Medikal turizm hizmeti tedarik zinciri tasarımında işbirlikçi bir bütünleşik yöntem önerisi
A collaborative methodology for designing the medical tourism service supply chain
Yazar: SALİHA KARADAYI USTA
Danışman: DR. ÖĞR. ÜYESİ ŞEYDA SERDAR ASAN
İstanbul Teknik Üniversitesi / Fen Bilimleri Enstitüsü / Endüstri Mühendisliği Ana Bilim Dalı / Endüstri Mühendisliği Bilim Dalı
Derece: Doktora, 2020
Konu: Endüstri ve Endüstri Mühendisliği = Industrial and Industrial Engineering
Dizin: Tedarik zinciri yönetimi = Supply chain management

Özet:
Medikal turizm (MT), hastaların ikamet ettikleri ülke dışında tedavi görmek için tıbbi kurumlara erişebilmesidir. Yapılan literatür taraması ve sektör raporu incelemeleri sonucu bu çalışma kapsamında MT artan önemi dolayısıyla ele alınmıştır. Özellikle saç ekimi, diş tedavisi ve göz ameliyatı gibi isteğe bağlı olan, aciliyet göstermeyen tedavi tipleri üzerinde durulmuştur. 
Mevcut MT çalışmaları, özellikle iş birliklerinin önemine vurgu yapmakta, bu alanda araştırmaların yapılması gerekliliğine dikkat çekmektedir. Bu çalışmanın amacı MT hizmetlerinde tedarik zinciri yapısını ortaya koymak ve medikal turizm hizmet tedarik zinciri (MTHTZ) kapsamındaki "hizmet tasarımı" ve "tedarikçi iş birlikleri" süreçlerini bütünleşik olarak yönetmeye destek olacak bir yöntembilim önermektir. 
Bu amacı gerçekleştirebilmek için ilk olarak MT hizmeti tedarik zincirinde yer alan taraflar belirlenmiş, iş süreçleri tanımlanmış ve kavramsal bir model önerilmiştir. Yöntem olarak ise üçgenleme (triangulation) uygulanmış, bu kapsamda literatür taraması, derinlemesine görüşmeler ve uzman değerlendirmeleri gerçekleştirilmiştir. 
MTHTZ iş süreçleri hizmet tasarımı, müşteri ilişkileri yönetimi, talep yönetimi, kapasite ve kaynak yönetimi, tedarikçi ilişkileri yönetimi, hizmet sunumu yönetimi, hizmet telafisi yönetimi olarak tanımlanmıştır. Bu süreçlerin ilki olan "Hizmet Tasarımı", takip eden diğer süreçleri tetiklemesi sebebiyle seçilmiş, tezde bu iş sürecine odaklanılmıştır. Hizmet tasarımı, müşteri beklentilerini anlamayı, bu beklentilere istinaden belli kriterlere göre tedarikçi / kaynak bulmayı, ve son olarak da bu kaynakların kapasitelerini planlamayı gerektirmektedir. Tezin devamında hizmet tasarımı iş süreci kapsamındaki kararlara destek olan bir yöntembilim ortaya konmuştur.
Medikal turist ihtiyaç ve beklentilerini anlamak amacıyla  Uyarlamalı Seçime - Dayalı Konjoint (USDK) Analizi kullanılmış,. medikal turistlerden toplanan geri bildirimler sayma verilerinin analizi ve Hiyerarşik Bayes Regresyon analizi ile incelenmiştir. analiz sonuçlarına göre bir medikal turizm hizmet paketinde muhakkak olması gereken veya isteğe bağlı bırakılması gereken hizmetler net olarak tanımlanmıştır. Böylece bir asistan firmanın, medikal turistlere sunabileceği hizmet paketinin içeriği ve arka planda hangi hizmet sağlayıcılar ile iş birliği yapması gerektiği de netlik kazanmıştır. 
MTHTZ'de yapılacak iş birliklerinin tedarikçi/hizmet sağlayıcı ön seçim kararına destek olmak amacıyla bulanık kural tabanlı çıkarım sistemi kullanımı ile iş birliği / tedarikçi değerlendirme kriterleri belirlenmiş, literatür taraması ve sektör yetkilileri görüşleri ile bu kriterlerin bulanık veri setlerini elde edilmiş, veriler MATLAB'te analiz edildikten sonra kabul edilebilir iş birliği seviyesi netleştirilmiş ve farklı senaryoların gösterimi sağlanmıştır. 
