An Empirical Analysis of Socio-Economic Determinants for Tourist Destination Choices in Tanzania: A Case of the Coastal Circuit

Photo by Engin Yapici on Unsplash ABSTRACT Medical tourism has excellent potential and downfalls, which this paper will extensively cover. While medical tourism has great economic benefits to the host country and calls for the increase of professionalism and skill of physicians, it also influences doctors locating to private hospitals and skewing healthcare costs and access for locals. Given the many weights and balances to consider, the discussion of expanding this type of healthcare into Turkey is ethically needed. INTRODUCTION I watched from the hotel lobby as a group of men with surgically wrapped heads strolled in line behind a young woman; she was speaking to them in English with a heavy Turkish accent. Across the room was another group like this one, but the women had bandages on their noses. As a Turk, this sight was not new to me: over the years, I witnessed the number of foreigners coming to Turkey for medical procedures increase by tenfold. And, I began to see how savvy Turkish tourist companies became over time, creating enticing packages for people to tour the beautiful city of Istanbul while receiving a hair transplant procedure or rhinoplasty. While I understood why individuals would come to Turkey for their procedure ― lower prices, expert physicians, and a lovely tourist destination ― I began to question whether profiting from the health care of others was ethical. This paper examines whether it is ethical for Turkey to invest in a growing medical tourism field, which has the potential for significant economic benefits yet could threaten health inequalities between locals and foreigners. Further, it will outline why tourists choose Turkey as a medical tourism destination, the reasons to favor medical tourism, and the reasons to oppose it. Finally, the paper will conclude that Turkey should cultivate and invest in medical tourism, with suggestions for expanding the field into a thriving market. ANALYSIS By definition, a medical tourist is an individual who travels to a foreign country to experience both cultural tourism and medical treatment.[1] Global medical tourism is a $55billion industry, and the industry in Turkey is experiencing an annual growth rate of 22.6 percent.[2] In 2017, more than one million individuals traveled to Turkey for medical tourism, putting approximately ten billion dollars of foreign currency into the economy.[3] Medical tourists who traveled to Turkey received, on average, more than one procedure during their stay.[4] Due to the increasing demand for medical tourism, the Ministry of Health in Turkey emphasized the expansion of medical tourism in its strategic plan, implementing initiatives to grow the industry.[5] These initiatives include improving the quality of Turkish hospitals and receiving Joint Commission International (JCI) accreditation, which is an internationally recognized quality healthcare index.[6] There are multiple reasons why individuals choose Turkey as their destination for medical tourism. First, it is easy to travel to: individuals need only an E-visa, which they can easily receive through an online application.[7] In addition, Turkey has lower prices compared to the Western hemisphere.[8] The Turkish government incentivizes medical tourism through lucrative advertising specials. For example, Turkish Airlines offers discounted airline ticket prices of 50 percent for patients who demonstrate a patient admission document from a Turkish-certified health institution.[9] Private hospitals have opened advertising offices in the Ataturk airport as well.[10] Lastly, hotels and hotel chains collaborate with hospitals to offer lucrative tourist packages for patients.[11] While these perks and incentives draw people to Turkey, the lack of insurance coverage, high cost of treatment, and long wait times in their home countries are the most significant reasons that tourists choose Turkey as their medical destination.[12] Arab tourists previously traveled to the United States and the United Kingdom for medical treatment, but due to the implementation of strict travel sanctions after the September 11 attacks, they have had to look elsewhere.[13] For Arab tourists, the similarity of culture and religion in Turkey, a predominantly Muslim country, is also an enticing factor.[14] And, while Thailand and Singapore offer lower health care costs than Turkey, the shorter distance from the home country plays an important role in choosing Turkey as a medical destination.[15] European tourists choose Turkey for different reasons. For example, some surgeries conducted in Turkey are not available in Europe.[16] Patients from the Balkans and Central Asia prefer Turkey because of Turkey’s highly trained physicians and brand new, well-equipped hospitals compared to those in their home countries.[17] Interestingly, the low costs rank lower in importance than cultural similarity among those seeking care in Turkey.