a medical tourist perception of iranian hospital quality: limited employee foreign language skills negatively impact communication

background and objectives: medical tourism tourism is emerging as a fast growing healthcare industry with the potential to open a new economic opportunity for developing countries. iran has been the treatment destination of many medical tourists from middle eastern countries for many years, yet this field of services remains underdeveloped. the best judges for the challenges facing development of medical tourism are the travelling patients themselves. thus, this study aimed to explore the quality of iranian public and private hospitals as perceived by patient tourists who travelled to the country for treatment. methods: using a cross-sectional design, the study surveyed the perception of 39 medical tourists who referred to two public hospitals, and 40 medical tourists who referred to two private hospitals in tehran, between may to september 2011. the survey was carried out using a self-designed questionnaire with 16 questions asking about the different aspects of the hospital quality including staff, communication, expertise level, standards, and facilities. the reliability of the measurement tool was examined using cronbach’s alpha. t test was used to compare score mean of hospital quality and the related dimensions between public and private hospitals. the relationship between dimensions of hos­pital quality was calculated using pearson correlation coefficient.   findings: total hospital quality scored 73.29%. the hospital quality dimensions were rated as follows: staff, 80.89%; communication, 56%; expertise level, 80.67%; standards, 75.44%, and facilities, 71.67%. the overall hospital quality and all related dimensions except communication were rated significantly higher in private health settings as compared to public hospitals. a significant correlation was found between all dimensions of hospital quality as perceived by medical tourists, except between communication and facilities. the strongest correlation was found between standards and expertise level. the former dimension was also found on average the strongest predictor of other dimensions.   conclusions: while the overall quality of hospitals is generally satisfactory in terms of the measured dimensions, employee communication with tourist patients is challenged by their poor english language skills. therefore, both private and public hospitals need to address this deficiency by appropriate strategies. our results also suggest that promoting hospital standards could significantly improve other aspects of hospital quality.