Son aşamada ise gelen taleplerin ön seçimle belirlenen tedarikçilerden hangilerine atanacağına karar vermeye destek olması için bir matematiksel atama modeli önerilmiştir. Önerilen yöntemler adım adım İstanbul'daki bir asistan firma için uygulanmış ve önerilen yöntembilimin kullanılabilirliği/uygulanabilirliği tartışılmıştır.
Çalışma sonucunda bir asistan firmanın aracılık hizmetlerini yönettiği MTHTZ yapısı ortaya konmuş, zincir üyeleri ve iş süreçleri tanımlanmıştır. Hizmet tasarımı iş süreci kapsamında bütünleşik bir tedarikçi iş birliği yöntembilimi önerilmiştir. Bu kapsamda yapılan uygulamada ilk olarak müşterinin (bu durumda hastanın) bir MT hizmetinde hangi hizmet sağlayıcılardan faydalanmak istediği ortaya konmuştur. Devamında asistan firmanın tedarikçileri konumundaki hizmet sağlayıcılar için kriterleri belirlenmiş, ilgili tedarikçiler skorlarla değerlendirilmiştir. Son olarak, hem müşterinin tercihlerini dikkate alan, hem de belirlenen kriterlere istinaden tedarikçileri önceliklendiren bir matematiksel atama modeli ile, kapasiteleri de göz önünde bulundurarak asistan firmaya gelen taleplerin tedarikçilere atanması sağlanmıştır.

Abstract:
Medical tourism (MT) is the ability of patients to access medical institutions to receive treatment outside of the country of residence. As a result of the literature review and sector report reviews, MT has been addressed due to the increasing importance of this study. Particular attention was given to the optional and non-urgent treatment types such as hair transplantation, dental treatment and eye surgery.
Existing MT studies emphasize the importance of collaborations in particular and draw attention to the need for research in this area. The aim of this study is to reveal the supply chain structure in MT services and to propose a methodology that will support the management of "service design" and "supplier collaboration" processes within the scope of the medical tourism service supply chain (MTSSC).
In order to achieve this goal, the parties in MTSSC were clarified, supply chain processes were investigated, and the details of the operations were presented. By answering the first research question, seven business processes were described in detail. These processes are service design, customer relationship management, demand management, capacity and resource management, supplier relationship management, service delivery management and service recovery management. The definition of "Service Design", which is the first of these processes, is the understanding of the customer expectations, finding suppliers / resources according to specific criteria based on these expectations, and finally planning the capacities of these resources. Therefore, the first research question shaped the following research questions.
Secondly, it is aimed to understand the services preferred by medical tourists. Next, in the third stage, the criteria to determine the decision of collaboration with the suppliers that provide the services for medical tourists, and how they decide on the level of collaboration were emphasized. Fourth, how the medical tourist applications were assigned to these suppliers by considering the capacity values.
The method used in answering was triangulation for the first part. Triangulating means examining the results of a subject by using at least two methods. For this purpose, literature review, in-depth interviews and expert evaluations were carried out.
Literature, sector reports, websites of private enterprises were scanned in detail. Then, in-depth interviews were held with the operation manager of an assistant company, a corporate hospital chain's deputy director of the government incentives, the international marketing manager of a private dental hospital chain, and the founding member of an eye hospital chain. The conceptual framework was presented to them and definitions were updated in line with the feedback received. 
Next, this conceptual model was presented at the 8th International Health Tourism Congress, which was held in 2018, and academics and sector officials attending the congress were asked to evaluate the study.
Pre-prepared evaluation forms were distributed to them, and their opinions were collected in a written form. Verbal comments were also noted by the author of the thesis. The form was also transferred to the online environment, and was directed to all participants. After receiving their opinions and approvals of these experts, the conceptual model was finalized.
The defined business processes have shaped other research questions that will be examined in the following chapters of the thesis. 
