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2nd International Conference of Tourism, Hospitality and Recreation 2014 (EJTHR 2014),
Poznan (Poland), 19th -21st May.
Tourism and Medical Services.
The case of Elective Medical Tourism in Northern Greece.
Dr. Efstathios Velissariou
Associate Professor & Vice President of the
Technological Educational Institute of Thessaly (GR)
belissar@teilar.gr
Tzioumis Triantafyllos
Vice Chairman & Deputy CEO
Papanikolaou Hospital & Psychiatric Hospital of Thessaloniki
Email: tzioumis@yahoo.gr
Abstract
The present paper deals with the medical tourism and the medical services and their
contribution to the tourism development. Firstly, it presents a theoretical approach to the
definition and types of medical and health tourism and secondly the characteristics of medical
tourism market and services. Worldwide the market size is USD 24-40 billion, based on
approximately eight million cross-border patients worldwide spending an average of USD
3,000-5,000 per visit, including all medically-related costs, cross-border and local transport,
inpatient stay and accommodations (Patientsbeyondborders, 2013). One of the main reasons
for medical tourism growth globally, is the price variance for medical services, among the
healthcare systems and the private providers. In Greece, the Medical tourism market is still
limited and is generated primarily by domestic tourism visitors of SPA or by exceptional
events (e.g. cares of war victims from Libya). The exception is the hospitalization and health
care of holiday tourists in Greece who are facing a health problem or an accident.
The paper investigates the current situation and the perspectives for providing medical
services at health units in the geographic area of Thessaloniki and Chalkidiki in Northern
Greece. This area concentrates a large number of hotels and other tourist facilities but also
large hospital units. The results are based on a survey by CEO's of the major Hospitals
establishments in the area. The paper ends with the conclusions about the perspective of the
development of medical tourism in Thessaloniki and Chalkidiki and suggested ways, in order
to achieve the requested result.
Keywords: Health tourism, Elective medical tourism, Greece, Chalkidiki, Thessaloniki
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Introduction
The World Health Organization defines the term health as the following: "Health is a state of
complete physical, mental and social well-being and not merely the absence of disease or
infirmity." (Rulle, 2008, p. 29-30). In modern times diseases associated with modern lifestyle,
such as heart problems, anxiety or depression, which degrade the overall level of health, are
frequent occurrences (Rodriguez- Garcia, 2001). “Our health systems face tough and complex
challenges, in part derived from new pressures, such as ageing populations, growing
prevalence of chronic illnesses, and intensive use of expensive yet vital health technologies”
(Frenk, 2004).
Health and tourism are two concepts that at first glance seem irrelevant, though related in
many different levels. Improving health can serve as an incentive for traveling (Mathieson &
Wall,1982). So, the level of health services in the country of destination may be a part of the
tourist product and even contribute to its upgrading or downgrading. Regarding the
correlation between health and Tourism, the health can affects tourism through the health of
tourists but through the health conditions in the tourism destinations. This means that visitors
can either carry a disease from the country of origin to country of destination or vice versa.
Also it may concern the change in the number of incoming tourists due to adverse health
conditions in the country of destination and finally tourism can be influenced by health
tourism, which can increase the incoming tourism.
In an earlier research (Cossar et. Al, 1990), conducted in 13.813 travelers found that 36%
became ill in some way during the holiday, while 14% needed medical help and1% was
hospitalized. Dawood (1989), reports that 50% of international tourists are likely to have an
impact on their health from the trip. From his research, he finds out that accidents kill 25
times more tourists than contagious diseases. Hunter-Jones (2003), believes that tourism
correlates positively with health, creating positive effects on mental health (e.g. religious
holidays), on psychological health (elimination of stress). Specifically he refers to the
advantages of tourism for those get sick and he stresses that holidays can bring back the joy of
life, hope, raise a person’s morale and increase physical and intellectual activity. All of the
above combined with accommodation at specialized centers for patients and health care, are
evidence of the development of health tourism.
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1. Medical tourism
The Medical tourism is relatively a newer form of tourism, developed from the need to find
low-cost medical services and treatments globally. The medical tourism represents a special
form of health tourism. The Health tourism constitutes “The entirety of relations and
appearances that arise from the change of locality and stay of persons for enhancement,
stabilization and possible Revitalization of physical, mental or social well-being by use of
health services, whereas the place of the service is neither the main nor permanent place of
residence or work.” (Kaspar, C. 1996, p. 56). A common and special form of health tourism
is the wellness tourism. “Wellness tourism can be regarded as a subcategory of health
tourism” (Müller and Lanz, 1998). In 1961, the American doctor Halbert Dunn created the
word wellness out of well-being and fitness, as specified in his publication on the subject of
high-level wellness. He was the first who described the situation of a high level of well-being
including body and soul. (Vivien Breitrück & Elena Nunn, 2011:61). Wellness tourism can be
defined as "the sum of all the relationships and phenomena resulting from a journey and
residence by people whose main motive is to preserve or promote their health" (Mueller &
Lanz Kaufmann, 2001). In this context, it is important to make a distinction between wellness
tourists who are usually healthy and want to maintain or promote this state and cure guests
whose prime motive is recovery and to heal their illness (Mueller & Lanz Kaufmann, 2001).
