Contemporary Studies and Theories in Tourism

Introduction

The advancement of science and technology, the acceleration of globalization and the increase in expectations from health systems have caused people to seek international access to health services. As individuals’ desire to access fast and quality health services gained an international dimension, the concept of health tourism emerged, and a new economic market was created for countries. Cross-border mobility of people with the desire to access faster, cost-effective, and reliable health services is defined as health tourism (Rai, 2019). Health tourism; it is recognized as a dynamic, rapidly growing, multidisciplinary field of economic activity and knowledge. Many factors such as quality of health services, cost, culture, social norms, and treatment duration are effective in country preferences (Zhong et al., 2021).

Since health tourism occurs as a result of international mobility, cross-border travels for different purposes need to be categorized. Cohen (2014); evaluated health tourists in three subcategories: (a) Tourists for holiday and treatment purposes: Those who prefer countries whose travel reasons are not only for treatment purposes and have sufficient facilities for the treatment of their existing illnesses. (b) Vacationing patient: These are people who use their preferred region for a holiday after treatment. After the treatment, they continue holiday. They take the availability of these opportunities into account when choosing a country. (c) Mere patients: The main purpose of these people’s travel destination preferences is the use of healthcare services.

According to the generally accepted classification of health tourism worldwide, its three main sub-components are it is seen that there are tourism services including medical tourism, thermal tourism and spa-wellness tourism, care and rehabilitation services for the elderly and the disabled (Tengilimoğlu, 2017). Increasing costs of health institutions affect social security institutions financially. To solve such difficulties, social security institutions and private health insurance organizations focus on providing health services to their citizens at a lower cost by making lower-cost contracts with countries with quality health facilities. Thanks to technological developments, especially in medical services, a globalization effort has begun in healthcare services around the world, and with the development of transportation facilities between countries, such medical journeys have tended to increase.

Health tourism, which was previously considered an alternative type of tourism, has developed as a sector over time, its economic power has rapidly increased, and it has become an attractive field. In an increasingly globalizing world, people’s health needs and the ways they meet them have also differed. Motivated by factors such as inadequate insurance coverage in some countries, long waiting times, high healthcare fees, receiving better quality service and benefiting from high technology, health tourism has become a growing market and competitive area. In this context, Türkiye is on its way to becoming a strong actor in the field of health tourism with its tourism potential and health sector capacity. In this study, the general situation of health tourism in Türkiye will be examined in detail under the headings of medical, thermal, elderly, and disabled health tourism categories. In addition, the studies carried out by public authorities in Türkiye to regulate the health tourism sector will be mentioned and its potential will be evaluated.

Health Tourism at a Glance in Türkiye

Health tourism is a developing field all over the world due to basic factors such as people’s inability to access health services produced by qualified workforce in their own countries, their inability to access high technology, and the provision of better-quality health services at lower costs in other countries (Kaymaz, 2018). Globalization around the world, long waiting times in some countries, awareness of consumers, the search for new markets by the sectors, the ability to perform illegal procedures (such as abortion) in different countries, and the desire of the tourist mass, who also have a holiday habit, to find a cure for their chronic diseases while traveling are other factors that positively affect the development of health tourism.

Health tourism creates significant added value to economies due to its structure that affects many sectors such as hotels, agencies, and transportation, especially health facilities. For this reason, health tourism has the power to be a source of growth for the economies of the countries. While health tourism enables people to access quality health services, it has become a rapidly growing sector that supports economies by increasing the employment rate. For this reason, health tourism is considered as a priority sector by many governments, and various targets are set and supported by investments and incentives (Kılavuz, 2018).

Countries such as the United States, India, Germany, South Africa, Thailand, Brazil, Mexico, and Singapore are the leading countries in health tourism in the world. In a study conducted by Global Healthcare Resources (GHR) in 2016, the top seven most preferred countries for health tourism were stated as the USA, Germany, Türkiye, India, England, Thailand, and the United Arab Emirates (Tarınç, 2019).

Türkiye is one of the most ideal regions for medical tourism and alternative health tourism thanks to its climate, sea, beaches, thermal springs, thalassotherapy facilities, forests, plateaus, as well as the ease of transportation it offers with an international airline brand that flies to the most destinations in the world (Turkish Airlines). At the same time, Türkiye has become a rising value in the field of health tourism with the worldwide recognition of cities such as Istanbul, Ankara, Izmir and Antalya, tourism infrastructure that has become a state policy and its share from the world tourism market (Tontus, 2019a).

