**5. Efficiency in the perception of quality of the systemic competitiveness model: An experiment with foreign patients, accredited and nonaccredited clinics**

According to the Medical Tourism Association [29], the quality of medical procedures is determined by multiple independent variables reflected in international accreditations of clinics that offer healthcare services to national and foreign patients. According to Mason and Wright [30], having an international accreditations increases the possibilities of strate‐ gic alliances with international medical centers, as well as improves the perception of the confidence of foreign insurers for the transfer of patients. Both elements allow a greater par‐ ticipation of the world market of the medical tourism and the exaltation of the competitive advantages of receiving countries. Both the administrative operations and medical proce‐ dures have independent accreditations that serve as an international reference for the mobility of patients. According to Mckinsey and Company [31], Deloitte Consulting Group [32], The Joint International Commission (JCI) [12], and the Global Health Care Accreditation Program (GHAP) [13] are the world's leading quality referrals in medical procedures that influence the transfer of patients to a country of destination. In Colombia, five medical centers have JCI and GHAP accreditations that serve 64.2% of total foreign patients who consume medical services in Colombia [14]. The clinics are: (1) Imbanaco Medical Center, (2) The Cardiology Institute, (3) Cardiovascular Clinic of Colombia, (4) Hospital Pablo Tobon Uribe, and (5) University Hospital Santa Fe de Bogota.

According to the Colombian Association of Cosmetic Surgery [33], Hotels and Tourism Association of Colombia [34], and the Colombian Society of Aesthetic and Reconstructive Plastic Surgery [35], these accreditations were achieved through cooperation between local authorities and medical centers, adjusting the model of traditional competitiveness toward systemic competitiveness based on the harmony of local government objectives and strategies of international positioning of accredited clinics.

In order to determine if the international accreditations obtained by the five clinics improve the quality of the medical procedures offered, 200 foreign patients who consumed medical procedures were surveyed, of which 100 did so in the five accredited clinics and the other 100 in five other clinics without international accreditation. The survey rates of several items in the scale from one to five of which one reflects a low perception of quality and five reflects a high perception of quality.

The rate of quality of the accreditation group and nonaccreditation group is compared through arithmetic means in order to determine whether an international accreditation improves the performance in medical care. To compare the quality perceptions, it is neces‐ sary to know the arithmetic means through a T‐test for independent samples. It considers two initial tests: the normality test and a variances test. **Table 3** exposes the statistical inputs that will be used.

Before comparing variances, it is necessary to check the normality condition of the grades. Since we have a small amount of data, we use the Kolmogorov‐Smirnov test. The results are illustrated in **Table 4**.

Since the *P* values for both tests are high, the decision in both cases is to consider that the scores are normally distributed with the values of the estimated parameters. To compare the variances, an F‐Fisher test was used. Value of the statistic *f* = 0.47. Value of *P* = 0.082. At a significance level of 0.05, if the hypothesis of equality of variances is rejected, it is possible to consider that the variances are different. A T‐test for the difference of means is used, from independent samples. Value of the statistic: *t* = −1.78. P‐value = 0.083 at a sig‐ nificance level of 0.05. Since the calculated P‐value is greater than 0.05, the hypothesis can be rejected. That is to say that there are differences between means. However, as P‐value and significance level are very close, the difference is not significant. The above means that clinics with international accreditation supported by local governments through the systemic competitiveness model offer better quality in medical procedures offered than in those clinics that do not have international accreditation. That is, foreign patients perceive clinics with international accreditation as a better quality in medical care than those that do not have this instrument.

According to this statistical test, the application of the systemic competitiveness model, exogenous elements such as the adequacy of public space, generation of safe environ‐ ments for patients implies a greater efficiency and perception of quality of national medical procedures.


**Table 3.** Statistical inputs.

example is in the city of Medellin that through joint commissions that integrate the local gov‐ ernment representatives and medical operators, have established a roadmap for the industry

The establishment of direct communication vehicles between the medical tourism operators and the local government increased the tax and nontax benefits, and the adaptation of the public space for the attention of foreign patients increased the police force in areas bordering medical centers and created clusters of health that integrates the services and products most

**5. Efficiency in the perception of quality of the systemic competitiveness** 

According to the Medical Tourism Association [29], the quality of medical procedures is determined by multiple independent variables reflected in international accreditations of clinics that offer healthcare services to national and foreign patients. According to Mason and Wright [30], having an international accreditations increases the possibilities of strate‐ gic alliances with international medical centers, as well as improves the perception of the confidence of foreign insurers for the transfer of patients. Both elements allow a greater par‐ ticipation of the world market of the medical tourism and the exaltation of the competitive advantages of receiving countries. Both the administrative operations and medical proce‐ dures have independent accreditations that serve as an international reference for the mobility of patients. According to Mckinsey and Company [31], Deloitte Consulting Group [32], The Joint International Commission (JCI) [12], and the Global Health Care Accreditation Program (GHAP) [13] are the world's leading quality referrals in medical procedures that influence the transfer of patients to a country of destination. In Colombia, five medical centers have JCI and GHAP accreditations that serve 64.2% of total foreign patients who consume medical services in Colombia [14]. The clinics are: (1) Imbanaco Medical Center, (2) The Cardiology Institute, (3) Cardiovascular Clinic of Colombia, (4) Hospital Pablo Tobon Uribe, and (5) University

According to the Colombian Association of Cosmetic Surgery [33], Hotels and Tourism Association of Colombia [34], and the Colombian Society of Aesthetic and Reconstructive Plastic Surgery [35], these accreditations were achieved through cooperation between local authorities and medical centers, adjusting the model of traditional competitiveness toward systemic competitiveness based on the harmony of local government objectives and strategies

In order to determine if the international accreditations obtained by the five clinics improve the quality of the medical procedures offered, 200 foreign patients who consumed medical procedures were surveyed, of which 100 did so in the five accredited clinics and the other 100 in five other clinics without international accreditation. The survey rates of several items in

**model: An experiment with foreign patients, accredited and** 

to grow in accordance with the global vision of the local authorities.

136 Mobilities, Tourism and Travel Behavior - Contexts and Boundaries

demanded by patients.

**nonaccredited clinics**

Hospital Santa Fe de Bogota.

of international positioning of accredited clinics.


**Table 4.** Normality test result.
