28.0
28.0
100.0
150
100.0
100.0
Total
Figure 10. Distribution of answers to question “Would you agree to have dental care services performed in Lithuanian
private institution, in case it could lower your bill by 40-70% and given that the quality is the same level as in
Denmark?”
Willingness_plastic_lt analysis shows that all answers are nearly equally distributed, with quite
many “no” responses. It shows that plastic surgery causes more concerns among respondents, and
they become very cautious when it comes to choice of place. Almost the same number of people
would prefer it neither abroad nor specifically in Lithuania. Almost one third of respondents – 44
persons, would go to Lithuania for such procedure and 54 respondents would maybe go. 3 responses
are missing. Again, as in willingness_plastic_abroad, only “18-25” group accounts more “yes”
than “no” responses, in other groups they either equal or “no” is having bigger share of respondents’
voices.
willingness_plastic_LT
Cumulative
Frequency
Valid
Total
Valid Percent
Percent
yes
44
29.3
29.9
29.9
no
49
32.7
33.3
63.3
maybe
54
36.0
36.7
100.0
147
98.0
100.0
3
2.0
150
100.0
Total
Missing
Percent
System
33
Figure 11. Distribution of answers to question “Would you agree to have plastic surgeryservices performed in
Lithuanian private institution, in case it could lower your bill by 40-70% and given that the quality is the same level as
in Denmark?”
Originally, been_to_lt and negative_image_lt had to be derived from the answers of respondents,
who answered “no” in both questions number 15 and 16, but while creating a database, somehow
the mistake took place and database started recognizing “1” as “yes” and “0” as both “no” and no
answer. Hence, now I am unable to use SPSS for frequency analysis, so I have to perform it
manually. If necessary, datasets can be provided, so that it can be c hecked whether
I
performed fair job.
When manual calculations performed, it can be seen that only 18 persons have answered “no” in
both questions 15 and 16, so they would neither go to Lithuania for dental nor for plastic surgery
services. 5 of them have been to Lithuania before. That refers to been_to_lt variable. 9 of 18 have
negative image of Lithuania. That refers to negative_image_lt respectively. Only one of these
eighteen respondents both has been to Lithuania and has negative image of it.
When variable negative_traits_character_lt was analyzed, the results, distributed in a particular
way, were obtained. I must remind, that this and three following variables were created based on the
data gathered by statement evaluation, where respondents had to pick the option from 1 to 5, given 1
represented “strongly disagree” and 5 “strongly agree”, respectively. 26 respondents strongly
disagree with the statement, 41respondent just disagree, 60 respondents neither disagree nor agree –
remain “neutral” which seems the most suitable answer if the absence of particular knowledge or
personal experience take place. 18 respondents to some extent agree with the statement and 3
respondents strongly agree with it. Two persons avoided to answer this part of question.
Not_safe_place_lt analysis showed, that responses are distributed almost the same way as in
previous part of this question. 21 respondent strongly disagrees with the statement, 44 to some
extent disagree, 57 respondents remain “neutral”, 19 respondents to some extent agree, 7
respondents strongly agree. 2 respondents did not answer this part of question.
Political_regime_lt analysis gave such output: 14 respondents strongly disagree with a statement,
that political regime in Lithuania is not appealing, 31 respondent agrees to some extent disagrees, 68
respondents are somewhere in the middle between agreement and disagreement, 30 respondents are
34
on the path of agreement with this statement and 5 are in the end of this path, with full agreement
with the statement. Same as in previous parts of the question, 2 persons did not manage to answer it.
Some
positives
were
found
while
analyzing
the
last
variable
of
this
quartet
–
not_competent_doctors_lt possesses information, that 63 respondents disagree with the statement,
20 of whom do that to the full extent, 73 respondents are “neutral” and only 11 respondents doubt
the professional competencies of Lithuanian doctors.
The compatriots_responses variable analysis is presented both below and in Appendix. This is
quite an important variable for the research, because it has impact when making a decision whether
to implement a “trust-doctor network”. As it can be seen, almost 35 per cent of respondents find
their compatriots’ opinion and experience quite valuable and are ready to correct the direction of
their decision if comments are mostly positive. 71 respondent is not sure, whether this could affect
their decision, probably some other factors will be considered as well. Only 18% of respondents do
not tend to change their decision, even if their compatriots are fully satisfied with the services.