The Medical Tourism or Patient Tourism (Rulle, M., 2010), or Clinic Tourism (Barth, R. &
Werner C., 2005), or Global healthcare, is a term that was originally made by travel agencies
and the mass media to describe the rapidly growing practice of traveling worldwide, to have
healthcare. Medical Tourism is a direct result of Globalization of Healthcare; the industry is
coming up in vigorous speed. This emerging industry is set to boom because of several factors
which are not defined or observed clearly. Medical Tourism could be defined as “The Medical
Tourism is the set of activities in which a person travels often long distance or across the
border, to avail medical services with direct or indirect engagement in leisure, business or
other purposes” (Jagyasi, 2009). Medical tourism is distinguished from health tourism by
virtue of the differences with regard to the types of intervention (Bio-Medicine /
Complimentary medicine), setting (Hospital – Clinic / Non-Medical Facilities) and inputs
(Medicament and medical devices / Others). Carrera & Lunt (2010).
“Summarizing both parts, health and medical tourism are two categories with different
motives for travelling. While health tourism promotes the well-being of body and soul by
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offering relaxation and spa treatments, medical tourism offers body attractiveness, health and
vitality through operations. Apart from this, what they have in common is the focus on a better
quality of life and as a result an extended life expectancy, and the consciousness of the own
body.” (Vivien Breitrück & Elena Nunn, 2011:65)
In the Greek bibliography the Health Tourism is divided in health tourism – healthy living
and thermal-therapeutical tourism. The first form takes place in health tourism centers (health
resorts) and emphasizes in the overall improvement of health and physical fitness, while the
second form takes place in spa (spa resorts) and consists in the provision of specialized
medical services for rehabilitation of existing problems (Andriotis, 2000). Spathi (2000)
follows the same categorization and includes health products in the concept of health tourism,
which are natural products, made by traditional way with natural and herbal ingredients.
Finally, according to the study commissioned by the hotel Chamber of Greece and scripted by
the Institute for Social and Preventive Medicine (Doxiadis et all. 2012), the term "medical
tourism" indicates two types of services:
A) The medical assistance for travelers’ who are in a foreign country on holiday or on
business trip, or for temporary residence. It includes health emergencies (e.g. heart
attack) or regular health care needed for chronic diseases (e.g. kidney dialysis).
B) The elective medical tourism, where the patient chooses to travel in order to take a specific
medical service, motivated by factors such as (a) the cost of services, (b) the quality of
services and overall healthcare, (c) the long waiting time in the country of origin to
receive similar medical services and (d) the opportunity to combine medical care with
journey and entertainment.
Concerning the first type of services, “the medical assistance for travelers”, the most
significant groups of patients suffering from chronic diseases is renal patients, cancer patients,
heart patients, People with Hematological diseases, elderly people who require systematic
monitoring of medicine and pharmacy. As for the “elective medical tourism”, nowadays the
most widespread services are cosmetic surgery, dentistry, ophthalmological treatment,
artificial insemination, cardiac surgery, orthopedic-therapy and rehabilitation, cancer
treatment, and organ transplants. This paper looks into exactly this form of medical tourism,
in particular the elective medical tourism.
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2. The International market of medical Tourism
According to the Mc Kinsey & Company (2014) “Healthcare is now the world’s largest
industry — with a value and cost three times greater than the banking sector.” As the review
of patient mobility in Europe4Patients noted, a lack of data around mobility in general is
compounded in relation to information about the commercial sector (Rosenmöller M., et al
2006). The Editors of Patients Beyond Borders' (published in the USA) “…believe the market
size is USD 24-40 billion, based on approximately eight million cross-border patients
worldwide spending an average of USD 3,000-5,000 per visit, including all medically-related
costs, cross-border and local transport, inpatient stay and accommodations. We estimate
some 900,000 Americans will travel outside the US for medical care this year (2013).”
Patientsbeyondborders (2013).
“Youngman for his part stakes his claim at 5 million, based on the lowest estimates of official
figures from providing countries (TreatmentAbroad. (2009), Youngman, 2009 ), though there
is no way to assess the accuracy of this figure”. (Lunt, N. 2011:15). This number does not
include travelers in wellness, spa destinations or those who travel for diagnostic –
preventative checks. America was the destination for about six hundred thousand patients-
tourists, while respectively Europe was visited by 1.75 million and Asia by 2.25 million
patients-tourists. Almost every country participating in market share shows a significant
increase in its performance.