[18] The most important factor for choosing Turkey was quality: most tourists came from countries with a healthcare system marred by a lack of expertise or technological advancement.[19] One Turkish physician stated, “[Turkey] really ha[s] practices, doctors, services, hospitals and treatments that are above world standards in terms of health care.”[20] l. Ethical Permissibility of Medical Tourism in Turkey Health tourism has the potential to make a significant impact on the economic and social life of countries.[21] As a developing country, Turkey cannot afford to overlook this economic possibility.[22] The expansion of medical tourism in Turkey has allowed the country to reform its healthcare system into one that competes with health care quality in the Western hemisphere. Since 2010, there has been a significant increase in patients traveling to Turkey for health care.[23] The AK Party in Turkey pledged to promote health tourism in its campaign in 2011.[24] This inspired health care reform in 2013, with Turkey instituting a publicly funded and organized healthcare system.[25] In 2013, the Turkish government created publicly funded city hospitals. These hospitals were formed for medical tourism, meeting quality levels never-before-seen in the country.[26] In 2014, the Ministry of Health began granting accreditation to medical providers for medical tourism services and supporting translation services, patient transportation, and marketing.[27] Additionally, strategic initiatives were implemented to increase the number of Turkish medical school graduates.[28] The number of private medical schools increased from five before 2013 to 24 by the end of 2015.[29] A 50 percent tax reduction was granted to healthcare institutions that provided health care to foreigners.[30] Finally, Turkey began reforming hospital systems to obtain JCI accreditation. The growth of medical tourism in Turkey has resulted in positive reform of Turkey’s healthcare system. Turkey has over ten city hospitals in Istanbul, with qualified professionals proficient in English and other languages.[31] These hospitals are public and thus open and available for use by the general Turkish community, offering excellent quality health care to the country’s citizens. However, private hospitals have also flourished and, in some cases, have drained some of the doctors from public hospitals. With the increase in quality measures and regulatory healthcare committees, such as the Health Tourism Coordination Council (SATURK), Turkey’s healthcare system rivals the West's with highly trained professionals, competitive medical schools, and modern medical facilities.[32] Turkey has even reached the forefront of medical advancement: the World Eye Hospital is renowned for its cutting-edge ophthalmology services.[33] The investment in medical tourism has allowed Turkey to invest more in its private sector as well: the total expenditure on health as a proportion of the GDP rose from 2.4 percent in 1980 to 6.1 percent in 2008,[34] with an almost $2 billion national income from medical tourism in 2010. ll. Arguments Against the Ethical Permissibility of Medical Tourism in Turkey While public city hospitals were opened with the potential to support the Turkish medical tourism industry, private hospitals support 83 percent of the medical tourism market, and the gap between private and public hospitals has been growing yearly.[35] Private hospitals have mostly opened in urban areas, such as Istanbul, Ankara, and Antalya.[36] As a result, there has been a “brain drain,” in which members of the health workforce have left rural areas and have moved to urban cities where they can make larger profits from the medical tourism industry.[37] In addition, the use of public city hospitals has been met with concern regarding whether inequalities in health care between foreigners and Turkish citizens will arise. The Ministry of Health pays rent for the city hospitals in US dollars, exacerbating inflation in the Turkish lira currency and increasing reliance on high-paying medical tourists to support the public hospital system.[38] Due to this pressure, the prices for medical services are not consistently kept at affordable levels for Turkish citizens.[39] The head of The Private Hospitals and Health Institutions Association, Resat Bahat, stated, “Turkish citizens must receive priority for public resources. You cannot treat a Libyan or a Dutch when your own citizen is shaking at home with pneumonia. You [the public sector] can perhaps engage in medical tourism if you have excess bed capacity. But it is hard to do this [medical tourism] with the public sector.”[40] Rapid growth has also compromised patient safety and health care quality. While clinics must receive medical tourism certificates to provide treatment, fraud has risen.[41] In 2016, six out of ten hair transplant clinics were operating illegally.[42] These clinics offered hair transplants for as low as $800 when the treatment costs approximately $2000 i