Based on tables from Appendix, mostly young people, from “18-25” group would consider
compatriots’ opinion as an important factor. Percentage of “yes” answers is highest in this group –
45.5 ~ 46 per cent. The analysis also uncovered the fact, that men hesitate more than women – 55
per cent of men answered “maybe” in the question, while women gave mostly “yes” answer, and its’
percentage is higher, than “maybe” among women.
compatriots_responses
Cumulative
Frequency
Valid
Percent
Valid Percent
Percent
yes
52
34.7
34.7
34.7
no
27
18.0
18.0
52.7
maybe
71
47.3
47.3
100.0
150
100.0
100.0
Total
Figure 12. Distribution of answers to question “Would positive responses of your compatriots affect your decision to use
one or another service in Lithuania”
The other positive finding is that approximately 57 per cent believe they would not have any
difficulties speaking English in health care facilities. Such self-confidence is definitely a sign of the
35
fact, that these respondents will not hesitate because of the language issue – it is not an issue for
them. 41 respondent is not sure whether he/she would have any difficulties. Only 24 respondents,
what amounts to 16 per cent of sample size, are skeptical about their English language capabilities.
According to findings, there is no group, in which the amount of “yes” answers would be
significantly bigger than 20 per cent of the group size. Only “56-65” has no single “no” answer, but
it consists only of 3 persons, hence it is not considered of extreme importance.
difficulties_english
Cumulative
Frequency
Valid
Percent
Valid Percent
Percent
Yes
24
16.0
16.0
16.0
no
85
56.7
56.7
72.7
maybe
41
27.3
27.3
100.0
150
100.0
100.0
Total
Figure 13. Distribution of answers to question “Would you have difficulties speaking English in foreign health-care
facilities? (Keep in mind, that it is not a friendly talk, but a serious conversation, with a use of medical terminology)”
The last variable to be described is against_translator. The analysis showed that the vast majority
of respondents do not have anything against being provided with a translator – that amounted to 97
respondents, which is 64.7 ~ 65 per cent of answered population. 28 respondents are against being
provided with translator, probably they do not tend to share their private information with anyone
except from the doctor. 22 respondents answered “maybe”, which probably means that it depends on
the type of services they are willing to undergo.
3.8 Application of theory
In this part, I am going to apply theories, described in the theoretical part, and use information,
gathered by mean of survey, in order to answer the main research questions.
The first research question sounds like:
a) How big is the amount of trust of society to foreign (in this case Lithuanian) health-care
facilities? It must be mentioned, that Lithuanian state institutions cannot be considered as
objects of interest, because firstly – they fall under national health-care system, secondly,
Amber Life is not interested in providing its’ intermediary services via state hospitals – that
does not fall into its’ business concept.
36
When questioned, whether they would go to Lithuania either for plastic surgery or for dental care
services, the public gave quite satisfying responses, especially for the first of these two questions.
As mentioned above, in the description of variables, 86 out of 150 respondents said that they would
go to Lithuania, given that quality of dental care services is at least the same as in Denmark and that
savings can make 40 to 70 per cent of amount, which would be spent in Denmark, for the same
services. As to plastic surgery – approximately one third would go to Lithuania, given the same
conditions, as above, and one third would not go. From these results I can draw a conclusion, that
dental care services are not considered to be the ones’, which demand very thorough consideration
by customers – when had noticed the opportunity to benefit, respondents quite easily decided, that
they would travel there. Plastic surgery is considered to be a little bit more specific procedure, where
respondents do not tend to possess such incredible amount of trust to Lithuanian private health care
institutions, even given the benefits could be tremendous. Still, 44 out of 150, plus 54 have not made
their decision yet, which can be considered as potential to gain more customers, if some sort of
specific study carried out, with the purpose of finding out the conditions, able to turn “maybe”
voters into “yes” voters.
Since not all of 150 respondents stated they would go to Lithuania for these particular services, it is
obvious that some sort of distrust takes part, and has to be investigated. The approach is to imagine,
that at the moment, there is no Denmark with its’ attractive health-care facilities, no other
“respected” countries – there exists only Lithuania and respondents, who desire to undergo some of
proposed services. It is all about the perception of the country, its’ private health care facilities,
competencies of medical personnel. And the situation is: to pick Lithuania or not to pick, based on
knowledge, one possesses about the country and problem related issues, but not on the fact that other
alternatives exist. In other words – it is not about choosing the country among countries, but about
giving it a go, based on perceptions and knowledge, or leaving it out of track. Hence, I will take into
consideration results of such questions, where aspects directly related with the country were asked to
get assessed.
When respondents, who answered “no” both in question 15 and question 16, which were aimed at
finding out how many of respondents would agree to go to Lithuania, were asked whether they have
been to this country, only 5 out of 18 answered “yes”. When questioned, whether they have negative
37
image of Lithuania on their mind, 9 out of 18 answered “yes”. First of all, why only those, who gave
two negative answers before, are considered – because if they say “no” to dental care, but say “yes”
to plastic surgery in Lithuania, they do not seem as such who have total distrust. They probably
possess some particular perception of one of these services, but have nothing against the other.