According to Grail Research (2009) the most popular destinations for medical tourism are
Thailand (with 1.54 mil. patients in 2007), India (with 0.45 mil. patients in 2007), Singapore
(with 0.41mil. patients in 2006) and Malaysia (with 0.29 mil. patients in 2006). The most
popular of treatments are cosmetic surgery, dentistry, eye surgery, cardiology/cardiac surgery,
orthopedic surgery, organ, cell and tissue transplantation. On the other side of the Atlantic,
the Editors of Patients Beyond Borders' report that the top destinations are: Brazil, Costa
Rica, India, Korea, Malaysia, Mexico, Singapore, Taiwan, Thailand, Turkey, United States
and the worldwide medical tourism market is growing at a rate of 15-25%, with rates highest
in North, Southeast and South Asia.
In the TreatmentAbroad (2012) research 1,045 respondents took part. 55% of respondents
were from the UK. For all patients in the survey from all countries, Hungary was the leading
destination (12% of respondents), followed by Belgium (11%). Poland, Turkey, Spain, the
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Czech Republic and India were the destination for around 7% of patients each. About 42% of
the UK patients in the study went abroad for cosmetic surgery, 32% for dental treatment, 9%
for obesity surgery, and 4% for both infertility treatment and orthopedic surgery. 84% would
go back to the same doctor, dentist or clinic. 51% of respondents travelled to a country they
had never been to before for their treatment. The cost was cited by 83% of participants as the
most important reason for travelling abroad for treatment. Dental patients also cited the ability
to combine treatment with a holiday while cosmetic surgery patients cited worries about
hospital infection in the UK. Orthopedic, infertility and obesity surgery patients all cited the
ability to avoid waiting lists at home. 71% said they had saved more than £2,000 by travelling
overseas. 12.7% said they had saved more than £10,000 by going abroad for treatment.
It is apparent that the range of treatments available overseas for prospective medical tourists
are wide, including Cosmetic surgery (breast, face, liposuction), Dentistry (cosmetic and
reconstruction), Cardiology/cardiac surgery (by-pass, valve replacement), Orthopedic surgery
(hip replacement, resurfacing, knee replacement, joint surgery), Bariatric surgery (gastric by-
pass, gastric banding), Fertility/reproductive system (IVF, gender reassignment), Organ, cell
and tissue transplantation (organ transplantation; stem cell), Eye surgery, Diagnostics and
check-ups (Lunt, N. 2011:11).
It’s considered by many researches that the figures about the medical tourism volume are not
exact. The review from Lunta, N & Carrerab, P. (2010) about Medical Tourism has suggested
major gaps exist in the evidence base supporting medical tourist research such the
patient/consumer profile of those seeking surgery abroad, what shapes decision-making for
European patients, what types of information are used etc. On the other side, such numbers
are important to quantify economic impact and also to assess potential risk to source health
systems. Clarification is required around the sources and surveys used to provide numbers,
including the role of national agencies and private facilities in providing numbers. (Lunt, N.
2011:15)
Today, each patient can find through niche websites detailed price lists with the main
treatments, including transport and travel, flights, car rental, travel insurance, all medical
expenses etc. For the patient-tourist this summary of prices removes any uncertainty regarding
the total amount of the cost involved and ensures the possibility to have access to any chosen
services.
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3. Presentation of the research area in Northern Greece
In Greece until recently health tourism has not been sufficiently developed. The only form
showing relative growth is the SPA tourism, while lately Thalassotherapy presents growth
trends (Didaskalou, 2000). Greece can become a remarkable health tourism destination,
thanks to its stable, mild, temperate climate, which favors both holidays, as well as health
improvement. Combined with its natural beauty and rich cultural and historical tradition,
Greece can be an important health tourism destination (Andriotis, 2000).
In the 2nd Greek Medical & Health Tourism Workshop held in Moscow in October 2013 the
interest of the Russian tourism professionals for the medical tourism in Greece was intense.
Indeed, as pointed out, the Russian side clinched the first contracts with Greek private clinics,
while the Russians have shown particular interest in the thermal Spa and wellness centers of
Greece. During the workshop, more than 792 business meetings took place, while tour
operators, as well as 21 representatives of the leading Russian insurance companies were
present (Greek Travel Pages, 2013).
The objective of the present paper is the medical tourism in Thessaloniki and Chalkidiki in
northern Greece. Thessaloniki is the second largest urban center in Greece, following Athens
with approximately eight hundred thousand citizens (according to the census of 2011) and
concentrates a large number of Hospital and health facilities. Chalkidiki is located 60 km from
Thessaloniki and is a popular tourist destination, not only for the Greeks, but also for foreign
tourists. According to the data of the Hellenic Chamber of Hotels (2013), it was found that in
the area there are 35 five star hotels located with a capacity of 11.688 beds, 13 hotels of which
are established in Thessaloniki and 22 in Chalkidiki. Also there are 60 four star hotels, with a
capacity of 12.749 beds, 20 hotels of which are located in Thessaloniki. Finally, there are 130
three star hotels with 15.182 beds capacity, 41 of which are located in Thessaloniki.
