Theatre and the Development of Spa Tourism in Eighteenth-Century Tralee

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

The purpose of this paper is to propose a new model for enhancing medical tourism destination image by integrating the credibility of supplier- based official websites and buyer-based private SNS, which influence medical tourism destination credibility and image. Medical tourism websites provide supplier-based information storage but SNS information about Korean medical tourism contains buyer-based information. These two channels play important factors in positioning Korea as medical tourism destination.

The medical tourism has been changing the healthcare scene especially in the developing countries which offer a combination of low costs for medical services and experienced medical personnel. It gives them the potential to become a target of choice for medical tourists. Therefore, the aim of the paper is verification of Central and Eastern Europe as a medical tourism destination (MTD). Research were conducted in the light of primary and secondary research. Survey data were collected from 282 German and British tourists, using a self-administered questionnaire. The results indicated that the medical associations are most frequently chosen associations with Poland. The MTD associations are able to develop marketing strategies for medical tourism entities and destination management organisations.

Today, medical tourism is one of the fastest growing sectors of the tourism industry around the world. Medical tourism can contribute to the sustainable development and economic dynamism of countries. Therefore, in this study, we prioritize the world’s leading countries in medical tourism for Iranians. First, five main criteria and 20 sub-criteria were selected, which are the reasons for choosing a country as a medical tourism destination. In this paper a combined fuzzy SWARA-PROMETHEE approach was used to prioritize tourism destinations. The acronym PROMETHEE stands for Preference Ranking Organization Method for Enrichment Evaluation method and represents an useful MCDA (Multi-Criteria Decision Analysis) tool. On the other hand, SWARA acronym means Step-wise Weight Assessment Ratio Analysis. The criteria were weighted using the fuzzy SWARA approach. In the following, using the PROMETHEE approach, we prioritized eight countries as tourism destinations, then we identified criteria related to sustainability of medical tourism destinations and prioritized medical tourism destinations using these criteria as the contributions of this paper. The weights obtained for criteria “Abilities of skilled staff,” “Applied medical equipment,” “Marketing capability,” “Type of service provided,” and “Application of information and communications technology” were 0.176, 0.232, 0.108, 0.395, and 0.089, respectively. The results show that medical tourism destination priorities for Iranians are India (Phi = 0.1396), Malaysia (Phi = 0.1128), Panama (Phi = 0.0976), Mexico (Phi = 0.0790), Singapore (Phi = 0.0096), Taiwan (Phi = −0.0442), Brazil (Phi = −0.1747), and Costa Rica (Phi = −0.2196), respectively. Negative Phi values indicate below average performance of those countries and positive Phi values indicate above average performance of those criteria. The results indicate that countries with negative Phi values should be strengthened relative to the improvement of some criteria.

Medical Tourism Marketing

Aim. To analyse the current state of the medical services market in Nur-Sultan (Kazakhstan) in terms of providing medical care to foreign patients.Materials and methods. The dynamics of medical tourism in Nur-Sultan was identified using the method of retrospective analysis. The main clinics providing medical tourism services in the capital city of Kazakhstan were characterised in terms of their advantages over competitor centres.Results. A prerequisite for the development of medical tourism in a certain country is the development of the whole country as a tourist destination. The recognition of a country as a safe destination by international tourism rankings contributes to the confidence of medical tourists in the quality of the services provided. The following advantages of Nur-Sultan determining its potential as a medical tourism destination were identified: access to modern medical technologies and new facilities; a large number of medical institutions accredited by the Joint Commission International (JCI); a wide range of medical directions; a convenient geographical location; reasonable costs of medical services; security and political stability; the lack of a language barrier for patients from the Commonwealth of Independent States (CIS).Conclusions. The capital city of Kazakhstan demonstrates a growing trend in the number of medical tourists. The largest number of tourists is currently from the CIS countries: Uzbekistan, Kyrgyzstan and Russia. It can be considered that, under a proper governmental policy, Kazakhstan’s potential as a medical tourism destination will be realised in the nearest future.