Hence, I took into consideration only those, who rejected all proposals. Back to results, 5 out of 18
is approximately 28 per cent, hence the other 72 per cent have not been to Lithuania before, and
probably their point of view is based on mass media or other sources, but on what they have
experienced themselves. 9 out 18 are not of positive opinion about Lithuania. If to take assume, that
5 of these 9 have been to the country, it can be stated, that four persons, made up their negative
opinion based on either personal contact with Lithuanians in Denmark/ in other country or on media
based sources. The worst conclusion would be that 5 persons who have been to Lithuania, have
absolutely positive image on the country, hence 9 persons have formed their point of view even
without visiting it. In general, 18 respondents out of 150 does not seem the necessary amount to
panic or to conclude, that there is not enough trust to the country.
Next, negative statements about Lithuania were formulated, in order to find out, to which extent the
whole sample would agree with them. The results appear to be quite satisfying and do not possess
the sufficient degree of distrust. For instance, only 21 out of 148 agree or strongly agree with a
statement, that Lithuanians possess mostly negative traits of character. That means, other 127
respondents do not think the same. Only 26 agree with a statement, that Lithuania is not a safe place
to stay, only 35 respondents find political regime not appealing, only 11 respondents find Lithuanian
doctors not competent. All of these results do not allow me to conclude, that there is not enough
trust to Lithuania and its’ health care system. Basically, the matter of safety and/or political regime
raises hesitation level among respondents to the higher extent than other statements.
b) Perceived quality vs. objective quality. Positive or negative effect on the objective perception
of quality of services.
To answer this question, I am willing to partially implement SERVQUAL model – to use data,
which I found out in the model, to be more precise – in one of its’ parts. I am not going to calculate
scores, because the company is not providing any services yet, hence there is nothing to be evaluated
by consumers. The idea is to find out, what quality of services respondents expect from Lithuanian
38
private health care institutions. Their quality expectations obviously are based on comparison with
Danish one. If for instance a person is fully satisfied with quality level of dental care services here, it
will probably serve as etalon when trying to formulate expectations of quality abroad. The results
show, that only 15 expect quality of dental care services to be low or very low in Lithuania. At the
same time 34 respondents expect quality of plastic surgery services to be low or very low. Neither
15 nor 34 is a sufficient amount of “votes” to consider business idea not perspective. Absolutely
obvious that people have much more concerns about plastic surgery and not such high number of
people is willing to go to Lithuania for these services as for dental care. But to compare to 144
answers group, 34 is a little less than 25 per cent. Hence, there are 75 per cent of potential
customers, which is very satisfying.
Most of expectations fell into “medium” group. Most possibly, respondents were picking that
answer because of absence of experience in the field – based only on the overall perception of the
country. They chose not to underrate or overrate the services, while have not experienced them.
Generally, respondents have mostly non-negative expectations about quality of services. Getting to
SERVQUAL, I input value “non-negative expectations” and compare it to “perceived quality”,
assumed to be at least the same as in Denmark. I get that perceived quality at least matches
expectations if not exceeds. Comments of respondents, analyzed before, point at some factors,
which are considered to be of a great impact on perceived quality. Hence, taking them into account,
while keeping Amber Life’s input and output at the maximum level, can bring satisfying results.
Only “medium”, “high”, “very high” categories are taken into consideration, because there is no
intention to meet bad quality expectations i.e. they need no effort to be met, sort of automatically
met.
c) Language issues. Inability to communicate properly due to external reasons.
This issue is of a great importance when choosing a country for any sort of travel. According to
survey results, approximately 57 per cent of respondents stated they would have no difficulty talking
English in Lithuanian private health care institutions, even if the extensive use of medical
terminology would take place. Only 16 per cent of respondents said they would have difficulty. At
the same time 27 per cent said they would maybe have some. To resolve this issue, the services of
translator were suggested and such results were obtained -16 per cent would be against using
translator’s services, while 57 have nothing against and 27 would maybe be against. The results
39
seem to be quite satisfying. In general, 84 per cent are not against using the translator’s services,
probably this to some extent depends on the procedure one is willing to undergo. The more intimal it
is – the less likely someone will trust a not familiar person to know the details. On the other hand,
translators can easily be recognized as medical personnel, who promised to keep confidentiality. To
conclude, the language issue does not seem to be an issue, which could prevent this business idea
from successful implementation, because the majority of respondents either seem to be confident in
their knowledge either have nothing against some help. Even if 16% consist of the same respondents
in both of these questions, then they can be rejected from the potential customers, and still 84% of
sample size satisfies my demands.
