Le développement du tourisme médical concerne aujourd'hui plusieurs pays en voie de développement. le Maroc en a fait un acte stratégique. Plusieurs instituts de soins sont impliqués dans ce développement et nous chercherons à identifier comment ont évoluées les compétences des acteurs intervenants et des modalités de leur acquisition. Cette dimension est complémentaire des changements organisationnels qui ont été entrepris pour proposer des prestations à une clientèle de plus en plus diversifiée. / The development of medical tourism involves several developing countries today. Morocco has made the strategic act of the medical tourism. Many care institutions are involved in this development and we seek to identify how the skills of actors involved and the terms of their acquisition. This dimension is complementary to the organizational changes that have been set to offer services to a customer base increasingly diverse.

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Medical tourism is a relatively recent global economic and political phenomenon which has assumed increasing importance for developing countries, particularly in Asia. It has been slower to develop within the context of the tourism industry in English-speaking Caribbean countries but there is evidence that the tourism policy makers in the region perceive medical tourism as a potentially lucrative niche market. However, while the potential of medical tourism has seemingly been embraced by the region's political directorate, there has been limited discussion of the extent to which this market niche can realistically provide competitive advantage for the region. The argument of this conceptual paper is that the English-speaking Caribbean cannot hope to compete successfully in the global medical tourism market with many developing world destinations in Asia, or even with other Caribbean countries such as Cuba, on factors such as low cost, staff expertise, medical technological capability, investment in healthcare facilities or even in terms of the natural resources of sun, sea and sand. Rather, in order to achieve competitive advantage the countries of the region should, on the one hand, identify and develop their unique resources and competences as they relate to medical tourism, while, on the other hand, they should exploit the demand of the postmodern tourist for authentic experiences. Both these supply and demand side issues, it is argued, can be addressed through the development of a medical tourism product that utilises the region's indigenous herbal remedies. [PUBLICATION ABSTRACT]; Medical tourism is a relatively recent global economic and political phenomenon which has assumed increasing importance for developing countries, particularly in Asia. It has been slower to develop within the context of the tourism industry in English-speaking Caribbean countries but there is evidence that the tourism policy makers in the region perceive medical tourism as a potentially lucrative niche market. However, while the potential of medical tourism has seemingly been embraced by the region's political directorate, there has been limited discussion of the extent to which this market niche can realistically provide competitive advantage for the region. The argument of this conceptual paper is that the English-speaking Caribbean cannot hope to compete successfully in the global medical tourism market with many developing world destinations in Asia, or even with other Caribbean countries such as Cuba, on factors such as low cost, staff expertise, medical technological capability, investment in healthcare facilities or even in terms of the natural resources of sun, sea and sand. Rather, in order to achieve competitive advantage the countries of the region should, on the one hand, identify and develop their unique resources and competences as they relate to medical tourism, while, on the other hand, they should exploit the demand of the postmodern tourist for authentic experiences. Both these supply and demand side issues, it is argued, can be addressed through the development of a medical tourism product that utilises the region's indigenous herbal remedies. Reprinted by permission of Carfax Publishing, Taylor & Francis Ltd.

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台灣發展醫療旅遊／國際醫療服務一直備受爭議。本研究主要以意見場域為基礎，深度訪談與次級資料的論述分析為方法，探看台灣發展醫療旅遊的過程中，相關行動者以何種論述策略正當化自身持具之立場、其中又反映了何種為行動者視為當然之預設；進而找尋各方溝通之可能性。 依照「與國際醫療服務有關的政府主要推動計畫時程」和「論辯的主要議題」兩者，本研究將所探看的發展時間分為三時期，分別為：（1）關於醫療服務國際化是否應該發展以及如何發展的討論；（2）行政院核定以公司化、專區化作為主要發展方向所引發的論辯；（3）國際醫療納入自由經濟示範區之後的實體專區發展模式所引發的論述競逐；進而歸納並分析共23種論述策略。進一步從存續的策略和消失的策略提出以下幾點命題：存續的策略彰顯出行動者在意見場域中爭奪正統地位的原則，分有「存在非營利本質的醫療」和「全民照護優先」兩者；消失的策略則意味著從意見推進至俗見的面向，分有「失敗案例不具評判國際醫療成效之效力」及「配套一次到位的不可能及其必要性」。 綜觀整體發展過程發現，國際醫療服務似仍深陷論述的泥淖中：在蘊含著各式各樣論述策略的整體發展過程中，各方雖有「存在非營利本質的醫療」和「全民照護優先」兩個共同的論辯原則，但仍存在不可達致共識的鴻溝；其中，反對發展者論述的「策略性」似不如支持發展者要多元。這樣的態勢究竟將走向收斂或發散，值得持續觀察；然而，持著「有自己的想法並尊重他人想法，同時適度修正自己的想法」此心態，當是在這「亂中有序」的態勢中達致溝通的有效前提。 / The development of medical tourism in Taiwan has been a controversial issue in recent years. Based on the concept of “field of opinion,” the thesis uses discourse analysis and interview as methods to analyze: (1) how the related actors justify themselves with diverse discourse strategies; (2) the presumptions which are underlying those justifications and taken for granted by the actors; (3) the possibility for those actors with different opinions to reach the stage of consensus.The thesis follows two principles to analyze the collected data. One is the time schedule of the related government projects; the other is the main foci in the whole development process. With the two principles, the whole development process is split into three periods: (1) the debate upon whether medical tourism should be promoted and how to promote it; (2) the debate upon the possibility of organizing hospitals in corporate form within a specific bounded area; (3) the debate upon if it is right to set up international medical centers in the “free economic pilot zones.” The thesis founds 23 discourse strategies that actors used to justify themselves in the whole development process. Furthermore, the author argues that the subsisting strategies represent the principles actors hold to compete for the orthodoxy in the field of opinion. In the thesis, the principles refer to “medical affairs as nonprofit” and “citizen first.” The disappearance of strategies then represents the doxa which used to be opinions. In this regard, the thesis founds that those failing government projects become unrelated to the effectiveness of medical tourism which is being promoted. While everyone knows that to have all supporting projects settled is impossible, forming the supporting projects once and for all is still necessary. All in all, the author argues that although “medical affairs as nonprofit” and “citizen first” are the two common principles between the supporters of medical tourism and their counterpart, to reach the stage of consensus, there is still a long way to go; the supporters seem to have more diverse strategies to confront their counterpart. After all, respecting each other and modifying one’s own opinion in progress might be the effective presumption to get settled in such a full-of-chaos-but-ordered condition.