Author: Medical Tourism Magazine
According to the World Health Organization (WHO), health is “a state of physical, mental and social well-being and not merely the complete absence of disease or infirmity.” In accordance with this definition, wellness can be equated with health. Health and wellness involves several well-being dimensions including physical, mental, social, sexual, emotional, cultural, spiritual, educational, occupational, financial, ethical and existential dimensions.
This article represents an attempt to develop an understanding of current health and wellness tourism around the world. The aims are to:
- clarify concepts because of the usual incipiency and lack of conceptual rigor regarding health and wellness tourism;
- qualify procedures and patient safety as crucial factors;
- importance of destination branding.
Brief History: Health and Wellness
Past ancestors: Ayurvedic Medicine (India, 3000 BC); Chinese Medicine (Emperor Sheng Nung, 2038–2698 BC); Thai Traditional Medicine; Japanese Onsen; Russian Steam Bath; Tell el Amarna Therms (Egypt, 1350 BC); Greek Thalassa (Hippocrates, 460–355 BC); Roman Thermae/Balnea Publica (II BC–III AC); Arabian Medicine (8th-15th century, Al Razi 850–923); Turkish Haman; Dead Sea Salts Baths; Egyptian Mansuri Hospital (Cairo, 1248) – Travellers came from all over the world; Native American Sweat Lodge; Mexican Temazcalli; Australian Aboriginal Steam Baths; Mineral Springs in Spa near Liége (14th); Climatotherapy (XVIII/XIX Centuries) in Madeira and Canarias Islands; Scientific Medicine (19th century).
Recent years: 1959 – Inauguration of Golgen Door Spa, in California; 1987 – Official beginning of the Global SPA industry – SpaFinder Magazine; 1991 – International SPA Association – ISPA (USA); 1996 – European SPA Association
In health and wellness tourism, quality/excellence, safety and ethics are deeply connected.
– ESPA (Brussels); 1998 – Guide of the 100 Best SPAS of the World; 2003 – Spa Asia Magazine; 2007 – Medical Tourism Association – MTA, USA; 2007 – I Congress on Medical Tourism Worldwide, Munich; 2008 – I International Health Tourism Congress, Turkey – Association of Improving Health Tourism; 2008 onward — Congress took place in different cities in Turkey; 2008 – First Annual World Medical Tourism Association Congress; 2008 onward — Congress took place in different cities in USA; 2010/2012 – Annual European Medical Travel Conference (EMTC) – Venice, Barcelona, Berlin; 2012 – I International Conference on Health and Tourism, Faro, Portugal; 2013 – International Medical Travel Exhibition and Conference, Monaco; 2014 – II International Congress on Health and Tourism, Albufeira, Portugal.
Emergent Paradigms on Health and Medicine
Preventive Medicine – promotes healthy lifestyles and diets, stress management, intellectual stimulation and fitness with a focus on wellness assessments versus illness.
Predictive Medicine – individual health promotion based on diagnostics of genetic and environmental determinants.
Holistic Medicine – whole-being, meaning physical well-being, mental awareness and wisdom, spiritual harmony and equilibrium.
Integrative Medicine – brings together orthodox Western medicine/Allopathic and other Eastern holistic medicines – Chinese, Ayurvedic and Indigenous knowledge and environmental consciousness. Integrative medicine emphasizes wellness, wholeness and a preventive approach to health. Western medicine is based on an illness model concerned with treating disease rather than enhancing wellness.
Anti-Aging – medicine that combines all those preceding paradigms.
Definition: Health and Wellness Tourism
Health and wellness tourism includes travelling both nationally and internationally to places and facilities, such as hospitals, clinics, thermae, thalasso, wellness SPAs, and fitness centers and wellness resorts.
In 2012, it was estimated that a million medical tourists travelled around the world for outbound/ inbound medical tourism.
The purpose of health and wellness tourism is medical care and health, beauty, relaxation, recovery and rehabilitation treatments. There are more than a hundred-million health and wellness tourists around the world each year. Health and wellness tourism includes medical tourism, elderly age tourism, disability tourism, thermal tourism and thalasso-therapy tourism.
Wellness tourism includes consumers who travel to maintain their well-being and life satisfaction through the experiences of healthy treatments. Wellness has to do with quality of life. In a holistic approach to health (Chinese, ayurvedic and integrative medicines), wellness treatments and therapies restore the vital balance among bodies, mind, and spirit toward equilibrium and health harmony. This harmony re-balances and restores the energy flow bringing about overall well-being.
Health tourism refers to patients who travel nationally or internationally for healing therapies in hospitals and clinics. Health tourism includes medical tourism, aesthetical/plastic tourism, thermal tourism and thalassotherapy tourism.
