Added Value of Health Tourism and its Potential in Bursa
HB221-236 UDC: 338.486.6
Bursa Chamber of Commerce and Industry Bursa, Turkey
Added Value of Health Tourism and its Potential in Bursa
In the rapidly globalizing world health tourism has gained momentum as exports from the place of origin. Since 2002, our country launched the Health Transformation Program reaching the fast, quality and efficient health service levels in developed countries. Compared to the United States and European countries, more cost-effective provision of quality services has provided our country with advantages. Turkey has now started working on receiving a deserved share in the world health tourism market. Turkey has established a health tourism policy as in many countries that have achieved success in the health tourism. Due to awareness of stakeholders in all sectors, mainly in all relevant ministries, health care providers, travel agencies, accommodation facilities and intermediaries, there has been an increase in patient flow for planned treatment. At this point, activities have started with all stakeholders of the city by showing the citys position in the health tourism with thermal and medical potential and its expert human resources possessed by the historical thermal city of Bursa. The importance of the contribution of the tourism sector to the national economy in terms of Bursa is increasing every day. Bursa, which tries to combine its natural and cultural wealth with service of high quality, in the future will be the city receiving more health tourists. In order to achieve this, development of health tourism service areas, definition of potential by analyzing current situation and development of strategies based on these determinations are important in terms of defining the target destinations.
Key words: Health Tourism, Thermal Tourism, Bursa.
Health tourism is a rapidly growing type of tourism both in our country and around the world. The annual trade volume in the world in this sector is about USD 100 billion and 20 million people are travelling for health tourism. Particularly in the countries of high demand where tourism is spread over 12 months, the development of health tourism which is the most important type of tourism in terms of sustainability of quality of the tourist sector has become an inevitable occasion.
According to the data of the Ministry of Culture and Tourism in average the incoming tourists stay for a week and spend 630 USD in total. However, the foreign patients coming to our country for treatment (medical tourists) stay for 10 days in average and spend 10 thousand USD; the foreign patients coming for rehabilitation stay for a month and spend 7 thousand USD just in the health institutions. Although the number of medical tourists is less than the normal amount of foreign tourists, the amount of money the spent is 10-15 times more than the amount spent by normal tourists.
Turkey has made a significant progress in the field of health tourism in the last 15 years and now is following India, Malaysia, Thailand and Hungary which are considered successful at this sphere. Due to its geographical location Turkey appeals to a population of one billion within a distance of 3-hour flights. At the same time the thermal water acquired from more than 2000 sources in our country which lies on an important geothermal line ranks the first in terms of the source potential among thermal waters in Europe due to its flow rate and temperature and various physical and chemical features, and ranks the third in terms of hot spring applications.
Bursa has a significant potential to become a brand city in the health tourism due to its medical infrastructure and healing thermal resources. As a result of the prominence of Bursa in the health tourism sector, with the increasing number of domestic and foreign people coming to Bursa for treatment and other necessities, the sector which covers medical tourism, thermal tourism / SPA-wellness and third age / disabled tourism will support the economic and social development of Bursa, and thus will contribute that Bursa becomes a city of tourism which can compete both on national and international levels. Besides the foreign currency inflow in terms of economy, it will also create new professions and employment.
2. Health Tourism
Health Tourism is called the travel from the location to another place (domestic or foreign) for to receive service for any health reasons (Diner, 2010).
The health tourism, which is a special type of tourism, has been emerged for the aim of treatment of people by traveling and accommodating in another place outside of the location. The target groups of health tourism are people of weak health and people willing to protect their health (Aydn O. , 2012).
From a different point of view, Health Tourism is Movements of people for to protect the health and for treatment for a certain period of time (usually 21 days) to the tourism facilities based on natural resources to meet the requirements of cure, accommodation, food and entertainment (Boz, 132).
2.1. Types of Health Tourism
2.1.1. Medical Tourism
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Although the health tourism does not have a long history, the history of the medical tourism dates back to many years. The most significant feature of medical tourism in the past is that it is expensive. Therefore, rich patients of poor countries bore the high treatment prices in Europe and America for to receive medical service of higher quality. As the health tourism developed and became popular, the travel between the countries became easier and thus the medical tourism has developed.