A large number of tourists, mainly from the Balkans, arrive in the area by car. In the two
nearby borders (with FYROM and Bulgaria) the arrivals exceed 2 million per year. In the year
2013 the airport of Thessaloniki, which serves Chalkidiki as well, recorded 1.379.590
passengers’ arrivals from abroad (Hellenic Civil Aviation Authority, 2014). The main arrivals
were from Germany (34.5%), Russia (15.1%), Cyprus (10.7%), Italy (9.4%) and United
Kingdom (7.9%). Based on the statistical Data of the Hotel Association of Thessaloniki, for
the period January-August 2013, about 51.4% of night spends held by the Greeks. The first
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place of foreign visitors is taken by the visitors from Russia with 5.1%, the second place is for
the Cypriots with 4.4%, the third place for the visitors from Turkey with 3.9%, the fourth
place for the visitors from Israel by 3.5% and the fifth place for the Italians with 3.0%.
A remarkable fact is that in the year 2012 the first place among the foreigner’s night spends in
hotels of Thessaloniki goes to the visitors from Libya with 12.7%. In particular, war victims
from Libya who were in Greece for medical treatment, along with their helpers, recorded in
the year 2012 a total of 146.937 nights spends (Thessaloniki Hotels Association, 2014).
According to the president of the Hotel Association of Thessaloniki, “the provision of
healthcare for injured Libyans is the result of successful agreements and generates significant
economic benefits” and he points out that “following the right strategy, Thessaloniki could
well be turned into powerful Balkan Medical Center and an ideal tourist destination center
for Medical services” (Christoforidou, S. 2012).
The overall establishment of health services in the area is highly developed in both private and
public sector. The health services offered by the State are divided into three levels:
Primary care, which is provided by the hospital and ambulant clinics, health center of
insurance institutions, health centers and regional clinics and private clinics and
diagnostic centers and consists in overcoming temporary and emergency incidents and
transportation of patients.
The secondary care provided by general hospitals and private clinics.
The tertiary care which covers the first two categories and additional services for
research, education and training, as well as highly specialized medical operations.
Health services are provided by both public (hospitals, health centers, regional health center,
insurance organizations), as well as by private entities (clinics, diagnostic centers, health
centers). In accordance with the Ministerial decision FEK 2831/τ.Β'/14-12-11 public hospitals
of Thessaloniki and Chalkidiki are nine (9) General Hospitals, with a capacity of 3880 beds,
four (4) Special Hospitals with a capacity of 1000 beds and one (1) General Military Hospital.
According to the official website of the Medical Association of Thessaloniki
(http://www.isth.gr/) the number of private clinics in Thessaloniki is nineteen (19). Within
each of these Hospitals and clinics operate 13 Dialysis Units and there are 5 additional private
clinics for Chronic Dialysis which are established in the area. In the Healthcare establishments
of the region must be added other (secondary) establishments such:
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12 Rehabilitation Centers (of privet sector)
5 In vitro fertilization (IVF) Treatments Centers (of privet sector).
4 Centers for Counselling and Treatment of addicts persons (Privet and Public sector)
1 Counselling Center for teens and Young people
1 Unit οf Physical Detoxification
2 Adult Residential Treatment Programs.
5 Adult Outpatient Treatment Programs.
2 Therapeutic Detoxification programs for teens and Young people
4. Primary research
4.1. Object and methodology of the primary research
The main purpose of the research was to explore the potential development of medical
tourism in the region of Thessaloniki and Chalkidiki. In particular, the research aimed to
identify:
If and how the health units (Hospitals and Clinics) operate in medical tourism.
To collect information regarding the characteristics of medical tourism.
To evaluate the Health Facilities, the Treatments, the Medical personnel and the health
services.
To assess the cost of medical services.
To indicate the measures and conditions for the development of medical tourism and
To suggest actions for the promotion of medical tourism.
For the purpose of the research, it was considered appropriate the research to be held among
CEOs of Health units (Hospital and Clinics), who could respond to specialized research
queries. In particular, the survey has been conducted among the following health care
professionals in Thessaloniki and Chalkidiki area:
a. CEOs or General Directors of health unit groups
b. Directors of public hospitals.
c. Privet clinic managers.
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The survey was conducted in the spring of 2013 through personal interviews using a
structured questionnaire. The aim of the primary research was more qualitative rather than
quantitative. The results of the interview were not easy to be quantified because the weight of
the answers of the participants was different. For example, in the survey participated a CEO
of a medical group that was in charge of 13 clinics, 5 rehabilitation centers and 47 diagnostic
centers. His answers were much more important than the answers of a manager of an
individual rehabilitation center who also participated in the survey. For these reasons, the
research was mainly qualitative and the results show only the trend and not the exact volume.