This study is based on the phenomenon of increasing female workforce participation in West Nusa Tenggara. The purpose of the study is to analyze the influence of social, economic and demographic factors on the work decisions of female workers in West Nusa Tenggara. The social factors are education level, marital status, women's position in the household and internet usage. The economic factor is household income. The demographic factors are age and area of residence. The type of research used is quantitative descriptive. The data used in this study are secondary data with a cross-sectional type obtained through the National Labor Force Survey (Sakernas) data in August 2023. The data analysis used is binary logistic regression. The results of the data analysis show that education level, marital status, women's position in the household, internet usage, household income, age and area of residence have a positive and significant effect on the work decisions of female workers.

This research investigates the evolving dynamics of global tourist preferences and consumer behavior in the postpandemic era, with a particular focus on identifying the key factors influencing destination choices. The study compares tourist preferences across three popular destinations – Spain, Italy, and Thailand – by analyzing statistical data and reviews from tourists in these countries. The findings highlight significant variations in the ways that economic, cultural, and safety concerns shape travel decisions. Economic factors such as income levels, travel costs, and service availability are shown to play a crucial role in destination selection, with tourists increasingly becoming sensitive to price fluctuations. The study also emphasizes the growing importance of safety, especially in light of the COVID-19 pandemic, with many tourists prioritizing destinations that offer clear health protocols and measures to ensure their well-being. Furthermore, the research reveals a rising demand for environmentally conscious travel, with a focus on destinations that promote sustainability and eco-friendly practices. Social media also emerges as a pivotal tool influencing trip planning, with a notable 72% of tourists indicating its impact on their destination choices. The research suggests that tourism businesses must adapt to these shifting consumer demands by enhancing safety measures, adopting digital technologies, and emphasizing sustainability in their offerings. The results provide valuable insights for tourism experts seeking to navigate the post-pandemic landscape and enhance the competitiveness of their destinations on the global market.

Coronavirus disease 2019 (COVID-19) pandemic is continuing to have severe effects on tourism-related industries, as safety precautions have become essential to follow. Based on this, this study aims to explore the role of perceptions of the tourist of safety in tourism destination choice with the mediating effect of tourist trust (TT) in the context of the Chinese tourism sector. In addition, this study considers improvements to safety measures for sustainable tourism and the benefits of the technology transformation in the travel industry because of COVID-19. For this study, a quantitative approach was used, and data were collected through convenient sampling. The questionnaire was measured on a 5-point Likert scale, and a cross-sectional approach was adopted for data analysis. The findings of this study show that the effect of the perceived safety of the social environment, perceived safety of facility and equipment elements, perceived safety of human elements, perceived safety of management elements, and perceived safety of natural environments is significant and positive on the tourist destination choice (TDC). In addition, TT is a significant mediator between these elements and TDC. Furthermore, this study concluded that COVID-19 had increased travel anxiety, with particularly negative effects on the Chinese tourism sector, but that the adoption of perceived safety measures could be beneficial in regaining TT for traveling, eventually giving tourists confidence in choosing their traveling destination.

The purpose of this study is to examine the factors and their level of influence on the choice of adventure tourism destinations in Quang Binh, Vietnam. The author has synthesized prominent studies related to adventure tourism, combined with the search for underlying theories to build a research model. SPSS 20 software was used to analyze based on the survey results of 260 tourists including domestic and foreign tourists, to verify the relationship of these factors to the choice of adventure tourism destinations. The results show that there are 5 factors influencing the choice of Quang Binh as an adventur e tourism destination, arranged in the following order: (1) Travel costs; (2) Cultural experience, people of the destination; (3) Communication and advertising; (4) Tour guide capacity; (5) Brand of the operating company. Based on the research results, the author has made some recommendations to help develop adventure tourism in Quang Binh better.

Based on the popularity of mobile information and the important role of mobile information in marketing, the use of mobile information to publish travel information and travel advertisements has become a new choice for operators, which can also attract sports and fitness people. This article studies the influence of official microblog of tourist destination on tourists’ choice of tourist destination. In this study, five factors, such as the usefulness of official microblog, are taken as independent variables, tourist destination selection as dependent variables, and the mediating role of use attitude is taken into account. A research model is established to explore the impact of these variables on tourist destination selection. The results show that usefulness, ease of use, interactivity, and entertainment have direct effects on tourists’ willingness to choose tourist destinations; ease of use and interactivity can indirectly affect tourists’ choice of tourist destinations using attitudes; perceived trust needs to have a positive effect on tourists’ willingness to choose tourist destinations using attitudes.

This research established a model to evaluate the attractiveness of Chinese cities to foreign tourists, focusing on the influence of factors such as economic development, transportation, culture, environment, cuisine, and tourism resources on their choice of tourist destinations. The model uses the Term Frequency-Inverse Document Frequency (TF-IDF), Analytic Hierarchy Process (AHP), Weighted Comprehensive Evaluation (WCE), keyword frequency analysis, and Principal Component Analysis (PCA) for dimensionality reduction. The study calculates the top 10 cities that are the most appealing to international visitors, among them Shanghai and Beijing ranking highly due to their economic power, convenient transportation complete infrastructure, and rich cultural heritage. Economic factors and transportation are more likely to be focused on when foreign travelers are travelling in China or planning travel strategy. Moreover, Spearman's rank correlation analysis demonstrates a strong correlation between predicted and actual rankings, which verifies the accuracy and effectiveness of this model.