Service design is the basis for business processes. It is a well-defined and structured service development process that is shaped according to the needs and expectations of the patient in order to create a medical tourism experience. To achieve this, at first it is necessary to understand customer expectations, to determine what the target market segment is, and to identify the capabilities and resources that service providers need to meet their needs. In this way, service providers can design their service processes, plan their capacities and human resources, and make sourcing decisions accordingly. Therefore, service design directly affect business processes which are customer relationship management, demand management, capacity and resource management, supplier relationship management, service delivery management and service recovery management. In this context, according to the definition of service design, it is necessary to understand customer needs and expectations first.
In the second stage of the study, a questionnaire prepared in five languages was completed with the participation of real medical tourists in order to understand the direction of their service preferences. Considering these preferences of medical tourists, it is understood that health, accommodation and transfer services are must-have service items for the medical tourists.
Therefore, in the second stage, the methods that can be used for service design are listed via a literature review, and "conjoint analysis" was chosen to present the voice of customer with a dynamic structure. Conjoint analysis has different techniques that should be applied for different characteristics. Therefore, Adaptive Choice-Based Conjoint (ACBC) Analysis was selected as the most appropriate approach to medical tourism service.
In order to apply the ACBC analysis, a grant application was made to Sawtooth Software for full access to Lighthouse Studio. As a result of application, full access to the software was provided for 18 months. The questionnaire prepared by using the software which shapes the next questions with the previous answers of the participants. The questionnaire, which was prepared in Turkish, was sent to academicians and sector authorities who contributed to the first stage of the thesis, and were asked to comment on the clarity of the questionnaire and on the problems they identified, if any. The Turkish questionnaire was finalized with the contribution of 17 participants. Then, with the financial support provided by Istanbul Technical University, the questionnaire was translated into foreign languages (Russian, French, Arabic). The translations made by a private translation bureau was reviewed by lecturers of ITU School of Foreign Languages once again, and the survey was finalized with the necessary arrangements.
With the medical tourism service package offered to medical tourists, the ACBC survey prepared was directed to real medical tourists online. With the aim of accessing the medical tourists who can fill in the questionnaire, many assistant companies and health institution officials have been contacted via LinkedIn, and they have been asked to refer them to their patients who have received or planned to receive medical tourism services. Participants had access to the survey between December 2018 and June 2019.
The feedback collected from medical tourists was examined by numerical analysis and Hierarchical Bayesian Regression. In line with the feedbacks obtained, the services that should be optional are clearly defined in a medical tourism service package. Thus, it was become obvious that the content of the service package that an assistant company shoul offer to medical tourists.
In the second stage of service design, after the determination of medical tourist preferences, in the third stage, it was focused on determining the criteria and the levels of collaboration that were taken into consideration in the collaboration arrangements. Thus, it became possible to determine the collaboration score, to prioritize the suppliers according to these scores.
In the third stage, finding the suppliers (in other words, service provider / resource), evaluation process and criteria of these identified suppliers were discussed. In order to determine which criteria are taken into consideration, literature was reviewed, and sector experts were consulted and the factors to be taken in the collaboration arrangement were determined. A conceptual framework covering the medical institution, assistant company and medical tourist was drawn up with detailed scanning of the sector reports and literature. The operations, tools and methods used in the collaboration arrangement step were detailed.The literature emphasized the factor of "customer preferences" and the "customer satisfaction" survey results. In addition, 7 assistant companies and 7 health institution officials were contacted through LinkedIn  and they were asked what they paid attention to in setting up collaboration. Through these feedbacks, the "physical structure and quality adequacy" factor of the institution, and especially the "market reputation" factor of an institution to be collaborate for the first time were added to the evaluation criteria.
Due to the uncertain structures of these determined factors, "fuzzy rule-based inference system" was used as a method. The same sector officials were consulted to clarify the data sets of these previously identified factors. Fuzzy datasets were defined by expert opinios, collaboration arrangement rules were determined, and the rules were applied to these defined datasets using "MATLAB Inference System". 
At the last stage, a mathematical assignment model proposal was developed to assign requests to the suppliers with mathematical programming.
As a result of the study, supply chain structure of an assistance company managing MT services, chain members and business processes of MTSSC were defined. It is revealed that a customer (in this case the patient) wants to benefit from which service provider in a MT service. Subsequently, the criteria for service providers of the assistance company were determined, and the relevant suppliers were evaluated with scores. Finally, a mathematical assignment model that takes into account the preferences of the patients and prioritizes the suppliers based on the specified criteria by considering the capacities was suggested.