It should also be noted that the significance of the responses of managers of public hospitals
was different than that of the private clinics, because the purpose and the approach were
different.
The survey was conducted among directors, CEOs and managers of the 13 public hospitals,
the 24 private clinics and other secondary health facilities that were presented above. It should
also be noted that many of the participants in the survey had been CEOs or directors in
regions except those of Thessaloniki and Chalkidiki, while others are in charge of groups
which operate in other regions of Greece. The number of executives that participated in the
survey covered a very significant share of Health Units in the specific areas. Overall, the
answers concerned 7 of the 13 public hospitals of the regions, 8 of the 24 private clinics, 4 of
the 12 Rehabilitation centers and another 8 health facilities, such as dialysis units, artificial
insemination units and centers of molecular biology. In total, the participants of the survey
were at the time of the survey or formerly responsible of 10 hospitals involving a total of 23
clinics, 9 rehabilitation centers, 6 Hemodialysis centers, 2 Chronic Dialysis Centers and 2
Centers of Molecular Biology throughout Greece.
4.2. Results of the primary research
a) Medical tourism and Characteristics of the patients in the research area
According to the results of the primary research many hospitals have developed the Elective
medical tourism, while others provide medical treatment for tourists. In fact, some health
units have developed both forms of medical services. In particular the 72.7% of CEO’s, said
that they have offered treatment to patients from other countries that came for this purpose.
An 81.8% of executives said that they have treated patients from other countries who were in
Greece for another purpose (tourism) and that these health services represent 1% of turnover.
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In addition, the medical Tourism assessment accounts for 1% to 5% of turnover for hospitals.
It should however be noted, that there was a particular private hospital in Thessaloniki, in
which the year 2012 the medical tourism (due to patients from Libya) represented 40% of its
turnover.
The main nationalities who receive health services in Greece are Englishmen, Germans,
Scandinavians, Americans, French, Italians and Poles, Czechs, Libyans, Balkans and
Russians. Demographically, the patients belong to high and middle class, but also are
economic migrants. The nationalities that receive health services from private clinics in the
research areas of Thessaloniki and Chalkidiki are from Libya, the Balkan countries, Russia,
Germany, and other countries from Central and East Europe. The main nationalities who
receive health care in the public hospitals in the area are citizens from Albania, Bulgaria and
other nationalities of the Eastern Europe.
To the question "through which distribution channel do you receive tourists-patients in
hospital?" the CEO of the public sector answered mainly unsystematically and randomly,
while private sector executives replied that their patients come through physicians Associates,
hotels, tour operators, facilitators and the Libyan Embassy.
b) Evaluation of the Medical Services
The evaluation of the medical staff in the region of Thessaloniki-Chalkidiki, (in scale, 5 for
Excellent, 4 for Very Good, 3 for Good, 2 for Average and 1 for Poor) recorded an average of
4.1. In particular the 18.2% of respondents assessed the medical staff as excellent, 72.7% as
very good and 9.1% as good. A very important fact is no CEO considers that physicians are
average or poor. The assessment of medical treatments in a scale of 1 to 100, where “100”
represented Pioneering treatments and “0” Outdated, showed an average of 77.3%, a result
that is acceptable, but can be improved and can easily, through some investments, lead to a
higher level.
All executives (100%) responded positively to the question whether the existing health
infrastructure (clinics, hospitals) can attract prospective tourists – patients to region, for the
existing treatments of health tourism. To the question “What, in particular treatments –
medical services can attract foreign patients – (a) in the region, (b) in your clinic especially”,
the respondents referred manly to cosmetic surgery, ophthalmological surgery, invasive
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surgery, hemodialysis and in vitro fertilization (I.V.F.). The following table (1) presents the
detailed results.
Table 1: Attraction of medical services and treatments for foreign patients.
Medical services
In the area
In your clinic
Cosmetic surgery
55.5%
25.0%
Ophthalmology
44.4%
25.0%
Invasive surgery
33.3%
37.5%
Hemodialysis
33.3%
50.0%
In vitro fertilization (I.V.F.)
22.2%
50.0%
Transplants
22.2%
12.5%
Cardiological
22.2%
12.5%
Dental treatment
11.1%
12.5%
Diagnostic – checkups
11.1%
--
Robotics
11.1%
12.5%
Detox
11.1%
12.5%
Rehabilitation
11.1%
12.5%
c) Infrastructures of Medical services
The managers believe that the needed establishments for the medical tourism development in
the region are thalassotherapy, physical medicine and rehabilitation centers, providing
specialized medical services centers and centers of geriatric services. The required facilities in
the clinic, for which they are responsible for, are hospitality infrastructure of the clinic,
physical medicine and rehabilitation, geriatric services and specialized medical services.