Digital marketing thru the use of social media has been proven to be an effective tool to reach out to a wider audience. This study was conducted to determine the same effectiveness of social media as a medium for marketing a multi-faceted and highly diverse line of products in the tourism industry by identifying the power of social media usage over the travelers’ choice of tourist destinations.
 With the descriptive correlational research design applied in the study, the profile of the 397 local and foreign travelers and their social media usage were identified thru a survey questionnaire distributed and retrieved from Clark International Airport Corporation (CIAC) and surrounding areas in Clark.
 Data gathered was processed using SPSS and was able to determine the association among variables using the Chi-square test; that social media usage indeed influence the traveler’s choice of tourist destinations and that their prior thoughts change as they read comments and review post. It has been identified that the monthly income and occupation of respondents have an association with their social media usage concerning travel and that the social media platform they utilize has an association with their social media usage about traveling.

Digital movie platforms are one of the most prominent modern entertainment mediums that play an increasing role in influencing audience perceptions on various topics, including tourist destinations. The study aimed to evaluate the impact of digital platform films on perceptions of tourist places among the Jordanian public, using a questionnaire on a purposive sample of 400 Jordanians. The study revealed that the majority of respondents (47.2%) watch films on digital platforms extensively, with Netflix being the most popular platform for film consumption. The beautiful depiction of these locations was the main feature of digital platform films that shaped respondents’ perceptions of destinations. Furthermore, digital platform films about destination depictions, as well as their role in promoting cultural communication and understanding, significantly influenced the choice of destinations. Although the impact of these films on promoting tourist destinations was moderate, it has been proven that increasing the number of viewers of films on digital platforms significantly enhances their ability to shape the image of tourist destinations and improve communication and cultural understanding. Results show that younger and more educated consumers are more interested in the places depicted when they use these channels. Demographic factors influence media consumption patterns, and digital films can be great tools for tourism marketing and cultural interchange. The findings of the study also show that there is no correlation between the degree of respondents' viewing of digital platform films and the role these films play in promoting tourist destinations from the study sample perspective. This indicates that the frequency of watching digital platform films does not influence the promotion of tourist destinations. Meanwhile the results demonstrate that there is a positive correlation between the degree of respondents' viewing of digital platform films and the role these films play in influencing their choice of tourist destinations. This suggests that the more respondents watch digital platform films, the more these films influence their choice of tourist destinations. Furthermore, the study opens pathways for tourism policy makers to collaborate with media producers to create cinematic portrayals that both attract international interest and enrich the domestic tourism landscape. Future research could expand on these insights by exploring the long-term effects of repeated digital film exposure on tourism behaviors and investigating how genre-specific content contributes to the appeal of travel destinations.

In the international tourism market, the number of arrivals in Asian regions is increasing every year, and that of foreign tourists in Mongolia, a new tourism market, is also rapidly rising. This study tests differences in the destination choice among international tourists visiting Mongolia using the Plog’s personality model. It classifies Mongolia into several regions using the recreation opportunity spectrum and then tests whether Plog’s personality types significantly affect the destination choice. Analytical results based on the data of an on-site survey of 406 U.S., South Korean, and Russian tourists recruited at eleven representative destinations present that while the tourists are categorized into psychocentric, midcentric, and allocentric types, allocentric tourists are the largest in number. Also, Plog’s personality types are found to differentiate tourist destination choices when socio-demographic and travel-related confounding variables are controlled for. Allocentric tourists are likely to visit primitive areas, whereas psychocentrics tend to visit urban tourist attractions. Accordingly, this study confirms the validity of the recreation opportunity spectrum and Plog’s personality types, using the case of Mongolia with unique natural, urban, and tourism settings. Also, tourism service providers and marketers may benefit from the segmentation technique and analytical results suggested in this study in order to assess the needs of their visitors. Highlights This study uses the recreation opportunity spectrum and Plog’s model together. The study conducts a survey of inbound tourists in Mongolia. Tourists’ destination choice can be varied by personality characteristics.

