This study explores the relationship between financial well-being and health tourism spending in the United States, emphasizing the financial dynamics of healthcare access through Sen’s Capability Approach. Analyzing gender- and age-segmented data, it examines how financial constraints shape health tourism decisions, explicitly focusing on process freedom and conversion factors. Regression results show that, while general effects were often non-significant, detailed segment-specific analyses reveal significant variations by gender, age, and service type. Worsening financial conditions led to increased spending on prolonged and incidental health tourism for specific demographics, indicating adaptive economic behaviors. The findings highlight the bi-directional influences between financial well-being and health tourism, emphasizing the importance of targeted financial policies and support systems to improve healthcare access for vulnerable groups. This study underscores the nuanced role of financial well-being in health tourism decisions, providing insights for tailored interventions to meet diverse healthcare needs.
AnandS.PeterF.SenA. (2004). The concern for health equity. In AnandS.PeterF.SenA. (Eds.), Public health, ethics, and equity (pp. 15–20). Oxford University Press.
2.
BeladiH.ChaoC.EeM. S.HollasD. (2019). Does medical tourism promote economic growth? A cross-country analysis. Journal of Travel Research, 58(1), 121–135. https://doi.org/10.1177/0047287517735909
BrüggenE.HogreveJ.HolmlundM.KabadayiS.LöfgrenM. (2017). Financial well-being: A conceptualization and research agenda. Journal of Business Research, 79, 228–237. https://doi.org/10.1016/j.jbusres.2017.03.013
5.
Centers for Disease Control and Prevention. (2023). 2024 CDC yellow book: Health information for international travel. Oxford University Press. https://www.cdc.gov/yellow-book/index.html
ClevelandM.PapadopoulosN.LarocheM. (2011). Identity, demographics, and consumer behaviors: Interna-tional market segmentation across product categories. International Marketing Review, 28(3), 244–266. https://doi.org/10.1108/02651331111132848
8.
CohenE. (2008). Medical tourism in Thailand. In E.Cohen (Ed.), Explorations in Thai Tourism (pp. 225–255). Emerald Bingley.
9.
CohenM.ElliottF.OatesL.SchembriA.MantriN. (2017). Do wellness tourists get well? An observational study of multiple dimensions of health and well-being after a week-long retreat. Journal of Alternative and Complementary Medicine, 23(2), 140–148. https://doi.org/10.1089/acm.2016.0268
10.
CollinsA.MedhekarA.WongH. Y.CobanogluC. (2019). Factors influencing outbound medical travel from the USA. Tourism Review, 74(3), 463–479. https://doi.org/10.1108/TR-06-2018-0083
11.
DickeyD.FullerW. (1979). Distribution of the estimators for autoregressive time series with a unit root. Journal of the American Statistical Association, 74(366), 427–431. https://doi.org/10.1080/01621459.1979.10482531
12.
DiniM.PencarelliT. (2022). Wellness tourism and the components of its offer system: A holistic perspective. Tourism Review, 77(2), 394–412. https://doi.org/10.1108/TR-08-2020-0373
13.
DolnicarS. (2008). Market segmentation in tourism. In A.WoodsideD.Martin (Eds.), Tourism management: Analysis, behaviour and strategy (pp. 129–150). CAB International.
14.
DolnicarS.LeischF. (2017). Using segment level stability to select target segments in data-driven market segmentation studies. Marketing Letters, 28, 423–436. https://doi.org/10.1007/s11002-017-9423-8
15.
EmanuelJ. (2020). Which country has the world’s best healthcare?Public Affairs.
HallR. (1988). Intertemporal substitution in consumption. Journal of Political Economy, 96(2), 339–357. https://doi.org/10.1086/261539
21.
HanefeldJ.SmithR. (2015). Financing mechanisms. In LuntN.HorsfallD.HanefeldJ. (Eds.), Handbook on Medical Tourism and Patient Mobility (pp. 104-111). Edward Elgar Publishing.
22.
HayashiF. (2000). Econometrics. Princeton University Press.
23.
HeungV.KucukustaD.SongH. (2010). A conceptual model of medical tourism: Implications for future research. Journal of Travel & Tourism Marketing, 27(3), 236–251. https://doi.org/10.1080/10548401003744677
24.
HopkinsL.LabontéR.RunnelsV.PackerC. (2010). Medical tourism today: What is the state of existing knowledge?Journal of Public Health Policy, 31(2), 185–198. https://doi.org/10.1057/jphp.2010.10
25.
HudsonS.ThalK.CárdenasD.MengF. (2017). Wellness tourism: Stress alleviation or indulging healthful habits?International Journal of Culture, Tourism and Hospitality Research, 11(1), 35–52. https://doi.org/10.1108/IJCTHR-09-2015-0111
IssenbergS. (2016). Outpatients. The astonishing new world of medical tourism. Columbia Global Reports.
28.
JohnstonR.CrooksV.SnyderJ.KingsburyP. (2010). What is known about the effects of medical tourism in destination and departure countries? A scoping review. International Journal for Equity in Health, 9(24), 1–13. https://doi.org/10.1186/1475-9276-9-24
29.
KemppainenL.KoskinenV.BergrothH.MarttilaE.KemppainenT. (2021). Health and wellness–related travel: A scoping study of the literature in 2010–2018. Sage Open, 11(2), 1–20. https://doi.org/10.1177/21582440211013792
30.
KennedyP. (2008). A guide to econometrics (6th ed.). Wiley-Blackwell.
31.
KhanM.ChelliahS.HaronM. (2016). Medical tourism destination image formation process: A conceptual model. International Journal of Healthcare Management, 9(2), 134–143. https://doi.org/10.1080/20479700.2016.1142046
32.