In this way, the flow of patients is no longer to developed countries from undeveloped countries, but to developing and undeveloped countries from developed countries (Reisman, 2010).
Indeed, the medical tourists can be of any age and are recently mostly old or retired people belonging to European and developed countries. The main reason of these tourists traveling from such countries as America and the United Kingdom to other countries to receive medical treatment is that medical treatment in their own countries is expensive and the waiting list is very long (Smith & Puczko, 2009).
2.1.2. Thermal Tourism
Water is seen as the oldest treatment and relaxation tool used in the world. Conceptually, spa (a Turkish word) is derived from the word indoor spa (a facility built). Ilca means hot water source. The Latin word of thermal is a word from the Romans and spa is the synonym. In Rome, grand spa resorts were named as Terme. ermik is a word using in certain areas in colloquial speech, means bath in Persian. (Karaglle, 2014)
2.1.3. SPA-Wellness Tourism
Wellness: It is the activities that people make to become healthier, to improve performance, to live longer and raise their quality of life. The word was created by combining the prefix and suffix of well-being and fitness concepts.
Wellness is a lifestyle philosophy based on improving the body, spirit and mind balance.
SPA (Salus Per Aquam): SPA is derived from the initials of the Latin Salus Per Aquam meaning health through water. This term has been used since the Roman time till today for the body care and treatment where thermal or sea water is used mainly (Ycel, 2003).
It represents health obtained through using water. It is used as a meaning of complementary treatment having a sense of relaxation and relief obtained by applying water: hot, cold and various types. It includes all applications that can be done with water.
People are searching the ways of relaxing physically and mentally by getting rid of busy work environment and stressful living conditions. SPA is a whole set of services including health and sport industry which cannot be limited as per climate conditions (Sekliuckiene & Lang-viniene, 2009).
General SPA applications are performed as balneotherapy (therapy with spring water), hydrotherapy (water therapy), thalassotherapy (therapy with sea water), thermal mud baths, etc. (zbek & zbek, 2010).
2.1.4. Disabled and Third Age Tourism
The proportion of rapidly aging population in our world is increasing over time in the total population. Today the generation above 50 years of age is better educated and fit as they are aware of the preventive health care. Their economic indicators are constantly developing. Therefore, they are more active and are more interested in luxury services than before. When free time due to retirement is also included, the third age group constitutes an excellent market for tourism.
In particular, in the last 20 years the share of third age tourism increased in the group of health tourism due to the above-mentioned economic developments in Europe (Aydn, Constantinides, Mike, Cemal Ylmaz, & Lanyi, 2012).
Projections of the United Nations declare that after 35 years population above 60 years of age will be about 2 billion, that this number will be higher than population of children (0-14 years) and that the rate of people at the age of 80 years and above will rapidly increase in the category of the elderly (Ritchie, Neil, & Cooper, 2003).
With the existing capacity and health tourism strategy our city plans to establish fully-equipped Third Age living centers with health facilities providing comfortable and safe health service, thermal hot springs-SPA wellness, hiking trails, sports and anti-aging centers. The projects developed in this field are being examined. Thanks to the planned projects Bursa will become a world health tourism center where patients will have thermal physical therapy with 7, 14, and 21-day stay.
2.2. Factors developing the Health Tourism:
The following factors are effective in the emergence and development of health tourism:
Advantages of being treated in the countries with different and advanced technological infrastructure and scientific data are expanded,
Significant savings in treatment of acute diseases,
Expansion of opportunities for people to receive better quality treatment in another country other than health service in their own country,
Search of alternatives because of the problems people experienced with their health insurances,
The will of people to receive the procedures during their treatments,
The desire of patients and their companions to combine some touristic activities while being treated,
Increase in awareness-raising activities in health tourism as transportation and technological opportunities increase, and transportation costs decrease (Diner, 2010).