ABSTRACTExperiences with Spa products consumption are under theorised, overlooked and disregarded in most developing countries. This qualitative study examined individuals’ experiences. These experiences are important as they are fundamental in the assessment of the contributions of Spa products consumption to an individual and to the development of Spa tourism. In-depth interviews were conducted with 30 purposively sampled respondents. The study was carried out within seven study sites of day Spas and thermal and mineral springs. Thematic analysis was implemented, identified spiritual upliftment, personality development, gastronomic benefits and emotional healing as the dominant factors influencing individual experiences with Spa products consumption in Zimbabwe. The study concluded that experiences with Spa products consumption are different among individuals, but at the same time being instrumental to the development of the consumer psychosocially and economically. Positive experiences help in the development of Spa tourism in diverse social settings. These findings are significant as they offer means by which the Spa sector can propose reasonable strategies and mechanisms to optimise the consumption of the Spa products for individuals’ well-being and the development of Spa tourism in Zimbabwe. Given these findings, there is a need to promote the use of Spa products by individuals through various means.

Objective: The study attempts to examine the behavioural intention of the medical tourist in choosing Malaysia and Indonesia as medical tourism destination by aligning with SDG3. Theoretical Framework: There are three determinants (behavior intention, perceived quality, patient satisfaction and trust as mediator are included in the current study. Method: We plan to investigate the key determinants in of choosing Malaysia and Indonesia as destination for medical tourism. Results and Discussion: This study illustrates that all the variables are vital in influencing Malaysia and Indonesia as destination for medical tourism. Hence, all antecedent factors need to be taken into consideration which will influence the medical tourists from Malaysia and Indonesia perspective. Research Implications: Future research should focus on the comparative discussion for public hospitals and private hospitals in order to improve Malaysia’s and Indonesia’s performance in competing with other country as well as building trust among the medical tourists so that we (Malaysia and Indonesia) will be their first choice for medical tourism. Originality/Value: By understanding the relationships between behavioral intention, perceived quality, patient satisfaction and trust, the destination country would have a better idea how to and improve their marketing efforts in attracting as many medical tourists as possible.

ABSTRACTThis study examines the relationships among perceived warmth, perceived competence, hospitals’ facilities, doctors’ expertise, interaction with other patients, hospital prestige, and Malaysia’s image as a destination for medical tourism. Data were collected from tourists in Malaysian private hospitals. The findings provide evidence that perceived warmth, perceived competence, hospitals’ facilities, and doctors’ expertise predict hospital prestige which affects Malaysia’s image as a destination for medical tourism. The moderating role of interaction with other patients is confirmed on certain relationships. The findings of this study extend the literature on hospital prestige in medical tourism and are useful for the management of hospitals.

Population genetics of the shrimp Artemesia longinaris (crustacea, penaeidae) on the south-west atlantic coast

PurposeThe interest in medical tourism is due to the increasing number of scholarly publications on the subject. Polish researchers are progressively contributing to this discourse, shedding light on various research contexts within one of the prominent medical tourism destinations in Central and Eastern Europe. This article is aimed at mapping the knowledge of and outlining the directions for developing medical tourism research in Poland.Design/methodology/approachThe study was conducted in the form of a bibliometric review, including performance analysis and science mapping. The analysis included texts by Polish researchers indexed in the international Web of Science and Scopus databases and the Polish BazEkon database. In addition, publications found in Google Scholar, Nauka Polska (Polish Science) and Biblioteka Nauki (Library of Science) were included. VOSviewer was used for the bibliometric analysis.FindingsA total of 97 scientific publications from 2003–2023 were studied. The analysis provided an insight into the main themes of Polish researchers from the perspective of the discipline they represent. Five clusters were identified: (1) “global aspects of medical tourism,” (2) “medical tourist,” (3) “development of medical tourism,” (4) “Poland as a medical tourism destination” and (5) “medical tourism destinations worldwide.” On the one hand, an interdisciplinary approach to medical tourism makes it possible to gain broader knowledge that goes beyond one scientific discipline. On the other hand, the results show the diversity of medical tourism research and the dilemmas involved.Research limitations/implicationsThe limitation of this article is the analysis chosen, which does not consider the scientific quality of the articles studied. Instead, we identify leading and future issues that should be of interest to researchers and used by practitioners and managers of medical tourism destinations.Originality/valueThe review and subsequent mapping of scientific output made it possible (1) to understand the different perspectives on the definition of medical tourism, (2) to assess the 20-year contribution of Polish researchers to the development of medical tourism research and (3) to identify key contexts for further research.