KimS.Adu-AmpongE. A. (2024). Disabilities, functionings and capabilities: The capability approach in accessible tourism. Current Issues in Tourism, 28(2), 272–286. https://doi.org/10.1080/13683500.2023.2300989
33.
KukkM. (2014). Distinguishing the components of household financial wealth: The impact of liabilities on assets in Euro area countries (Working Paper Series Eesti Pank (Central Bank of Estonia) 2/2014).
LuntN.SmithR.ExworthyM.GreenS.HorsfallD.ItalicMannionR. (2011). Medical tourism: Treatments, markets and health system implications: A scoping review. OECD. http://www.oecd.org/els/health-systems/48723982.pdf
37.
MajeedS.KimW. (2023). Emerging trends in wellness tourism: A scoping review. Journal of Hospitality and Tourism Insights, 6(2), 853–873. https://doi.org/10.1108/JHTI-02-2022-0046
38.
MazanecJ. A.DolnicarS. (2022). Segmentation – tourism. In J. Jafari & H. Xiao (Eds.), Encyclopedia of tourism (pp. 1–4). Springer.
39.
MohamadW. N.OmarA.HaronM. S. (2012). The moderating effect of medical travel facilitators in medical tourism. Procedia-Social and Behavioral Sciences, 65, 358–363. https://doi.org/10.1016/j.sbspro.2012.11.134
40.
MoschisG. P. (2012). Consumer behavior in later life: Current knowledge, issues, and new directions for research. Psychology & Marketing, 29(2), 57–75. https://doi.org/10.1002/mar.20504
41.
MurrayM. (2006). Avoiding invalid instruments and coping with weak instruments. Journal of Economic Perspectives, 20(4), 111–132.
42.
NussbaumM. (2000). Women and human development: The capabilities approach. Cambridge University Press.
43.
OrmondM.KasparH. (2019). Medical travel/tourism and the city. In M. Ormons & H. Kaspar (Eds.), Handbook of global urban health (pp. 182–200). Routledge.
44.
PerronP. (1989). The great crash, the oil price shock, and the unit root hypothesis. Econometrica, 57(6), 1361–1401. https://doi.org/10.2307/1913712
45.
PessotE.SpoladoreD.ZangiacomiA.SaccoM. (2021). Natural resources in health tourism: A systematic literature review. Sustainability, 13(5), 2661. https://doi.org/10.3390/su13052661
PorterN.GarmanE. (1993). Testing a conceptual model of financial well-being. Journal of Financial Counseling and Planning, 4, 134–164.
49.
PuczkóL.StackpoleI. (2021). Marketing handbook for health tourism. Stackpole & Associates.
50.
RidderstaatJ. (2021). Households’ net financial wealth as a determinant of tourism demand cycles: Evidence from U.S. Travel to selected Caribbean destinations. Journal of Travel Research, 60(3), 564–582. https://doi.org/10.1177/0047287520925174
51.
RidderstaatJ. (2022). Beyond income: U.S. households’ financial position perceptions and their willingness to consume tourism. Current Issues in Tourism, 25(12), 2006–2028. https://doi.org/10.1080/13683500.2021.1935794
52.
RidderstaatJ. (2023). Measuring hidden demand and price behavior from U.S. Outbound health tourism spending. Tourism Economics, 29(3), 759–787. https://doi.org/10.1177/13548166211067925
53.
RidderstaatJ.SinghD.DeMiccoF. (2019). The impact of major tourist markets on health tourism spending in the United States. Journal of Destination Marketing and Management, 11, 270–280. https://doi.org/10.1016/j.jdmm.2018.05.003
54.
RiitsaluL.SulgR.LindalH.RemmikM.VainK. (2024). From security to Freedom—The meaning of Financial Well-being changes with age. Journal of Family and Economic Issues, 45(1), 5669. https://doi.org/10.1007/s10834-023-09886-z
StockJ.WrightJ.YogoM. (2002). A survey of weak instruments and weak identification in generalized method of moments. Journal of Business & Economic Statistics, 20(4), 518–529. https://doi.org/10.1198/073500102288618658
66.
StockJ.YogoM. (2005). Testing for weak instruments in linear IV regression. In D.Andrews (Ed.), Indentification and inference for econometric models (pp. 80–108). Cambridge University Press.
67.
StorchiS.JohnsonS. (2016). Financial capability for well-being: An alternative perspective from the Capability Approach. (Bath papers in international development and well-being; No. 44). Centre for Development Studies, University of Bath.
Tomoaia-CotiselA.ScammonD.WaitzmanN.CronholmP.HalladayJ.DriscollD.SolbergL. I.HsuC.Tai-SealeM.HiratsukaV.ShihS. C.FettersM. D.WiseC. G.AlexanderJ. A.HauserD.McMullenC. K.ScholleS. H.TirodkarM. A.SchmidtL.. . . StangeK. (2013). Context matters: The experience of 14 research teams in systematically reporting contextual factors important for practice change. The Annals of Family Medicine, 11, S115–S123. https://doi.org/10.1370/afm.1549
United Nations World Tourism Organization. (2018). Exploring health tourism.
73.
VogelsangT. (1993). Essays on testing for nonstationarities and structural change in time series models [Unpublished doctoral dissertation]. Princeton University.
74.
VoigtC.LaingJ. (2013). A way through the maze: Exploring differences and overlaps between wellness and medical tourism. In BotterilD.PenningsG.MainilT. (Eds.), Medical tourism and transnational case (pp. 30–47). Palgrave McMillan.
75.
WooldridgeJ. (2016). Introductory econometrics: A modern approach. South-Western Cengage Learning.
76.
YogoM. (2004). Estimating the elasticity of intertemporal substitution when instruments are weak. The Review of Economics and Statistics, 86(3), 797–810. https://doi.org/10.1162/0034653041811770