3. Added Value of Health Tourism:
The number of countries that do their best to improve health tourism is increasing every day. Success of health tourism in Asia raises the global interest and competition and this seems unstoppable. For example, although Singapore is a destination with relatively higher costs in terms of thermal tourism, it aims to attract 1 million patients that are expected to bring in an amount of 1, 8 billion $. If this goal is achieved, it will create new jobs for at least 13,000 people in the country.
Dubai has created a new Health City to prevent tourists of the Middle East from visiting Asia and Europe (z, 2014).
Until 2017, 23 million patients from the USA are expected to visit various countries for health tourism, and their expected expenditures will make 79.5 billion dollars.
Health tourism is observed to grow 35% per year and turnover of this sector is estimated to be 100 billion USD / year.
The top 5 countries receiving tourists in terms of health tourism are Panama, Brazil, Malaysia, Costa Rica and India. On the other hand, the European countries have begun to acquire a significant share of medical tourism using advantages of the European Union membership.
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Hungary is one of the leading countries in health tourism with an annual income of 2 million $ only for dental treatment. In addition, Belgium has a significant share of the sector in terms of aesthetic surgery and obesity treatment.
Developed countries tend to use the relaxing properties of thermal waters, climate and environmental opportunities along with any other tourism types to protect human health, to increase labor productivity and to ensure healthy living. In fact, medical tourism, which is a sort of health tourism, is growing day by day and includes applications of people to hospitals, clinics or similar health institutions for both treatment and aesthetic purposes (Aydn O., 2012). Thus, health tourism does not only cover thermal tourism or SPA tourism, but medical applications as well (bi, 2009).
4. Health Tourism in the World
Health is an important factor that leads people to international tourism movements. As we mentioned earlier, the trading volume of health tourism is said to be 100 billion dollars / year. This trading volume is performed by 22 million health tourists. Taking into consideration potential and development of medical tourism in the world, it is stated that its importance will increase in the coming years and that there will be an environment of global competition (Aydn, Aypek, Aktepe, & ahbaz, 2011).
According to the data of the World Tourism Organization (WTO), the number of tourists in 2010 was 980 million. This figure has reached over 1 billion in 2011 with an annual growth of 3.5%.
Turkey was ranked 7th in 2010 with 27 million tourists among the world tourism destinations, and in 2011 increased to 6th with 29 million tourists. However, when evaluated in terms of tourism revenues derived from the movement, Turkey cannot be among the countries on the top (World Tourism Organisation/WTO, 2012).
Many centers in the world (Karlovy Vary in Czech Republic, Baden-Baden, Germany, Heviz - Hungary, etc.) have been marketed as thermal, SPA center / destination for long years. It is possible to add the destinations of thalassotherapy using seawater in recent times.
5. Health Tourism in Turkey and the Country Policy
Turkey, especially in the past 20-year period has achieved a significant growth in health tourism and today began to compete with such countries like Hungary, India, Malaysia, Thailand, which are the most successful countries in the world as per the health tourism. Thus, Me-dRetreat, indicated as the most reliable medical tourism company of the United States, indicated India, Thailand, Malaysia, Brazil, Argentina, Turkey, North Africa as both exotic destinations and places to get quality medical services. The most important factors for selection these countries are their being the most corporate, experienced and high-quality service providers in the international medical tourism sector (Connel, 2006).
Our countrys hospitals and developed health institutions and infrastructure equipped with advanced technologies, trained doctors and health professionals such as qualified human resources in medical tourism are the essential elements for to make Turkey to enter the top 5 in the world ranking
5.1. Ministry of culture and tourism of the Republic of turkey, turkeys tourism strategy (2023)
Establishment of alternative tourism-oriented (health and thermal, golf, winter sports, nature tourism, etc.) cities which may be presented with different sectors such as health, education, etc., by providing the integration of indigenous, different types of tourism with each other (T.C. Kltr ve Turizm Bakanl).
5.1.1. the tourism Diversification Strategy
Developing health tourism and thermal tourism, winter tourism, golf tourism, marine tourism, eco-tourism and mountain tourism, congress and fair tourism initially among alternative tourism types
Spreading the tourism season on all year depends on the diversification of the tourism product; in this context development of the types of tourism identified will be provided as priority (T.C. Kltr ve Turizm Bakanl).