Table 2: Responses regarding the required facilities in the region and in their clinic
Needed infrastructures/facilities
In the region
In your clinic
Physical medicine and rehabilitation centers
18.18%
23.33%
Specialized medical services centers
18.18%
20.00%
Centers for geriatric services
13.64%
21.67%
Thalassotherapy
25.76%
3.33%
Larger hotel complexes
9.09%
0.00%
Psychiatric clinics and detox clinics
9.09%
5.00%
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Additional Private clinics
6.06%
0.00%
Hospitality infrastructure of the clinic
0.00%
26.67%
Total
100.00%
100.00%
d) Offering of Treatments and medical services
To the question “Which of the following treatments should be offered or supported in health
units in the region of Thessaloniki-Chalkidiki”, the responses were as follows: Physical
Medicine & Rehabilitation (24.24%), Cosmetic surgery 24.24%, Thalassotherapy-Spas
(19.70%), Nephrology – Hemodialysis (13.64%), Eye Surgery (10.61%).
In the question “Which of the following treatments should be offered or supported in your
health unit” the results ranked between the first place “Cosmetic Surgery” with 35.4% and the
second place “Physical Medicine & Rehabilitation” with 31.2%
Table 3: Treatments should be offered or supported in the health units
Treatment
In the region
In your clinic
Physical Medicine & Rehabilitation
24.24%
31.25%
Cosmetic surgery
24.24%
35.42%
Thalassotherapy-Spas
19.70%
4.17%
Nephrology – Hemodialysis
13.64%
10.42%
Eye Surgery
10.61%
6.25%
Orthopedic
4.55%
8.33%
Detox
3.02%
4.17%
e) Assessment of the Cost
The executives believe the cost of private health services at health units in the region, are on
average 54.5% (at the same level as the other health tourism destinations), with a slight
tendency towards the expensive (27.3%) while 18.2% considers that cost low, compared to
other tourism destinations. The results at the same question, excluding the executives from
the public hospital and the pricing policy which is determined by the State, are different in the
scale of “expensive” by 10% (table 4).
Table 4: Cost Assessment of the health services at health units in the region
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Level
Public and Private
Private Clinic
Expensive
27.3%
37.5%
On average
54.5%
37.5%
Considers that cost low
18.2%
25.0%
Regarding the cost, the executives’ opinions are divided into whether the cost of the medical
services offered in the region is the most determining factor for the choice of destination of
the medical tourism. In particular, 37.5% of the executives of the private sector disagree,
37.5% agree, while 25% are neutral in their point of view. If in the sample, we include the
private sector managers' responses, then 45.5% of CEOs disagree, 36.4% agree, while 18.1%
are neutral (table 5).
Table 5: The cost of the medical services as the dominant factor for the destination choice
Public and Private
Only private clinics
Totally Disagree
9.1%
12.5%
Disagree
36.4%
25%
Neutral
18.2%
25%
Agree
27.3%
25%
Totally Agree
9.1%
12.5%
100.0%
100.0%
5. Conclusions and proposals
5.1 Conclusions
Summarizing the results of the primary research can be concluded that:
The areas of Thessaloniki and Chalkidiki concentrate a large number of hotels and tourist
infrastructures.
Every year the tourist arrivals by plane come up to 1.4 million, while a large number of
tourists arrive by car.
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In the area operates a large number of hospitals and private clinics, which offer a wide
range of treatments, while all managers believe that the existing health facilities can
attract medical tourists to the region.
The main treatments that can be provided for medical tourism, according to the results of
the survey are: Cosmetic surgery, Ophthalmology, Invasive surgery, Hemodialysis, In
vitro fertilization (I.V.F.), Transplants and Cardiological surgery.
The volume of medical tourism in the area is very limited (1-5% of turnover) and
concerns the treatment of tourists due to accidents or exceptional incidents, such as the
healthcare Libyan war victims, who in the year of 2012 reached 147,000 nights in the
hotels of the area. These victims have boosted both the arrivals in hotels in Thessaloniki,
and in hospitals.
The evaluation of the medical staff and also the medical services was very satisfactory.
The staff assessment was particularly high with a 4.1 out of 5 rating, while the
infrastructure and facilities assessment were satisfactory (77.3 index out of 100), which
indicates that there is opportunity for improvement.
The cost of Medical services was assessed as being at medium levels, or a bit higher
comparing to other health tourism destinations. However, the majority of respondents did
not consider that the cost is the main factor for the choice of destination for medical
tourism.
Lastly, the survey showed that there is no systematic acquisition of patients for medical
purposes, but only individually and due to accidental events.
