INTERNATIONAL CONFERENCE

MANAGEMENT, LEADERSHIP AND INNOVATION

TOWARDS A BETTER CHANGING WORLD

ROMANIAN-AMERICAN UNIVERSITY, Bucharest, Romania

2 nd – 3 rd of November 2017
Balneary tourism face to face with
medical tourism - a comparative
exploratory research

phd. student Florența Larisa ILE

Bucharest University of Economic Studies, Romania

prof.phd. Gabriela ȚIGU

Bucharest University of Economic Studies, Romania
Our research is based on semi-structured interviews undertaken with
managers of the tree balneary tourism industry in september 2017.

They are representing companies based on traditional spa treatment

(before 1989) and which now have partially changed the orientation to
the wellness industry, sustained by investments in new or renovated
hotels.

Their products have been updated to the new trends in spa tourism
industry but still need many efforts to become efficient.

Their companies still have as major clients segment the seniors looking
for treatment financed completely or in fraction by National Social
Security Fund.
The balneary tourism as a form of health tourism is placed
between wellness and medical tourism.

The limit of these tourism forms is difficult to establish,

considering that frequently there are different opinion regarding
the demarcation and assigning of specific health tourism
services for each type.

If the balneary tourism could be considered generally a medical

tourism form, then, it`s business model could be useful for
tourism companies performing in this field.

We try to aware about the development of balneary tourism in

the light of the medical tourism business model.
1. Short history of the medical tourism

The Sumerians, in 4000 b. Chr., built a place for healing around a thermal
spring, visited by many travelers for its healing properties

In Japan, people have travelled for over 1000 years for medical purposes
to the “Onsen” mineral springs,

Ancient Romans built resorts with thermal health spas, and therapeutic
temples

Ancient Greeks traveled to the sanctuary of the healing god, Asklepios, in

Epidauria - the most famous healing center in the antique world, the place
where sick people went, hoping to heal. There are also some mineral
springs in the neighborhood that could have been used in the healing
process.
Today, Epidauria is considered the birthplace of medical tourism.
Early the 16th century, Europe became a destination for medical tourism,
due to roman baths or spa.

In the 1900, USA and Europe became medical centers of major interest,
but only for rich persons

In the 80’s –90’s travels for aesthetic surgical procedures and dentistry
appeared.

Today, medical tourism, despite its ancient existence, became the newest
phenomena, with an accelerate expansion.

The report issued by VISA and Oxford Economics (2016), estimate the
medical tourism industry:
• to growth up to 25% year-over-year for the next 10 years
• 3 - % of the world’s population will travel internationally for healthcare and
health-related treatment.
• the medical travel market could rise to an astronomical USD 3 trillion by
2025.
 2. What is medical tourism? Definitions

On the 9th National Conference on Health Economy held in

Rostock/Germany in 2013, the health tourism has been defined as „the
branch of health and tourism economy that contributes to maintaining
and restoring health and well-being in particular by using validated
medical services”.
The health tourism is considered to by the umbrella of medical
tourism and wellness tourism
Medical tourism is considered a trip outside person’s place of residence
for the purpose of receiving a medical treatment, investigation or
therapy, the tourists making use of destination’s infrastructure,
attractions and facilities (Smith and Puczko, 2014)

Medical tourism is not only a journey in order to improve health, but it

is an economic activity implying service trade, representing a merge
of at least two economic sectors: tourism and medicine (Bookman
and Bookman, 2007).
 What is not medical tourism?

Medical tourism in not a medical travel

Medical travel involves just a single purpose of travelling, the medical

treatments, interventions and therapies (Smith and Puczko, 2014). In this
situation, the travellers does not value the destinations in a touristic
meaning, even they are using the accommodation and transport
facilitations.

Medical travel is the process by which a consumer (a patient) gets

treatment for a medical condition. Treatment is nearly always invasive. It
includes dental implants, fertility treatments, alternative or experimental
procedures, addiction treatment, Lasik eye surgery, cancer therapies, as
well as major surgery procedures (Munro, 2012)
 Fig. 1 The balneary tourism position
Sursa: Iordache, Sarbu, Ciochina, 2016