5.1.2. Regions where Existing tourism Areas Will Be Improved
Integration of health and wellness units such as thalassotherapy to the existing firms will be provided (T.C. Kltr ve Turizm Bakanl).
5.2. Ministry of Health of the Republic of turkey, Strategic Plan 2013-2017, Strategic Aim and Objective
The aim is to continue to improve the health care system as a means of contributing to Turkeys economic and social development and global health; and the objective is to strengthen the health tourism in Turkey (T.C. Salk Bakanl).
To make a promotion within the scope of health tourism and to create attraction
To improve quality of services delivery covered by health tourism
To expand the scope of health tourism services
To improve governance of health tourism (T.C. Salk Bakanl)
5.3. Ministry Of Development of the Republic of Turkey
5.3.1. Health tourism in turkeys tenth Development Plan
Turkeys Tenth Development Plan 2014-2018
Purposes and Scope of the Program
In parallel with receiving medical treatment, using thermal sources, increasing rehabilitation services and services which enable people to feel them good and healthy, health tourism offers an important opportunity considering the potential of our country.
Through this program, enhancing the competitiveness is intended by increasing quality of services in medical tourism, thermal tourism and elderly-disability tourism in which Turkey is in the position of emerging market around the world.
Objectives of the Program
Establishment of 100,000 beds in thermal tourism
Providing service to 1,500,000 (600,000 therapeutic) foreign thermal tourists in thermal tourism
3 billion dollars of revenue in thermal tourism
Being in the worlds top 5 destination for medical tourism
Treatment of 750,000 medical patients
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5.6 billion dollars of revenue in medical tourism
Establishment of 10 thousand beds in the elderly tourism
150,000 foreign tourists visiting our country in the elderly tourism
Obtaining 750 million dollars in elderly tourism (T.C. Kalknma Bakanl).
5.4. Ministry of Economic of the Republic of Turkey
Under notification Supporting the Service Trade of Foreign Exchange Earning published in 2012 by the Ministry of Economic, supports for development of health tourism could be summarized as follows:
Support for access to the market
Overseas promotional support
Overseas unit support
Trade mission and reception committee supports
Advisory support (T.C. Ekonomi Bakanl).
6. Potential of Health Tourism in Bursa
Bursa is a city of healing as a historical background. When you go back to the 5th century Bursa, you witness the ekirge Spas referred with the name of Byzantine empress Theodora, and to the fact that Suleiman the Magnificent got treatment in Kkrtl Spas in the 16th century. Bursa is a 1500 year-old city of thermal. Thermal history of our province city brand was registered with membership in the European Historic Thermal Towns Association (EHTTA).
Bursa offers high quality and more economical healthcare services. It became an important health tourism center of health and tourism investments in recent years. Bursa is the health base of its region with 43 hospitals (4 of them are JCI accredited hospitals), 4,000 medical doctors and 18 thousand health personnel. While our market share in health tourism has been increasing with each passing day, we see that some branches of the fore. Particularly in IVF (In Vitro Fertilization), Physical Therapy and Rehabilitation, Eye, Plastic Surgery, Dental, Cardiovascular Surgery, Orthopedics, Neurosurgery, Organ Transplantation fields, its a challenging center.
Thermal treatment is carried out in the Uluda University Atatrk Research and the Practice Rehabilitation Center, in Military Hospital of the Ministry of National Defense and two private centers.
Our city has very rich geothermal potential and therapeutic thermal water with a high mineral content. To maintain its competitiveness in this area and the thermal city identity, it has been inevitable to establish a thermal cure park-cure center which transforms the thermal water to treatment with scientific medical treatments. In this regard, the Governor of Bursa, the Metropolitan Municipality, BUSAT and BTSO have launched studies. Establishment of the Thermal Cure Center will be reflected to the longer stays in our hotels. A thermal cure center and a cure park beside will make Bursa the new thermal tourism destination in the world.
Beside medical and thermal potential of Bursa, natural and cultural features are also of great importance. We can let the health tourists visiting our city for treatment to experience other tourism diversities as well. As a result, thermal and medical tourism, religious tourism, cultural tourism, ski tourism, historical tourism, marine tourism can be experienced in Bursa.