4. Conclusion
4.1 Summary of results
The initial purpose of the report was to elaborate on the trust issue, to find out what do potential
consumers expect from quality, to inquire whether English language would be a difficulty. The
survey, which was carried out, helped to uncover these and some other useful aspects. The obtained
survey results contribute to some other parts of business plan as well, while this report is just a step
towards having collected all necessary data, needed for actual business plan writing. For instance,
the importance of feedback, left by compatriots, who had an opportunity to undergo some of the
services was found out. The results are encouraging to create a database, which would be something
similar to TrustPilot. At least, it will not be odd. I also found out, that people are willing to save
money when it comes to dental care services. When questioned about willingness to use these
services abroad, but not stating that it would help to save money, the results for dental care were
distributed as follows: 40 – 20 – 40 per cent, for yes – no – maybe, but when introduced the country
and the savings range, the results changed to 60 - 20 – 20. Unfortunately, I cannot say the same
about plastic surgery services, because the amount of those who were willing to do plastic surgery
abroad decreased, when Lithuania was mentioned. From that I can make a conclusion, that people
are neither negative nor very positive about plastic surgery in Lithuania – they just do not possess all
necessary knowledge about this country’s competence in the field yet. In general, there is no distrust
to Lithuanian facilities as such, most people do not have negative opinion on Lithuania and its’ traits
as well as most of them would even go there for proposed services. The research found out that
Lithuanian private health care institutions are prepared to match consumers’ quality expectations, as
well. Most of surveyed public expect medium quality of services, hence that is default target. It
40
could be also stated that intentions are to satisfy those, who are expecting high or very high quality
of services, and no irremovable obstacles are noticed yet. The other founding is that most of
respondents are confident in their knowledge of English and would have no difficulties talking in
health care institutions. Otherwise, the majority would not be against using translator’s services.
There also some other findings were obtained, most of a supportive character, such as attitude
towards quality and price level of these services in Denmark. These statistics might be of use when
developing a precise business plan and estimating potential clients’ proportion. These are general
findings of the report.
4.2 Future recommendations
When performing such sort of research, I expect one the most important parts to accomplish is to
correlate theoretical part with practical. In my case, there were not many theories used in the
theoretical part – it mostly consists of analyzing the matters, from which research questions arise.
Hence, I cannot state that the research is to a high extent theory based. It was initially planned to be
more of a practical rather than theoretical.
The other aspect of importance is sampling – in my case only four of six groups of respondents,
based on age, are of more or less sufficient size. Only 3 respondents belong to “56-65” age group
and only 2 respondents belong to “66+” age group, while initially these two groups were considered
as mostly filled with potential customers. Hence, if one plans to research something that will assume
age as one of the most important aspects, he must control it, that every group makes at least minimal
needed amount out of total sample size.
One of the problems I faced was to collect the necessary amount of filled questionnaires. Initially
the idea of storing it online seemed to achieve needed results in short terms. But the idea had
underachieved, hence I had to think of new data collecting methods. The suggestion is to develop
the strategy beforehand to have a reserve plan, taking into account all obstacles that might be faced.
If one will have intentions to follow this track and to gain more precise knowledge of Danes
perceptions and preferences in this field, he should consider making questionnaire as informative as
possible, to avoid misunderstandings or wrong interpretations. Questions should cover all aspects of
your interest from all sides. For instance, some moments of my questionnaire could be uncovered
even broader if I asked some more questions on the matter. Extensive, though informative
questionnaire seems better option. These are basically all of major concerns.
41
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Prices:
Plastic
surgery
services:
Lithuania
-
http://www.nordesthetics.com/en/plastic-surgery-
lithuania?nocache=1 ; Denmark -http://www.plasticsurgeon.dk/priser.html.
43
Dental care services: Lithuania -http://www.dentaltourismexpert.com/dental-care-in-lithuania.html;
Denmark -http://www.sdent.dk/priser/?gclid=CPPXg6mK268CFcjwzAodoQt-aQ
Ravichandran, K. & Tamil Mani, B. & Arun Kumar, S. & Prabhakaran, S. (2010). Influence of
Service Quality on Customer Satisfaction. Application of Servqual Model. International Journal of
Business and Management, 5(4). Available at:
http://www.ccsenet.org/journal/index.php/ijbm/article/view/5158/4616
Reeves, Carol A. and Bednar, David A. (1994). Defining Quality: Alternatives and Implications.