This study aimed to determine the performance of tourism investment and trade in Indonesia following the outbreak of COVID-19 and other economic and non-economic factors. Goods and services for Indonesian tourism from 8 sample countries over 26 years were examined using a tourism economy approach and a gravity panel model of the flow of investment and trade. Regarding research originality, the model developed is constructing tourism economic theory applying the Keynesian method. The results showed that economic factors, such as GDP per capita, interest rates, exchange rates, prices, and economic distance, and non-economic factors, such as population, travel alerts, and pandemics, significantly affect investment flows and the tourism trade. Furthermore, tourism competitiveness increased globally in 2019. However, potential economic leakage in FDI and trade were identified. As a result, the government must emphasize long-term and efficient investment and trade in the tourism sector, particularly in the context of systemic shocks such as a pandemic.JEL Classification: C58, D58, Z32, Z38How to Cite:Singagerda, F. S., Desfiandi, A., & Marantika, E.R. (2023). The Gravity Model of Indonesian Tourism Trade and Investment. Etikonomi, 22(1), 143–154. https://doi.org/10.15408/etk.v22i1.25222.

This study explores tourist affinity and animosity and their effects on foreign tourist destination choices before and after a foreign holiday. To achieve these research objectives, semistructured interviews with critical incident techniques were employed to recall tourists about their past foreign holidays, to identify their specific affinity and animosity components towards foreign destinations, and to explore their impacts on tourist destination choices. As a result, 17 interviews lasting 40 min to almost 1.5 hr were done. The results show that tourist affinity including components such as feelings of sympathy, admiration, and attachment toward a specific foreign country are positive drivers of tourist destination choices, while tourist animosity including components such as war animosity and the pandemic of COVID-19 animosity negatively influences tourist intention to visit and provide word of mouth. As such, this study tracks tourist affinity and animosity on tourists’ attitude changes during holidays, enriches the literature on tourism affinity and animosity, and also provides a further understanding of Vietnamese tourist destination choices.

Global health care and the services it provides are changing rapidly with the development and advancement for our societies. This is due in large part to advanced technology and rising costs and high demand of medical treatments. These factors have created a booming industry in medical tourism. This growth has lead to the need of research of the market and those who participate in medical tourism. This research aims to identify the factors that influence destination choice of potential medical tourists through the identification of variables that affect destination choice as well as individual attributes of potential participants. A discrete choice modeling approach is used to address the operational challenges of incorporating behavioral elements in choice analysis. Also, a multinomial logistic model was used to gain a deeper understanding affects potential participants’ destination choice. The research reveals that attitude towards health, desired treatments, and information source are significant variables in medical tourism destination choice. The study also shows that socio-demographics affect destination choice. Most notably, gender (male), experience living abroad, and experience with medical treatments abroad affect destination choice.

The pandemic caused by the SARS-CoV-2 virus (COVID-19) has transformed the tourism sector to an unprecedented extent, creating new challenges and new development paths. Although the recovery of tourism is fraught with uncertainties, the changes in tourists’ travel habits offer a unique opportunity for tourism to recover in a way that respects the principles of sustainable development. Several international studies suggest that the pandemic has significantly transformed tourists’ travel habits and destination choices, making them more environmentally conscious and shifting their preferences towards inland destinations close to nature. To test these claims, we examined tourists’ destination choices and the factors influencing them in a sample of 500 respondents in Hungary before the pandemic and after the restrictions on travel, businesses, gatherings, and mask requirements were lifted in the summer of 2021. Our results show that there was no significant change in the destination choices of the tourists surveyed. The main influences were the aspects of safety and comfort; the consideration of environmental concerns, despite our assumptions, did not play a significant role.

Poverty is a crucial and worldwide phenomenon. The main purpose of the study is to investigate the relationship exists between socio-economic factors, social factors, and poverty, the relative influence of economic and social factors on poverty and to describe causality between time series in the VAR system. This study utilized the Vector Error Correction Model (VECM) by using quarterly time-series data, 1994Q1 to 2018Q4, that have been collected from the world development indicators (WDI) and Economic Survey of Pakistan. The study identified education, unemployment, inflation as economic factors while zakat and rainfall as social factors that can reduce poverty. The findings of this study indicate that inflation and unemployment have a positive and significant relationship with poverty in the long run in Pakistan while education, rainfall, social welfare programs, and zakat has a negative relationship in the long run with poverty. Besides, the study also found that in the short run, there is no relationship between economic and social factors with poverty. Moreover, the study found that in the long run that the relative contribution of education and rain increases, 28% and 20%, is greater than the contribution of inflation, social welfare programs, unemployment and zakat, 3.8%, 0.5%, 2.5%, and 0.08%. Similarly, its contribution to poverty reduces up to 44% in the long run. This study helps policymakers to take important decisions about economic and social factors while designing policies to reduce poverty. The results suggest that the state bank of Pakistan should adopt a contractionary monetary policy to control inflation and policymakers can develop policies like education for all. The government should develop a business environment to create more employment opportunities.