6.1. Why Bursa is in Health Tourism?
Thermal Historical Background
Expert physicians and medical personnel
Acquired experience in thermal treatment
Health facilities with advanced technology
7 different sources and total of 300 liter/sec geothermal capacity with the works of Jeotermal A..
Availability to different and alternative tourisms with history and green fields of the city.
The rapid rise of Health and Tourism Investments in the city in recent years
Urban Dynamics and Sensitivity of Public Opinion
Significant geographical position of the city (Proximity to stanbul)
The preferred destination of Bursa because of its geographical and cultural proximity to the Balkans, the Middle East, the Russian and Turkish Republics
7. Conclusion and recommendations
2 million foreign patients and $ 20 billion of foreign exchange flow are intended for the 2023 targets of our country. At the advanced age tourism, 10 thousand bed capacity, 150 thousand old, foreign tourists and income of USD 750 million were targeted for 2023.
Turkey is a fertile area for planned therapeutic patient flow with its geographic location and strategic geopolitical location. European continent with population of 740 million is growing older and the average of age rises to over 20% of most countries across the continent. The Russian Federation with its population of 143 million and $ 1 billion patient output annually is another supply deficit focus and patient potential with the age average of 39 and 18% of elderly population.
As a result, health tourism has taken place in the strategic action plan in the Ministry of Health particularly, and the Ministry of Culture and Tourism, Ministry of Economy, Ministry of Development.
7.1. suggestions for Development Health tourism in turkey
For development health tourism in Turkey:
Activities to support the creation of new thermal plants concept in potential cities such as Bursa which are more developed than the ones in Germany and France.
Ensuring communication with patient via conference by private health institutions on the condition of operating time of the foreign patient call center established within the Ministry of Health.
Foreign language and communication skills training should be made for staff working at the health and accommodation facilities in Turkey.
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Intermediate labor force should be supported by training in such areas as reception, accompaniment, billing needed for both medical and thermal tourism.
In order to create confidence in health facility and health services that patients will receive, to form the private health tourism insurance policy which will be paid by the health service provider; these health insurances promoted by the government in the early years by one or several insurance companies organized on international level will increase the brand value of Turkey. This insurance policy should also contain complications that may arise after treatment. So tourists will be able to receive treatments of complications free in their own country if required or in the country they had the treatment.
Leading provinces of health tourism in Turkey should be determined by the Ministries and support should be given in promotion
7.2. Suggestions for Development Health Tourism in Bursa
For development health tourism in Bursa:
1.1. Large scale integrated thermal cure center-cure park and establishment of accommodation facilities:
a. Approximately 150 decares of hot water in the context of urban renewal in the city center
b. Yenice Mountain Region: 7,5 km from the city center, 1,006 hectares area
1.2. Establishment of a comprehensive mineral spring center (such as Vichy, France)
1.3. Establishment of a Thermal Museum
1.4. Carrying out feasibility studies for establishment of 3rd Age Life Center
1.5. Determination of effective and efficient strategies for international promotion
1.6. Making educational planning to train intermediate staff speaking foreign language
1.7. Carrying out feasibility activities for establishment a Thalassotherapy Centre on Mudanya and Trilye coasts.
1. Aydn, D., Aypek, N., Aktepe, C., & ahbaz, P. (2011). Trkiyede Medikal Turizm. Ankara: Salk Bakanl Salk Hizmetleri Genel Mdrl.
2. Aydn, D., Constantinides, C., Mike, C., Cemal Ylmaz, A. G., & Lanyi, A. (2012). Salk Turizminde Sreler ve Arac Kurulular Aratrma Raporu.
3. Aydn, O. (2012). Trkiyede Alternatif Bir Turizm; Salk Turizmi. KM Sosyal ve Ekonomik Aratrmalar Dergisi, 91-96.
4. Boz, M. (132). Turizmin Gelimesinde Alternatif Turizm Pazarlamasnn nemi.
5. Connel, J. (2006). Medical Tourism: Sea, Sun, Sand and Surgery. J. Connel iinde, Tourism Management , 1093-1100.
6. Diner, M. Z. (2010). Dunyada Ve Trkiyede Salk Turizmi-2010 Durum Tespit Raporu ve zm nerileri. Trkiye Salk Vakf ve Salk Dernei.