The aim of this paper is to compare and assess the position of the spa and wellness sector in the structure of tourism in the Czech Republic. In this context, the article deals with the brief history of the Czech spa tourism and the development of spa tourism in the spa resorts, including the focus of specialized literature review. The methodological part consists of an explanation of the existing statistical information about the spa sector. The main part of the paper deals with the geographic analysis of current spa centres (the capacity of spa and total collective accommodation facilities, the number of spa patients and guests, guest attendance and their geographical structure). The assessment also includes the determination of the importance of the spa for overall spa tourism. Furthermore, the paper also deals with the development and localization of the selected forms of wellness tourism. As a pilot example, aquaparks built especially in the last 20 years in the Czech Republic were chosen.

This study investigated the intersection of healthy and sustainable human settlement, and land use for spa tourism in rural areas. Recognizing the crucial role of youth in shaping the future of tourism, this research aimed to provide an insight into the young local rural community representatives’ perception of sustainable spa tourism development and to identify whether these attitudes are shaped by their socio-demographic characteristics. The applied methodology was the Sustainable Tourism Attitude Scale (SUS-TAS). A total of 254 respondents took part in this research. Using SPSS 30.0.0, the gathered data were subjected to additional analyses based on factor analysis, descriptive statistics, and the general linear model. The results showed a general positive attitude of local community members towards the further development of spa tourism in their communities. The especially important factors were the following: long-term planning of development, environmental protection, negative attitudes towards spa tourism development, economic benefits, as well as community participation. By providing an empirical analysis based on the use of robust tools for measuring youth attitudes, this research offers valuable insights for policymakers, planners, and community leaders into how they can design and implement tourism strategies that align with sustainability principles while fostering local economic development and environmental stewardship. The ultimate goal is to contribute to the broader discussion on developing healthy, sustainable human settlements that balance economic benefits with ecological and social well-being. Synergy/harmony between communities and their natural surroundings is essential for the social, economic, and environmental sustainability of rural human settlements. Mineral springs and spas facilitate sensory experiences for individuals (both tourists and residents) through the utilization of natural resources and the environment.

In this paper, location factors important for the development of Spa tourism in Srebrenica was analyzed. Crni Guber Spa is located at 596 meters above sea level and is the highest spa and climatic place in northeastern Bosnia. Until the beginning of the war in 1992 in Bosnia and Herzegovina, the backbone of the economic development of the municipality of Srebrenica was the development of spa tourism. Spa Crni Guber in Srebrenica was a well-known health resort for anemic diseases. The accommodation capacities of this Spa complex were damaged by the war, so this health resort is currently in stagnation. We single out the time after 1995 as a special period, because there are no conditions for tourist movements towards the Crni Guber Spa in Srebrenica. Conducted research indicates that for the launch of the Crni Guber Spa and the adequate use of medicinal waters for medical purposes, it is necessary to resolve property and legal issues related to accommodation facilities and medical equipment of this Spa as well as the issue of concessions regarding the exploitation of medicinal water. Analyzing the importance of location factors and other factors important for the development of Spa tourism, in addition to local development policy in the municipality of Srebrenica, author believes that hydrographic and climatic resources, accommodation capacities and the touristic market are of special importance. The analysis of the spatial distribution of medicinal waters presents their economic value and proposes guidelines for further use and protection of these resources. For this type of tourist activity in Srebrenica, the tourist policy of local and state authorities is of great importance, as well as the connection between tourist organizations in order to attract visitors for treatment, recreation and rest. This paper presents a contribution to theoretical and practical research for the development of Spa tourism in the municipality of Srebrenica.

The aim of this paper is to identify preferred Central and Eastern Europe (CEE) medical tourism destinations (MTD) and medical services in the context of socio-demographic determinants. The computer-assisted web interviewing (CAWI) method was used. A total of 282 completed self-administered questionnaires were collected from Britons and Germans, who constitute a large segment of medical tourists in CEE. Subsequently, the responses were analysed using the chi-square test and the method of logistic regression function. The results indicated that the chosen destinations and medical services vary depending on gender, age and nationality. The survey results have implications for scholars, allowing them to understand the way Britons and Germans evaluate MTDs and medical services in CEE, as well as for medical tourism facilitators/brokers and destination management organisations engaged in the process of creating a medical tourism product. The obtained results have also implications for further research related to the development of medical tourism in CEE.