The Academy of Management Review, 19( 3), pp. 419-445. Special Issue: "Total Quality". Available
at: ftp://ftp.cba.uri.edu/classes/dellabitta/PRICE%20SEMINAR%20%20BUS%20610/ARTICLES%20V1/DEFINING%20QUALITYALTERNATIVES%20&%20IMPLICATIONS.pdf
Smart Survey Design. Available at: http://s3.amazonaws.com/SurveyMonkeyFiles/SmartSurvey.pdf
SPSS FAQ: What does Cronbach's alpha mean? Available at:
http://www.ats.ucla.edu/stat/spss/faq/alpha.html
Sztompka, Piotr (2000). Trust: A sociological theory. Available at:
http://site.ebrary.com.ez.statsbiblioteket.dk:2048/lib/stats/docDetail.action?docID=2000682
THE DANISH HEALTHCARE SYSTEM RANKS NUMBER 2. Available at:
http://www.copcap.com/content/us/quick_links/news/latest_news/2008/news_4th_quarter_2008/the
_danish_healthcare_system_ranks_number_2
Torres, Nadia & Gutierrez, Sonia (2007). The purchase of foreign products: The role of firm’s
country-of-origin reputation, consumer ethnocentrism, animosity and trust. Documento de trabajo
13/07. Available at:
http://gredos.usal.es/jspui/bitstream/10366/75189/1/DAEE_13_07_Purcching.pdf
This link is not working at the moment, hence I cannot retrieve all details to make a proper
reference. It was used in Arbitrage section.
http://web.ebscohost.com.ez.statsbiblioteket.dk:2048/ehost/pdfviewer/pdfviewer?vid=2&hid=106&s
id=ccdfe347-512a-4256-ba99-98abaa9cd60e%40sessionmgr15
44
Appendix A
45
46
47
Appendix B
Part I
48
Part II
Part III
Gender
gender
Cumulative
Frequency
Valid
Percent
Valid Percent
Percent
female
70
46.7
46.7
46.7
male
80
53.3
53.3
100.0
Total
150
100.0
100.0
49
Dental_care_dk by age
dental_care_DK
Cumulative
age_group
18-25
26-35
36-45
46-55
Valid
Valid
Valid
Valid
Frequency
66+
Valid
Valid
Valid Percent
Percent
yes
27
49.1
49.1
49.1
no
28
50.9
50.9
100.0
Total
55
100.0
100.0
yes
33
82.5
82.5
82.5
no
7
17.5
17.5
100.0
Total
40
100.0
100.0
yes
24
85.7
85.7
85.7
no
4
14.3
14.3
100.0
Total
28
100.0
100.0
yes
19
86.4
86.4
86.4
no
3
13.6
13.6
100.0
22
100.0
100.0
yes
2
66.7
66.7
66.7
no
1
33.3
33.3
100.0
Total
3
100.0
100.0
yes
2
100.0
100.0
Total
56-65
Percent
100.0
Plastic_surgery_dk by age
plastic_surgery_DK
Cumulative
age_group
18-25
26-35
36-45
Valid
Valid
Valid
Frequency
Percent
Valid Percent
Percent
yes
5
9.1
9.1
9.1
no
50
90.9
90.9
100.0
Total
55
100.0
100.0
.00
1
2.5
2.5
2.5
yes
4
10.0
10.0
12.5
no
35
87.5
87.5
100.0
Total
40
100.0
100.0
4
14.3
14.3
yes
50
14.3
46-55
Valid
no
24
85.7
85.7
100.0
Total
28
100.0
100.0
.00
1
4.5
4.5
4.5
yes
5
22.7
22.7
27.3
no
16
72.7
72.7
100.0
Total
22
100.0
100.0
56-65
Valid
no
3
100.0
100.0
100.0
66+
Valid
no
2
100.0
100.0
100.0
Price/quality ratio satisfaction
price_quality_dental_DK
Cumulative
Frequency
Valid
Valid Percent
Percent
abs.uns.
12
8.0
11.2
11.2
part.uns.
35
23.3
32.7
43.9
neutral
18
12.0
16.8
60.7
part.sat.
35
23.3
32.7
93.5
abs.sat.
7
4.7
6.5
100.0
107
71.3
100.0
43
28.7
150
100.0
Total
Missing
Percent
System
Total
price_quality_plastic_DK
Cumulative
Frequency
Valid
Total
Valid Percent
Percent
abs.uns.
1
.7
4.2
4.2
part.uns.
5
3.3
20.8
25.0
neutral
6
4.0
25.0
50.0
part.sat.