7. bi, S. (2009, Temmuz 17). Turizm Haberleri. Mart 20, 2015 tarihinde http://www.turizmhaberleri.com: http://www. turizmhaberleri.com/koseyazisi.asp?ID=1135 adresinden alnd
8. z, O. (2014). Salk Turizmi Kapsamnda Medikal (Tbbi) Turizm Ve Trkiyenin Olanaklar. O. z iinde, Salk Turizmi Kapsamnda Medikal (Tbbi) Turizm Ve Trkiyenin Olanaklar, 2257- 2279.
9. Karaglle, Z. (2014). Termal Turizm. (A. Uyar, Rportaj Yapan)
10. zbek, D., & zbek, T. (2010, 11 10). JeotermalKaynaklarn Salk ve Termal Turizme Entegrasyonu. 03 25, 2015 tarihinde www.jmo. org.tr: http://www.jmo.org.tr/resimler/ekler/40222ade2401c27_ek.pdf?dergi= HABER%20B%DCLTEN%DD adresinden alnd
11. Reisman, D. (2010). HealthTourismSocialWelfare Through International Trade, Edward Elgar Publishing, Cheltenham.
12. Ritchie, B. W., Neil, C., & Cooper, C. P. (2003). B. W. Ritchie, C. Neil, & C. P. Cooper iinde, Managing Educational Tourism, 84.
13. Sekliuckiene, J., & Langviniene, N. (2009). Service Perspectives in Health and Sport Tourism in Lithuania: Case of SPA. J. Sekliuckiene, & N. Langviniene iinde, Economics & Management, 505.
14. Smith, M., & Puczko, L. (2009). Health and Wellness Toursim. Elsevier Press, 150.
15. T.C. Ekonomi Bakanl. (tarih yok). Dviz Kazandrc Hizmet Ticaretinin Desteklenmesi. Mart 17, 2015 tarihinde www.ekonomi. gov.tr: http://www.ekonomi.gov.tr/portal/content/conn/UCM/path/Contribution%20Folders/web/Hizmet%20Ticareti/ Sekt%C3%B6rler%20ve%20Destek%20Programlar%C4%B1/01.D%C3%B6viz%20Kazand%C4%B1r%C4%B1c%C4%B1%20 Hizmet%20Ticaretinin%20Desteklenmesi/02.Destek%20Mevzuat%C4%B1 adresinden alnd
16. T.C. Kalknma Bakanl. (tarih yok). T.C. Kalknma Bakanl Onuncu Kalknma Plan 2014-2018. Mart 16, 2015 tarihinde www. kalkinma.gov.tr: http://www.kalkinma.gov.tr/Lists/Yaynlar/Attachments/518/Onuncu%20Kalk%C4%B1nma%20Plan%C4%B1.pdf adresinden alnd
17. T.C. Kltr ve Turizm Bakanl. (tarih yok). Trkiye Turizm Stratejisi 2023 Eylem Plan 2007-2013. Mart 18, 2015 tarihinde www. ktbyatirimisletmeler.gov.tr: http://www.ktbyatirimisletmeler.gov.tr/Eklenti/906,ttstratejisi2023pdf.pdf?0 adresinden alnd
18. T.C. Salk Bakanl. (tarih yok). T.C. Salk Bakanl Stratejik Plan 2013-2017. Mart 19, 2015 tarihinde www.sgb.saglik.gov.tr: http://www.sgb.saglik.gov.tr/content/files/stratejikplan20132017/index.html adresinden alnd
19. World Tourism Organisation/WTO. (2012). UNWTO .
20. Ycel, C. (2003, Eyll). www.tursab.org.tr. Mart 20, 2015 tarihinde Trkiye Seyehat Acentalar Birlii: http://www.tursab.org.tr/ dosya/1019/03eySPA_1019_1740531.pdf adresinden alnd
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