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 2 5. Reference list .................................................................................................................................................42 Appendix A ........................................................................................................................................................45 Appendix B ........................................................................................................................................................48 Part I ..............................................................................................................................................................48 Part II .............................................................................................................................................................49 Part III ............................................................................................................................................................49 3 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: ï‚· Lithuanians possess mostly negative traits of character ï‚· Lithuania seems to be not a safe place to travel to ï‚· Lithuanian political regime seems not appealing ï‚· 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 5. Reference list Björnberg, Arne & Garrofe, Beatriz & Lindblad, Sonja (2009). Euro Health Consumer Index 2009: Report. Health Consumer Powerhouse. Available at: http://www.healthpowerhouse.com/files/Report%20EHCI%202009%20091005%20final%20with% 20cover.pdf Bolton, Ruth N. and Drew, James H. (1991). A Longitudinal Analysis of the Impact of Service Changes on Customer Attitudes. Journal of Marketing, 55(1), pp. 1-10. Available at: http://www.ruthnbolton.com/Publications/LongitudinalAnalysisofServiceChangesonAttitudes.pdf Buttle, Francis (1994). SERVQUAL: review, critique, research agenda. European Journal of Marketing, 30(1), pp. 8-32. Available at: http://140.117.77.118/2009/m954011064/References/20080927Buttle1994.pdf Cronin, Joseph J. Jr. and Taylor, Steven A . (1992). Measuring Service Quality: A Reexamination and Extension. Journal of Marketing, 56( 3), pp. 55-68. Available at: http://www.jstor.org/stable/1252296 Denmark age structure. Available at: http://www.indexmundi.com/denmark/age_structure.html Dong Kyoon Yoo & Jeong Ah Park (2007). Perceived service quality: Analyzing relationships among employees, customers, and financial performance. International Journal of Quality & Reliability Management, Vol. 24 Iss: 9, pp.908 – 926. Available at: http://www.emeraldinsight.com/journals.htm?articleid=1631037&show=html Enevoldsen, Vaida V. (2011). Attracting Danish tourists to Lithuania. MSc thesis. Available at: http://studenttheses.cbs.dk/bitstream/handle/10417/2962/vaida_vitkute_enevoldsen.pdf?sequence=1 Europeans and their Languages. Special Eurobarometer. Available at: http://ec.europa.eu/public_opinion/archives/ebs/ebs_243_en.pdf p13 Gefen, David (2000), E-commerce: the role of familiarity and trust. The International Journal of Management Science, pp. 725-737. Available at: http://onemvweb.com/sources/sources/ecommerce_role_familiarity_trust.pdf Gelfanova, V. & Lavrov, N. Trust as cultural phenomenon. Available at: http://www.delorus.com/medialibrary/detail.php?ID=1896 How many foreign languages should our children learn? Available at: http://www.kalba.lt/kiekuzsienio-kalbu-privalome-ismokyti-savo-vaikus.html Iarossi, Giuseppe (2006). The Power of Survey Design: A User's Guide for Managing Surveys, Interpreting Results, and Influencing Respondents. Available at: http://books.google.dk/books?id=E42 8XHVsqoeUC&pg=PA264&lpg=PA264&dq=iarossi+2006&source=bl&ots=fxFJczDpwl&sig=rahs lWuyJHBWWqX-VHycDEH448&hl=da&sa=X&ei=jpSdT6uKKpDFswarhvlU&ved=0CFIQ6AEwBA#v=onepage&q=iaros si%202006&f=false Kim, Yu K. and Lee, Hyung R. (2011). Customer satisfaction using low cost carriers. Tourism Management, 32(2), pp. 235-243. Available at: http://pdn.sciencedirect.com/science?_ob=MiamiImageURL&_cid=271716&_user=6461235&_pii= S0261517709002386&_check=y&_origin=article&_zone=relatedPdfPopup&_coverDate=2011-0430&piiSuggestedFrom=S0022435900000294&wchp=dGLbVlVzSkzV&md5=0814724c644e04cccbc54eaaf692fdea/1-s2.0-S0261517709002386-main.pdf Mathur, Poonam (2006). Recent Trends in Plastic and Cosmetic Surgery in Denmark. Available at: http://ezinearticles.com/?Recent-Trends-in-Plastic-and-Cosmetic-Surgery-in-Denmark&id=390393 Miller, Michael. RES 600: Graduate Research Methods: Reliability and Validity. Available at: http://michaeljmillerphd.com/res500_lecturenotes/reliability_and_validity.pdf Mora, Michaela (2011). Validity and Reliability in Surveys. Available at: http://relevantinsights.com/validity-and-reliability New York State Department of Health Office of Managed Care (2007). Dental Care Survey. Medicaid Managed Care Members. Available at: http://www.health.ny.gov/health_care/managed_care/reports/dental/docs/pdf/final_report_dental_car e.pdf Nihtila, Annamari (2010). A Nordic Project of Quality Indicators for Oral Health Care. Report. Available at: http://www.thl.fi/thl-client/pdfs/a389b3ed-a262-44c5-bad0-b9d3eecdf089 Parasuraman, A. & Zeithaml, V. & Berry, L. (1988). Servqual: A multiple-item scale for measuring consumer perceptions of service quality. Journal of Retailing, 64(1). Available at: http://areas.kenanflagler.unc.edu/Marketing/FacultyStaff/zeithaml/Selected%20Publications/SERVQUAL%20A%20MultipleItem%20Scale%20for%20Measuring%20Consumer%20Perceptions%20of%20Service%20Quality. pdf Plant, M and Miller, T (1977). Disguised and undisguised questionnaires compared: Two alternative approaches to drinking behaviour surveys. Social Psychiatry and Psychiatric Epidemiology, 12(1), pp. 21-24. Available at: http://www.springerlink.com/content/u10044h117051874/ 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