Cooperation Perspectives in Sustainable Medical Tourism: The Case of Lithuania
Round 1
Reviewer 1 Report
I had a chance to review the previous versions of this paper. At the last round of reviewing, I found it perfect and recommended acceptance. I see the authors have improved their manuscript once again, and it has become even better. I have enjoyed reading this. This is a kind of pioneer study, and the methodology, the results, and the interpretations are ok and enough. In my opinion, there is not reason to deepen the analysis. The paper will be of interest to the international audience in its present form. So, my recommendation is ACCEPT as is.
At the stage of proof checking I recommend to avoid too short and too lengthy paragraphs.
Author Response
Response to Reviewer 1 Comments
We are very grateful for your support that this study is interesting and important.
Thank you.
Reviewer 2 Report
The article presents a current, interesting and not well recognized topic of factors determining the cooperation in medical tourism on example of medical tourism in Lithuania. Many post communist countries (e.g. Poland, Czechia, Hungary) see medical tourism as the one of the basic tourist product for foreign tourists. Therefore it is very crucial to increase the knowledge of its development determinants, also through cooperation among facilitators.
Work needs revision due to the several issues:
1. The literature review appears thorough and rich, especially in the part of medical tourism notion explanation. The literature review complement is necessary regarding to issue of the cooperation and its possibilities. There is also a need to define the notion of possibility of cooperation. If there is no enough scientific literature in the field of the cooperation in medical tourism, authors should extend their review to general theory of cooperation in tourism/in tourism destination (e.g. Bramwell & Lane, Jamal & Getz, Beritelli, Żemła, more articles of Czernek).
2. The authors narration does not seem clear. Presented subsections in literature review do not conclude with proposed hypotheses for further empirical endeavor. Thus a fundamental doubt arise with regard to the appropriateness of the chosen factors facilitating the cooperation in medical tourism ("The basis for cooperation is communication, form of work organization, coordination of work, sharing of knowledge and experience..."). The Authors does not provide a clear reasoning pattern leading to the particular chosen components of the conducted empirical research. There is also a need to take a closer look at coherence between the aim of the article (64-65), research questions (61-63), conceptual framework (fig. 2) and research tasks (281-283).
3. There is also doubt what is the article’s aim:
- “The aim of this article is to investigate a conceptual framework for cooperation possibilities in the sustainable medical tourism” (64-65).
- “The purpose of the research is to identify the possibilities of the cooperation improvement in Lithuanian sustainable medical tourism” (270-280).
4. There are two, closely connected research questions (61-63) – but basically one, the second is more of a specification, second-order.
5. Why the authors did not include the local and state authority as facilitators of collaboration in medical tourism? In the research findings such bodies appeared (tab. 2 "State Department of Tourism, municipal tourism centers").
6. In table 2 authors wrote "uncommon activities between facilitators" and in 331st line of text - "common activities between facilitators"?
7. The questionnaire of written interview should be added to the current study.
8. The claim that the article deals with sustainable medical tourism is probably a pretext to present it to Sustainability for publication. I don’t see sustainable perspective in the study and empirical research. This dimension should be truly integrated in the narrative of the article.
9. The efficiency of the authors is a bit amazing/surprising. The research was conducted in March-May and the article was ready to review on 23rd of May. Perhaps it is reason the authors didn't have enough time for deeply analysis of research findings and taking into consideration all essential points in conclusion and discussion - there is lack of the theoretical and practical implication and limitation of research. What is the theoretical underpinning of this current study? Why the research is necessary? What are the theoretical contribution? How does it add to the current knowledge?
Author Response
Response to Reviewer 2 Comments
We are very grateful for your comprehensive and valuable comments again. Please see below our response to your comments.
Point 1: The literature review appears thorough and rich, especially in the part of medical tourism notion explanation. The literature review complement is necessary regarding to issue of the cooperation and its possibilities. There is also a need to define the notion of possibility of cooperation. If there is no enough scientific literature in the field of the cooperation in medical tourism, authors should extend their review to general theory of cooperation in tourism/in tourism destination (e.g. Bramwell & Lane, Jamal & Getz, Beritelli, Żemła, more articles of Czernek).
According to your suggestions we added some new sources such as: Bramwell & Lane; Sonya Graci, Wendt and etc. We also defined the notion of possibility of cooperation.
Point 2: The authors narration does not seem clear. Presented subsections in literature review do not conclude with proposed hypotheses for further empirical endeavor. Thus a fundamental doubt arise with regard to the appropriateness of the chosen factors facilitating the cooperation in medical tourism ("The basis for cooperation is communication, form of work organization, coordination of work, sharing of knowledge and experience..."). The Authors does not provide a clear reasoning pattern leading to the particular chosen components of the conducted empirical research. There is also a need to take a closer look at coherence between the aim of the article (64-65), research questions (61-63), conceptual framework (fig. 2) and research tasks (281-283).
In this article we don’t seek to propose hypotheses and it is not necessary requirement for the article.
The particular components were chosen for the empirical research under researches by Sureka et al., Czernek, Guo et al., Lee et al., Hudson, Wendt and etc.