Medical tourism involves travel to hospitals and clinics for medical treatments in different areas including cardiology, gynaecology, neurology, ophthalmology, oncology, orthopaedic, transplants, preventive medicine, artificial insemination, anti-aging medicine and plastic reconstructive medicine. Medical tourism is also known as medical travel, health tourism, health travel, healthcare tourism, healthcare abroad, medical overseas, and overseas medical.
Medical tourism has two components: inbound and outbound. In 2012, it was estimated that a million medical tourists travelled around the world for outbound/inbound medical tourism.
Medical tourism is a $100 billion global industry. The most important destinations include Argentina, Austria, Belgium, Bolivia, Brazil, Chile, Colombia, Costa Rica, Cuba, Cyprus, Czech Republic, Dubai, El Salvador, France, Germany, Greece, Guatemala, Hungary, India, Israel, Jordan, Malaysia, Mexico, Philippines, Poland, Singapore, South Africa, South Korea, Spain, Sir Lanka, Thailand, Tunisia, Turkey, United Arab Emirates, Venezuela and Vietnam.
Aesthetical tourism includes aesthetic surgery and treatments. In aesthetic/plastic tourism, the most important countries are the United States and Brazil. Other destinations are Argentina, Austria, Belgium, Bolivia, Costa Rica, Cuba, France, Germany, Greece, Hungary, Italy, Poland, South Africa, Spain, Tunisia, Turkey, United Arab Emirates and Venezuela.
Quality/Excellence and Safety
Within the scope of healthcare, the quality of procedures and patient/client safety is strongly connected. Quality is the level of excellence ensured by a continuous managerial system.
Safety is the condition/state of being secure from hurt/ injury and aims to prevent accidents and contagious diseases. It includes protective devices to prevent hazardous accidents and nosokomeion diseases.
Quality/Excellence and Main Safety Components
Safe Environment – air quality; water quality; reduced noise and visual pollution; free of radiation pollution (magnetic, electric, nuclear…); natural or recreated pleasant landscape – healthy trees, bushes and flowers.
Architectonic Requirements – Modern and pleasant-looking healthcare facilities that enable the fast physical, mental and spiritual well-being of patients and that makes their relatives and visitors rest and relax.
The main architectonic requirements are operating rooms located in sterilized areas; lounges designed as living rooms and libraries; assuring safety, patient well-being and reduced time in integrated examination rooms on the same floor; special architectural design that allows optimization of patient flow within the hospital and aims to prevent infections; floors, walls and ceiling materials must be easy to clean and disinfect; walls painted with soft colors, such as blue, green and pink; natural lighting and ventilation; and healthy plants.
Medical tourism hospitals must have a specialized staff which can speak different languages fluently, namely the official voice of the patient’s country.
“A new generation of healthcare facilities is emerging that is very different from familiar institutional models. Based on patient-centered care and healing the whole person, these health centers are spiritual sanctuaries with gardens, fountains, natural light, art and music. Research is learning how human emotions are linked to disease and that healing is promoted by surroundings that reduce stress and engage the senses in therapeutic ways.” – Jain Malkin
Hotel Structure and Services
The hospital (hospital like a hotel) requires healthcare humanization; beautiful lounges; several restaurants and cafeterias; shops; exhibition galleries; musical concerts; conference halls; containing simultaneous translation systems; and catering and laundry facilities specializing in the healthcare sector.
“A hospital is primarily a hotel in which health services are provided.” – Acibadem, Turkey
Technological Accuracy/Modern Technology
The latest international technology is put into service including accurate diagnosis equipment; a fully equipped digital radiology department; accurate radiotherapy treatments; cyber-knife; robotic surgery systems; advanced cardiology, ophthalmology and orthopaedics diagnosis; treatment equipment; and organ transplants.
Professional Healthcare Qualifications: Surgeons, Doctors and Others
Professional staff includes a high-qualified board of internationally certified surgeons and doctors specialized in different medical fields; highly qualified anaesthesiologists; qualified nurses; and others health professionals.
Multi-Language Staff Communicating Skills
Medical tourism hospitals must have a specialized staff which can speak different languages fluently, namely the official voice of the patient’s country. Good communication is very important to the safety and well-being of patients and their relatives.
Hospitals and clinics develop protocols with universities/ colleges and research centers. Turkey, Acibadem is affiliated with Harvard Medical International and Anadolu Health Center with John Hopkins Hospital.
It is very important that patient-centered healthcare include a warm and tender environment; attention to each individual patient’s needs; respect of cultural roots, alimentary traditions and religious beliefs; and patient participation in musical and theatrical groups.