5.2 Proposals
All indications resulting from the findings suggest that the necessary potentials for the
development of medical tourism in the region of Thessaloniki-Chalkidiki exist. In order to
make this development, it is required to take actions on the key axes which are described
below.
1. Aggressive pricing policy
An Aggressive policy is common practice during placement of a new product or when placing
existing product into a new market. Therefore, an aggressive pricing policy should be chosen.
This aggressive pricing policy concerns not only health units but also hotels which would
have to offer all-inclusive packages. The General conditions are encouraging for a pricing of
this type, because of the rapid reduction of labor costs in Greece, but also due to the reduction
16
of the salary of health professionals over the last three crisis years. In addition, this cost
reduction can be combined with creating attractive packages with hotels, outside the peak
tourist season.
2. Healthcare Accreditation
The health units of the region must proceed to Accreditation by international organizations,
because no Hospital in the area is certified. With the completion of the accreditation process
and in combination with the aggressive pricing policy and the tourist attractiveness of the
region, favorable conditions can be created for the development of medical tourism in the
region.
3. Promotion of the Medical Tourism opportunities in Thessaloniki – Chalkidiki
Creating a picture of Medical tourism in the region, with a view of local Medical facilities
abroad, through the Internet, media, Trade Fairs, etc. is necessary. This can be achieved
through the participation in all tourist fairs with emphasis in medical tourism, the creation of
websites with the aim of highlighting the city and the region in general, with reference to the
provision of medical services, and specialized information about the offered medical services,
treatments, facilities and cost.
4. Infrastructure - Establishments
As found by the survey, the existing medical infrastructure is considered satisfactory and able
to attract patients-tourists. However the infrastructure can be strengthened in:
Thalassotherapy Centers in hotels, and perhaps in some rehabilitation centers.
Additional centers for physical medicine and rehabilitation, of which there are many
modern ones in the area, are not necessary. However, it may be necessary to strengthen
such departments in the private clinics.
Creation of clinical departments providing specialized medical services, such as in vitro
fertilization, Ophthalmology etc.
Geriatric services, centers that are not specialized in the area. These should be modern and
have the ability to support the elderly foreigners, who wish to spend some time in Greece
and have the corresponding medical and nursing support.
New private clinics are not needed. However, the modernization and the Accreditation of
the clinics are required.
17
5. Medical treatments
Strengthening of specialized medical services to attract medical tourist in the treatments of
cosmetic surgery, physical Medicine and rehabilitation, Dialysis and Nephrology is essential.
The development of medical tourism can be achieved through successful collaborations
between Health Units of high standards with luxury Hotel facilities. The co-operating parties
should jointly contribute to the competitive profile and international projection of medical
tourism packages offered. Synergies and collaboration between medical and tourism services
should include, in addition to the basic medical operations and hospitalization of the patient
that is exclusive competence of the Health Unit, the following Rehabilitation after the medical
treatment, flight services, transfers, and additional services for guests and escorts, excursions
etc.
REFERENCES
Andriotis K. (2000) Thermal and Spa Tourism Study. Greek Ministry of Development. Greek
Tourism property SA. Estate Exploitation Program GNTO. Athens (in Greek).
Barth, Reno & Werner, Christian (2005) Der Wellness-Faktor: modernes
Qualitätsmanagement im Gesundheitstourismus. Relax-Verlag. Wien.
Carrera, P. & Lunt, N. (2010) A European perspective on medical tourism: the need for a
knowledge base. International Journal of Health Services, 40, 469-84.
Christoforidou, Sofia (2012) Health tourism destination Thessaloniki. Makedonia newspaper
23/04/2012 available in http://www.makthes.gr/news/reportage/87168/. [Last
access 15/01/2014].
Cossar, J., Reid, D., Fallon, R., Bell, E., Riding, M., Follett, E., Dow, B., Mitchell, S., and
Grist, N. (1990) A cumulative review of studies on travelers, their experience of
illness and the implications of these findings. Journal of Infection. 21, 27-42.
Dawood, R. (1989) Tourists’ Health- could the industry do more? Tourism Management. 4,
285-7.
Didaskalou, E. (2000) Health tourism: A new approach of Tourism Development on Insular
Areas. Paper presented at the International Conference “Tourism on Islands and
Specific Destinations”, December 14-16, Chios, University of Aegean.
Doxiadis, Katsapi, Souliotis, Tountas (2012) Development of Medical tourism in Greece.
Institute for Social and Preventive Medicine. Athens (in Greek).
18
Frenk, J. (2004) Health and the Economy. A vital relationship. OECD Observer No 243 May
2004. Available in: http://www.oecdobserver.org/news/archivestory.php/aid/1241/
Health_and_the_economy:_A_vital_relationship_.html#sthash.uTHcknoB.dpuf
Grail Research (2009) The Rise of Medical Tourism 2009, by Grail Research, LLC
Greek Travel Pages (2013) 2nd Greek Medical & Health Tourism Workshop30 October 2013.