6
4.0
25.0
75.0
abs.sat.
6
4.0
25.0
100.0
24
16.0
100.0
126
84.0
150
100.0
Total
Missing
Percent
System
51
Awareness about price level
price_level_plastic_DK
Cumulative
Frequency
Valid
Percent
Valid Percent
Percent
yes
17
11.3
11.3
11.3
no
99
66.0
66.0
77.3
partially
34
22.7
22.7
100.0
150
100.0
100.0
Total
price_level_dental_DK
Cumulative
Frequency
Valid
Valid Percent
Percent
yes
65
43.3
43.6
43.6
no
21
14.0
14.1
57.7
partially
63
42.0
42.3
100.0
149
99.3
100.0
1
.7
150
100.0
Total
Missing
Percent
System
Total
Price level satisfaction
price_level_sat_dental_DK
Cumulative
Frequency
Valid
Total
Valid Percent
Percent
abs.uns.
38
25.3
29.5
29.5
part.uns.
55
36.7
42.6
72.1
neutral
20
13.3
15.5
87.6
part.sat.
14
9.3
10.9
98.4
abs.sat.
2
1.3
1.6
100.0
129
86.0
100.0
21
14.0
150
100.0
Total
Missing
Percent
System
52
price_level_sat_plastic_DK
Cumulative
Frequency
Valid
Missing
Percent
Valid Percent
Percent
abs.uns.
4
2.7
6.9
6.9
part.uns.
14
9.3
24.1
31.0
neutral
28
18.7
48.3
79.3
part.sat.
7
4.7
12.1
91.4
abs.sat.
5
3.3
8.6
100.0
Total
58
38.7
100.0
System
92
61.3
150
100.0
Total
Quality satisfaction
quality_sat_dental_DK
Cumulative
Frequency
Valid
Valid Percent
Percent
abs.uns.
7
4.7
5.6
5.6
part.uns.
16
10.7
12.9
18.5
neutral
35
23.3
28.2
46.8
part.sat.
39
26.0
31.5
78.2
abs.sat.
27
18.0
21.8
100.0
124
82.7
100.0
26
17.3
150
100.0
Total
Missing
Percent
System
Total
quality_sat_plastic_DK
Cumulative
Frequency
Valid
Percent
Valid Percent
Percent
abs.uns.
1
.7
1.9
1.9
part.uns.
1
.7
1.9
3.7
26
17.3
48.1
51.9
neutral
53
Missing
part.sat.
12
8.0
22.2
74.1
abs.sat.
14
9.3
25.9
100.0
Total
54
36.0
100.0
System
96
64.0
150
100.0
Total
Medical care abroad
dental_care_abroad
Cumulative
age_group
18-25
26-35
36-45
46-55
56-65
66+
Valid
Valid
Valid
Valid
Valid
Valid
Frequency
Percent
Valid Percent
Percent
yes
33
60.0
60.0
60.0
no
6
10.9
10.9
70.9
maybe
16
29.1
29.1
100.0
Total
55
100.0
100.0
yes
18
45.0
45.0
45.0
no
4
10.0
10.0
55.0
maybe
18
45.0
45.0
100.0
Total
40
100.0
100.0
yes
8
28.6
28.6
28.6
no
3
10.7
10.7
39.3
maybe
17
60.7
60.7
100.0
Total
28
100.0
100.0
yes
7
31.8
31.8
31.8
no
2
9.1
9.1
40.9
maybe
13
59.1
59.1
100.0
Total
22
100.0
100.0
yes
1
33.3
33.3
33.3
no
1
33.3
33.3
66.7
maybe
1
33.3
33.3
100.0
Total
3
100.0
100.0
no
1
50.0
50.0
50.0
maybe
1
50.0
50.0
100.0
Total
2
100.0
100.0
54
plastic_surgery_abroad
Cumulative
age_group
18-25
Valid
Missing
Frequency
Valid
Missing
46-55
Valid
Valid
38.2
39.6
39.6
no
12
21.8
22.6
62.3
maybe
20
36.4
37.7
100.0
Total
53
96.4
100.0
2
3.6
55
100.0
yes
9
22.5
25.0
25.0
no
10
25.0
27.8
52.8
maybe
17
42.5
47.2
100.0
Total
36
90.0
100.0
4
10.0
40
100.0
yes
7
25.0
25.0
25.0
no
9
32.1
32.1
57.1
maybe
12
42.9
42.9
100.0
Total
28
100.0
100.0
yes
6
27.3
27.3
27.3
no
7
31.8
31.8
59.1
maybe
9
40.9
40.9
100.0
22
100.0
100.0
yes
1
33.3