There is not a firm description of health tourism based on natural

treatment factors (balneary tourism), but is accepted that refers to
travel being motivated by performing a medical procedure or
activities based on using water in order to promote physical and
psychical welfare. (Iordache, Sarbu, Ciochina, 2016)
Source Smith, M, Health, Wellness and Spa Tourism: Typologies and trends http://slideplayer.com/slide/10164580 retrieved on 31.10.2017)
 3. The driving factors for medical tourism at the country level
•private and state investments in the
infrastructure of the health system,
•international certification and
accreditation
•an international patient flow,
•lower costs of medical services,
•political and social stability,
•excellent tourism infrastructure,
•good reputation & clinical excellence,
•proofs for the history of medical
achievements,
•successful implementation of best
practices and of newest medical
technologies,
•highly educated medical personnel,
•insurance policies covering across
borders (portability)
•internationalization of the medical
workforce
•trade liberalization (the EU 2011
Directive for cross-border medical
services)
•lower air fares and the air companies
policy regarding the medical tourism
(Turkish Airlines, Lufthansa)
•development in information technology
(the internet impact in marketing)
•the medical or tourist visa policy
 Factors of demand for medical tourism

•the lower cost of medical procedures

•high level of medical technology and
•the partial coverage of health
insurances (or no insurance) equipments,
•the waiting lists, •proficiency of medical staff,
•the availability of medical services, •the increasing of personal income
•the good level of quality of care •the tendency for raising the travel
•the possibility to combine a leisure
spends.
journey with satisfying medical needs,
•the geographical nearness,
•willingness to travel
Trends in demand for medical tourism

Cultural Affinity (no barrier language and the same religion and traditions)
Distance (the nearness is very important as geographical characteristics)
Country specialization (travelling for fertility, esthetic, dentistry, orthopedic, ophthalmology,
etc)
The medical reputation (concerning problems that may arise when traveling for medical
care)
The requirement of after care medical services including a local medical partner or
telemedicine

The global aging (by 2025, travelers aged 65+ will more than double their international
travel to 180 million trips)
The results of semi-structured interviews

By medical tourism the responders understand the travel for an

invasive medical procedure: esthetic, orthopedic, dentist, bariatric, etc
They agree about the necessity of international accreditation and
certification
For the balneary spas it is compulsory to have better trained staff to
take care of tourists (basic medical knowledge, foreign languages
skills, etc )

They understand the wellness and recreational aspects and militate

for investments in this area.

The prevention become more important and must awareness it

amongst the population

50% of most balneary offer is concetrated of medical treatment and

reabilitation , 10% of prevention, 30% relaxation

The separation of flows between wellness is an common issue of spas

Typology of baleneary
tourism activities Main activities
for balneary
tourism
(medical
tourism
complementary products)
activities
(wellness
Activities for
products)
cooperation
(medical
travel
purpose)

Sursa: adaptare dupa Smith M., and Puczkó L. (2009) Health and Wellness Tourism . Oxford: Butterworth-Heinemann
 National
Social
Insurance
Fund

Doctor

personal
Patient/tourist
payment
Balneary spa
treatment

Travel
agency

National
accreditation

The current process of getting balneary treatment

Implementing the medical
Transport
tourism business model
facilities
suppose
Facilitator/
medical tour
operator Tele medicine/
e-health

Balneary Special trained

Medical staff to take care
Medical
tourist of every individual
concierge

Insurance
coverage

Prevention/
personal
Treatment/
After care payment
surveillance Complementary
activities National
Social
Tele medicine/ Insurance
e-health Fund
Changes & chalenges

• Excellent strategy and facilities for foreign and

national investments
• Medical achievements popularization
• Tourism sustaining orientation
Government • International travel sustaining (visas, frontiers,
airfares facilities)
• Assuming the concept of country specialized in
healing by water therapies
• Cross border EU Directive publicity (2011/24/EU)
• Extension of coverage by national insurance system

• DMO of the balneary/medical tourism (regional

and/or national)
• Regional medical tourism clusters: companies
acting in related fields (spa resorts, medical
Organizational hotels, air and ground transport, hospitals,
doctors, clinics, pharma, etc) education
institutions, local and regional authorities,
consultants, etc.
 Cooperation
B
with medical tour operators and facilitators
a with airlines companies
l with hospitals and clinics engaged in invasive medical tourism
n
e Products and Innovations
After care protocol
a
Tele medicine and e-health apps for pre, during and after treatment
r Personalization
y Differentiation and specialization (the unique value)

Market
Position on the market as seller of healthcare
c
Focus on solving a tourist problem not on the global spa offer
o Get international accreditation and certification
m
p
Staff
a • Eliminating the language barrier
n • Acting as a medical concierge (dedicated team)
y • New care specialists
• Animators specialized for medical tourism
Conclusions

The medical tourism will change from medical invasive

procedures to personalized treatments, alternative procedures,
anti-aging therapies, etc.

The spas will be more visible and will act differentiate in each
country based on the category or quality of natural healing
resources.

The management and marketing of the balneary spas should

be adapted to medical tourism business because of the
similarities of the influencing factors and the changes in
demand.
Thank you!