Accreditation and Certification
In medical/aesthetical tourism, it is important to attest to the excellence and safety of healthcare services for clients from other countries. The most important international accreditation institutions are the Joint Commission International (JCI); Canadian Council on Health Services (CCHSA); Deutche Akkreditierrungasstelle Chemie (GMBH); Commission on Laboratory Accreditation of the College of American Pathologists; Clinical Laboratory Accreditation Certificate; ISO 15189 and ISSO 9001:2000; Medical Tourism Association (MTA Certification); International Society for Quality in Healthcare (ISQUA); European Society for Quality in Healthcare (ESQH); International Organization for standardization (ISO); Trent Accreditation Schemes (TAS); King’s Fund Health Quality Services (KFHQS); and International Society of Aesthetic Plastic Surgery (ISAPS).
High Standard of Ethical and Professional Deontology
In health and wellness tourism, quality/excellence, safety and ethics are deeply connected. The aesthetical surgeons must avoid making several surgical operations, while informing the client/patient of the dangers of multiple aesthetical surgeries.
Importance of Branding Destinations
Health and wellness brand destination becomes more important to promote the image of high-quality healthcare in a location (city, region, country). Seeking to attract international patients from around the world, partners and stakeholders should work together to develop network synergies – health and wellness clusters. Hotels and resorts become healthcare facilities for prior and post-surgery medical travellers.
Attractive and Competitive Advantage of a Destination
The attractiveness and competitive advantage of medical/ aesthetical tourism are competitive prices on a global scale; international accessibility and proximity; international accreditation/certification; and excellence.
Excellence is defined as a high-level of holistic quality (several levels and parameters), which exceed expectations including accredited hospitals; qualified doctors; certified surgeons; qualified anaesthesiologists; qualified nurses and others professionals; advanced technologies; efficacious therapeutic procedures; faster medical services; affiliation with universities and research centres; humanization of healthcare; beautiful hospitals; hospitality/hotel structure; linguistically competent teams; healing climate; pleasant environment/ landscapes; healthy gastronomy; and partnership with luxury hotels and resorts.
About the Authors
João Viegas Fernandes is a founder and president of the Associação Portuguesa de Turismo de Saúde e Bem – Estar – APTSBE (Health and Wellness Tourism Portuguese Association). He is also the architect and advisor to Algarve Region Health & Wellness Tourism Cluster and Destination Branding. He is considered a visionary, pioneer and expert in health and wellness in Portugal.
As a professor, he conceptualized a discipline in health and wellness tourism, which he teaches in the School of Management, Hospitality and Tourism, of Algarve University. He has lectured in various universities in Portugal, Spain and Brazil and is researching health and wellness tourism around the world. Fernandes is a consultant in this area, both nationally and internationally.
Fernandes has spoken at several conferences in Portugal, Spain, Brazil, Turkey, Cape Verde and Monaco, on sustainable health and wellness tourism. He is the author of the book, “Thalassa,Thermae, SPA-Salute Per Aqua” (Lisboa, Portugal 2006). He also is co-author of several articles and books including “SPAS, Centros Talasso e Termas: Turismo de Saúde e Bem-Estar” (Lisboa, Portugal 2008); and “Turismo de Saúde e Bem-Estar no Mundo: Ética, Excelência, Segurança e Sustentabilidade” (São Paulo, Brazil 2011).
Fernandes was the chairperson of the I International Conference on Health and Tourism (Faro, Portugal 2012) and the II International Congress on Health and Tourism (Albufeira, Portugal 2014). He is an advocate of increased cooperation in health and wellness tourism among the eight countries which speak Portuguese.
Filomena Maurício Viegas Fernandes is a medical doctor and specialist in public health. She was the health delegate in several municipalities in the Algarve region and has been responsible for a number of programs on public health.
She has delivered presentations at various international conferences and is considered an expert in health and wellness tourism. Fernandes has been researching and teaching health and wellness tourism in the School of Management, Hospitality and Tourism, at Algarve University. She is the co-author of several articles and books including “SPAS, Centros Talasso e Termas: Turismo de Saúde e Bem-Estar” (Lisboa, Portugal 2008); and “Turismo de Saúde e Bem-Estar no Mundo. Ética, Excelência, Segurança e Sustentabilidade” (São Paulo, Brazil 2011).
Fernandes was a member of the organizing committee of the I International Conference on Health and Tourism (Faro, Portugal 2012) and is coordinating the II International Congress on Health and Tourism, in Albufeira, Algarve, Portugal, in 2014.