We took a closer look at coherence between the aim of the article, research questions, conceptual framework, and research tasks and changed the formulation of the first research question. We also tried to prove the purpose of our empirical research. In our opinion we answered to these questions and finally we achieved tasks which we raised in this article.
Point 3: There is also doubt what is the article’s aim: “The aim of this article is to investigate a conceptual framework for cooperation possibilities in the sustainable medical tourism” (64-65). “The purpose of the research is to identify the possibilities of the cooperation improvement in Lithuanian sustainable medical tourism” (270-280).
We agree with your doubts related to this article’s aim and we improved the aim of the article as well we think that now it is more suitable to our study. We left the same empirical research purpose as in our opinion it is suitable and correct for our research.
Point 4: There are two, closely connected research questions (61-63) – but basically one, the second is more of a specification, second-order.
According to your remarks we improved the formulation of the first research question.
Point 5: Why the authors did not include the local and state authority as facilitators of collaboration in medical tourism? In the research findings such bodies appeared (tab. 2 "State Department of Tourism, municipal tourism centers").
We would like to remark that both your mentioned facilitators: State Department of Tourism (this facilitator belongs to the first group of facilitators 238-239) and municipal tourism centres (this facilitator belongs to the second group of facilitators 240 line) are included in our research.
Point 6: In table 2 authors wrote "uncommon activities between facilitators" and in 331st line of text - "common activities between facilitators"?
Many thanks for this remark. It is just a technical mistake and we improved it.
Point 7: The questionnaire of written interview should be added to the current study.
Under the requirements of this scientific journal there is no foreseen to add the partially structured questionnaire of written interview. It should be pointed that our research is based on our research tasks: to find out how the conception of the cooperation is understood in the sustainable medical tourism; to analyse practice of the cooperation and communication between facilitators’ in Lithuania; and to identify the possibilities of the cooperation improvement in the sustainable medical tourism.
Point 8: The claim that the article deals with sustainable medical tourism is probably a pretext to present it to Sustainability for publication. I don’t see sustainable perspective in the study and empirical research. This dimension should be truly integrated in the narrative of the article.
We apologize for your doubts due to our choice to publish our manuscript in to Sustainability journal. We don’t want to agree with your comments about the lack of sustainable perspective in the study. We should point that in 2.1 subchapter “The concept of medical and sustainable medical tourism” we presented a sustainable perspective and also added some new comments related to this topic now. We would like to remark that our empirical research is orientated to the identification of the possibilities of the cooperation improvement in sustainable medical tourism and basic of this research is the cooperation.
Point 9. The efficiency of the authors is a bit amazing/surprising. The research was conducted in March-May and the article was ready to review on 23rd of May. Perhaps it is reason the authors didn't have enough time for deeply analysis of research findings and taking into consideration all essential points in conclusion and discussion - there is lack of the theoretical and practical implication and limitation of research. What is the theoretical underpinning of this current study? Why the research is necessary? What are the theoretical contribution? How does it add to the current knowledge?
In order to explain the efficiency regarding to our research it should be pointed, that our research in general was started last year. The exact time after the comprehensive improvement in the manuscript was indicated time from March- May. We would like to ensure the respected reviewer that we really worked hard and together and in our opinion we had quite enough time for the deep analysis of our topic.
As it was mentioned in a previous paragraphs we added some reviewer’s suggested theoretical and practical backgrounds in the particular field. When we talk about the theoretical underpinning of this study it should be pointed that there are quite limited number of sources related with our topic. Anyway we made a depth examination of the relevant issues with supporting evidence from the case.
The empirical research was necessary to disclose the purpose of our article and to analyse the possibilities of the cooperation improvement in Lithuanian sustainable medical tourism.
It also can be stayed that the theoretical background of our article close contributes with the practical part’s issues. We also improved the discussion and conclusions part of this article and we hope that now are better disclosed the theoretical and practical implications.
We believe that our research can be useful for the future investigations in this field related with the possibilities of the cooperation improvement.
According to your remarks about the essence of our research to the current knowledge it can be pointed that the essence of this research is to find more knowledge (as it was mentioned before there is a luck of such type information and researches) we added to the existing body of knowledge.
Thank you for your comments and suggestions. We truly hope that now our paper looks better.
Reviewer 3 Report
I suggest only to improve conclusions underlining better theoretical and pratical implications.
Author Response
Response to Reviewer 3 Comments
We are very grateful for your comments. Please see below our response to your comments.
Point 1: I suggest only to improve conclusions underlining better theoretical and practical implications.
According to your remarks we improved the discussion and conclusions part of this article and we hope that now are better disclosed the theoretical and practical implications.
When we talk about the theoretical underpinning of this study it should be pointed that there are quite limited number of sources related with our topic. Anyway we made a depth examination of the relevant issues with supporting evidence from the case.
We believe that our research can be useful for the future investigations in this field related with the possibilities of the cooperation improvement.
Thank you for your encourage of the improvement of this manuscript and we truly hope that now our paper looks better.
Round 2
Reviewer 2 Report
Dear Authors,
I'm very grateful for your serious approach to my opinion and comments on your manuscript and improvement of the paper. I agree with your complement the article and responses to my remarks.