33.3
33.3
no
1
33.3
33.3
66.7
maybe
1
33.3
33.3
100.0
Total
3
100.0
100.0
no
1
50.0
50.0
50.0
maybe
1
50.0
50.0
100.0
Total
2
100.0
100.0
System
System
Total
56-65
66+
Valid
Valid
Percent
21
Total
36-45
Valid Percent
yes
Total
26-35
Percent
55
Quality expectations in Lithuania
expectations_dental_LT
Cumulative
Frequency
Valid
very low
Valid Percent
Percent
2
1.3
1.4
1.4
low
13
8.7
9.0
10.4
medium
84
56.0
58.3
68.8
high
36
24.0
25.0
93.8
9
6.0
6.3
100.0
144
96.0
100.0
6
4.0
150
100.0
very high
Total
Missing
Percent
System
Total
expectations_plastic_LT
Cumulative
Frequency
Valid
very low
Valid Percent
Percent
7
4.7
4.9
4.9
low
26
17.3
18.1
22.9
medium
82
54.7
56.9
79.9
high
22
14.7
15.3
95.1
7
4.7
4.9
100.0
144
96.0
100.0
6
4.0
150
100.0
very high
Total
Missing
Percent
System
Total
Willingness to go to Lithuania for health care services
willingness_dental_LT
Cumulative
age_group
18-25
Valid
Frequency
Percent
Valid Percent
Percent
yes
36
65.5
65.5
65.5
no
5
9.1
9.1
74.5
14
25.5
25.5
100.0
maybe
56
26-35
36-45
46-55
Valid
Valid
Valid
Total
55
100.0
100.0
yes
19
47.5
47.5
47.5
no
8
20.0
20.0
67.5
maybe
13
32.5
32.5
100.0
Total
40
100.0
100.0
yes
15
53.6
53.6
53.6
no
3
10.7
10.7
64.3
maybe
10
35.7
35.7
100.0
Total
28
100.0
100.0
yes
13
59.1
59.1
59.1
no
6
27.3
27.3
86.4
maybe
3
13.6
13.6
100.0
22
100.0
100.0
yes
2
66.7
66.7
66.7
maybe
1
33.3
33.3
100.0
Total
3
100.0
100.0
yes
1
50.0
50.0
50.0
maybe
1
50.0
50.0
100.0
Total
2
100.0
100.0
Total
56-65
66+
Valid
Valid
willingness_plastic_LT
Cumulative
age_group
18-25
Valid
Missing
Frequency
Valid
Missing
Valid
Percent
20
36.4
37.0
37.0
no
15
27.3
27.8
64.8
maybe
19
34.5
35.2
100.0
Total
54
98.2
100.0
1
1.8
55
100.0
yes
10
25.0
26.3
26.3
no
14
35.0
36.8
63.2
maybe
14
35.0
36.8
100.0
Total
38
95.0
100.0
2
5.0
40
100.0
yes
7
25.0
25.0
25.0
no
7
25.0
25.0
50.0
System
System
Total
36-45
Valid Percent
yes
Total
26-35
Percent
57
46-55
Valid
maybe
14
50.0
50.0
Total
28
100.0
100.0
yes
6
27.3
27.3
27.3
no
10
45.5
45.5
72.7
6
27.3
27.3
100.0
22
100.0
100.0
yes
1
33.3
33.3
33.3
no
2
66.7
66.7
100.0
Total
3
100.0
100.0
no
1
50.0
50.0
50.0
maybe
1
50.0
50.0
100.0
Total
2
100.0
100.0
maybe
Total
56-65
66+
Valid
Valid
100.0
Negative traits of character
negative_traits_character_LT
Cumulative
Frequency
Valid
Valid Percent
Percent
1
26
17.3
17.6
17.6
2
41
27.3
27.7
45.3
3
60
40.0
40.5
85.8
4
18
12.0
12.2
98.0
5
3
2.0
2.0
100.0
148
98.7
100.0
2
1.3
150
100.0
Total
Missing
Percent
System
Total
Not a safe place to visit
not_safe_place_LT
Cumulative
Frequency
Valid
Percent
Valid Percent
Percent
1
21
14.0
14.2
14.2
2
44
29.3
29.7
43.9
3
57
38.0
38.5
82.4
58
4
19
12.7
12.8
95.3
5
7
4.7
4.7
100.0
148
98.7
100.0
2
1.3
150
100.0
Total
Missing
System
Total
Political regime
political_regime_LT
Cumulative
Frequency
Valid
Valid Percent
Percent