Available in http://news.gtp.gr/event/greek-medical-health-tourism-workshop-
2013/. [Accessed 14/12/2013].
Hellenic Civil Aviation Authority (2014) Statistical Data - Air Traffic Statistics. Available
in: http://www.ypa.gr/content/index.asp?tid=34&lang=2 last access 16/1/2014
Hellenic Chamber of Hotels (2013) Researches – Studies – Publications. Available in
http://www.grhotels.gr/GR/BussinessInfo/Pages/studies.aspx. [Accessed 17/01/14].
Hunter- Jones, P. (2003). The Perceived Effects of Holiday- Taking upon the Health and
Wellbeing of Patients Treated for Cancer. International Journal of Tourism
Research. 5, 183-196.
Jagyasi, P. (2009.) Medical tourism definition. Available in
http://community.medicaltourism.com/video/medical-tourism-definition-by [Last
access date: 13/01/14].
Kaspar, Claude 1996: Gesundheitstourismus im Trend. In: Kaspar, Claude: Jahrbuch der
schweizerischen Tourismuswirtschaft. Institut für Tourismus und
Verkehrswirtschaft, St. Gallen 1996, p. 53-61.)
Neil Lunta, Neil & Carrerab Percivil (2010): Medical tourism: Assessing the evidence on
treatment abroad. Maturitas 66:27–32
Mathieson, A. and Wall, G. (1982). Tourism: economic, physical and social impacts. London:
Longman.
Mc Kinsey &Company (2014): Healthcare Systems & Services – Overview. Available in
http://www.mckinsey.com/client_service/healthcare_systems_and_services. [Last access
13/1/14].
Müller, H. and Lanz, E. (1998). Wellness Tourismus in der Schweiz: Definition, Abgrenzung
und empirische Angebotsanalyse. Tourismus Journal, 2 (4), 477-494.
Mueller, H and Lanz-Kaufmann, E. (2001).Wellness Tourism: Market analysis of a special
health tourism segment and implications for the hotel industry. Journal of Vacation
Marketing. 7(1), 5-17.
Neil Lunt, Richard Smith, Mark Exworthy, Stephen T Green, Daniel Horsfall and Russell
Mannion (2011) Medical Tourism: Treatments, Markets and Health System
19
Implications: A scoping review. OECD, Directorate for Employment, Labour and
Social Affairs Available in http://www.oecd.org/els/health-systems/48723982.pdf
[Accessed 13/1/2014.]
Patientsbeyondborders (2013). Medical Tourism Statistics & Facts. Available URL:
http://www.patientsbeyondborders.com/medical-tourism-statistics-facts [Last Access
27/1/2014].
Rodriguez- Garcia, R. (2001).The Health Development Link: Travel as a public health issue.
Journal of Community Health. 26 (2), 93-112.
Rosenmöller M, McKee M, Baeten R, editors (2006). Patient mobility in the European
Union: learning from experience. Denmark: European Observatory on Health
Systems and Policies.
Rulle, M. (2008), Der Gesundheitstourismus in Europa: Entwicklungstendenzen und
Diversifikations-strategien. München, Germany & Wien, Austria: Profil Verlag.
Rulle, Monika; Hoffmann, Wolfgang; Kraft, Karin: Erfolgsstrategien im
Gesundheitstourismus: Analyse zur Erwartung und Zufriedenheit von Gästen, Erich
Schmidt, Berlin, 2010, p. 6
Spathi, S. (2000). The Health spa Tourism and the development of health tourism in Greece.
Center of Planning and Economic Research KEPE. Athens.
Thessaloniki Hotels Association (2014) Press release 4/10/2013. Available in:
http://www.tha.gr/default.aspx?lang=el-GR&page=52&newsid=114. [Accessed
25/11/2013]
TreatmentAbroad. (2009), United Kingdom: Medical tourism to the UK. Available:
http://www.treatmentabroad.com/medical-tourism/news/?EntryId82=250044.
Treatmentabroad (2012) Medical tourism research: The Treatment Abroad Medical Tourism
Survey 2012. Available in: (http://www.treatmentabroad.com/medical-
tourism/medical-tourist-research-2012. [Accessed 16/12/2013].
Press Vivien Breitrück & Elena Nunn, (2011): Health & medical tourism. Simply synonyms?.
In Alexis Papathanassis (Editor) The Long Tail of Tourism. Holiday Niches and
their Impact on Mainstream Tourism (pp 57-67). Gabler Verlag, Wiesbaden
Youngman, I. (2009), Medical tourism statistics: Why McKinsey has got it wrong.
International Medical Travel Journal. Available in
http://www.imtjonline.com/articles/2009/mckinsey-wrong-medical-travel/
[Accessed 13/1/2014].