1
14
9.3
9.5
9.5
2
31
20.7
20.9
30.4
3
68
45.3
45.9
76.4
4
30
20.0
20.3
96.6
5
5
3.3
3.4
100.0
148
98.7
100.0
2
1.3
150
100.0
Total
Missing
Percent
System
Total
Not competent doctors
Not_competent_doctors_LT
Cumulative
Frequency
Valid
Total
Valid Percent
Percent
1
20
13.3
13.6
13.6
2
43
28.7
29.3
42.9
3
73
48.7
49.7
92.5
4
8
5.3
5.4
98.0
5
3
2.0
2.0
100.0
147
98.0
100.0
3
2.0
150
100.0
Total
Missing
Percent
System
59
Compatriots
compatriots_responses
Cumulative
age_group
18-25
26-35
36-45
46-55
Valid
Valid
Valid
Valid
Frequency
66+
Valid
Valid
Valid Percent
Percent
yes
25
45.5
45.5
45.5
no
4
7.3
7.3
52.7
maybe
26
47.3
47.3
100.0
Total
55
100.0
100.0
yes
13
32.5
32.5
32.5
no
7
17.5
17.5
50.0
maybe
20
50.0
50.0
100.0
Total
40
100.0
100.0
yes
6
21.4
21.4
21.4
no
8
28.6
28.6
50.0
maybe
14
50.0
50.0
100.0
Total
28
100.0
100.0
yes
6
27.3
27.3
27.3
no
7
31.8
31.8
59.1
maybe
9
40.9
40.9
100.0
22
100.0
100.0
yes
2
66.7
66.7
66.7
no
1
33.3
33.3
100.0
Total
3
100.0
100.0
maybe
2
100.0
100.0
Total
56-65
Percent
100.0
compatriots_responses
Cumulative
gender
female
male
Frequency
Valid
Valid
Percent
Valid Percent
Percent
yes
30
42.9
42.9
42.9
no
13
18.6
18.6
61.4
maybe
27
38.6
38.6
100.0
Total
70
100.0
100.0
yes
22
27.5
27.5
27.5
no
14
17.5
17.5
45.0
maybe
44
55.0
55.0
100.0
Total
80
100.0
100.0
60
Language capabilities
difficulties_english
Cumulative
age_group
18-25
26-35
Frequency
Valid
Valid
20.0
20.0
20.0
no
31
56.4
56.4
76.4
maybe
13
23.6
23.6
100.0
Total
55
100.0
100.0
yes
7
17.5
17.5
17.5
no
24
60.0
60.0
77.5
9
22.5
22.5
100.0
40
100.0
100.0
yes
2
7.1
7.1
7.1
no
18
64.3
64.3
71.4
8
28.6
28.6
100.0
28
100.0
100.0
yes
2
9.1
9.1
9.1
no
10
45.5
45.5
54.5
maybe
10
45.5
45.5
100.0
Total
22
100.0
100.0
yes
2
66.7
66.7
66.7
maybe
1
33.3
33.3
100.0
Total
3
100.0
100.0
no
2
100.0
100.0
maybe
Total
46-55
56-65
66+
Valid
Valid
Valid
Percent
11
Total
Valid
Valid Percent
yes
maybe
36-45
Percent
100.0
Translator (human) services
against_translator
Cumulative
Frequency
Valid
Total
Valid Percent
Percent
yes
28
18.7
19.0
19.0
no
97
64.7
66.0
85.0
maybe
22
14.7
15.0
100.0
147
98.0
100.0
3
2.0
150
100.0
Total
Missing
Percent
System
61
against_translator
Cumulative
age_group
18-25
Valid
Missing
Frequency
Valid
20.0
20.4
20.4
no
32
58.2
59.3
79.6
maybe
11
20.0
20.4
100.0
Total
54
98.2
100.0
1
1.8
55
100.0
yes
6
15.0
15.8
15.8
no
29
72.5
76.3
92.1
3
7.5
7.9
100.0
38
95.0
100.0
2
5.0
40
100.0
yes
7
25.0
25.0
25.0
no
16
57.1
57.1
82.1
5
17.9
17.9
100.0
28
100.0
100.0
yes
3
13.6
13.6
13.6
no
16
72.7
72.7
86.4
3
13.6
13.6
100.0
22
100.0
100.0
yes
1
33.3
33.3
33.3
no
2
66.7
66.7
100.0
Total
3
100.0
100.0
no
2
100.0
100.0
System
Total
System
Total
36-45
Valid
maybe
Total
46-55
Valid
maybe
Total
56-65
66+
Valid
Valid
Percent
11
maybe
Missing
Valid Percent
yes
Total
26-35
Percent
62
100.0