The progress that the government has made in the field of health, especially with the Health Transformation Program implemented since 2003, the policies it has developed in the field of health tourism, especially in the period covering recent years, and the projects it has carried out, have given Türkiye the image of a great health country. In this context, in addition to the development of health services, Türkiye is taking firm steps towards becoming one of the leading countries in the field of health tourism, thanks to the development of health services and building a health system that exports health services and sets an example to the world, developing bilateral agreements with other countries, regulating this field through legal regulations, and developing its institutional structure.

Table 1.1 shows Türkiye’s number of tourist and health tourist, revenues from tourism and health tourism by years.

In 2003, Türkiye earned a total of $13.8 billion in tourism revenue, of which only 1.5 % was health tourism revenues ($203.7 million). By 2010, this rate had increased to 1.7 % and $433.4 million. In the following years, both Türkiye’s tourism revenues and health tourism revenues gradually increased. The Covid-19 epidemic, which emerged in December 2019, has deeply affected the health and health tourism sector as well as many other sectors. However, despite the pandemic conditions in Türkiye, the income from health tourism and its share in tourism revenues continued to increase. Türkiye, which earned $1.1 billion in health tourism revenue (7.9 % of total tourism revenue) in 2020, exceeded $2 billion in revenue for the first time in 2022 and earned $2.3 billion in health tourism revenue in 2023, earning 4.2 % of its total tourism revenue from health tourism. The number of foreign patients coming to Türkiye fluctuates over the years. The number of health tourists, which approached the limit of five hundred thousand in 2017, exceeded seven hundred thousand in 2019. It decreased in 2020 due to the pandemic, and in 2022, it exceeded the one million. In 2023, it is seen that 1.4 million health tourists come to Türkiye (TurkStat, 2024).

Medical Tourism in Türkiye

Although Türkiye entered the health tourism sector later compared to its Far Eastern country competitors, which entered the health tourism sector in the 1970s, it has become competitive in the sector thanks to its geographical location, qualified health manpower, price advantage, infrastructure regulations, quality tourism management and famous Turkish hospitality.

Medical tourism in Türkiye refers to the visit of foreign patients to the country for health services. Türkiye has significant potential in this field and is among the top 10 medical tourism destinations in the world (MedicalNews, 2024). When we look at the general situation of medical tourism in Türkiye, it is seen that it has strengths such as its geographical location, rich historical, cultural, and touristic texture, specialist physicians, experienced healthcare personnel and quality healthcare services, advanced medical device park, competitive price advantage, state support and infrastructure opportunities. The low number of employees who speak foreign languages and the slow functioning of the bureaucracy in public hospitals are the weaknesses. The ease of transportation to Türkiye and the higher risk of epidemics in Southeast Asia can be seen as an opportunity for Türkiye. Political instability and its possible repercussions in neighboring countries and the low-price policies of other countries in the sector are seen as a threat (Akbolat and Gülçindeniz, 2017; USTTAK, 2024).

Türkiye has become a very popular destination in terms of health tourism in recent years. The high-quality health services, modern medical technology, and affordable prices offered have made Türkiye a world-class health tourism center. Some of the prominent areas in health tourism in Türkiye are listed as follows (Turizm Günlüğü, 2022):

• Hair Transplant: Türkiye is a destination that has gained a worldwide reputation for hair transplantation. Hair transplantation procedures are successfully performed with specialist doctors and modern facilities.
• Eye Diseases Treatment: In the field of eye health, Türkiye is known for its quality services and specialist doctors. It is preferred for cataract surgeries, laser eye treatments and other eye diseases.
• Dentistry: Türkiye is also popular for cosmetic dentistry, implants, and other dental treatments. Service is provided by specialist dentists and modern clinics.
• Aesthetic Surgery: Türkiye is preferred for plastic surgery and body contouring procedures. Specialist plastic surgeons and reliable health institutions provide services in this field.
• IVF Treatment: Türkiye is also an important center for IVF treatment. With high success rates and experienced specialists, couples prefer Türkiye in this field.

In addition to these services, health services such as cardiac surgery, orthopedics, rheumatology, and check-up are also popular in Türkiye. Health tourism services in our country are at world standards and can compete with European Union countries. Therefore, a wide range is offered for patients who are considering Türkiye for health tourism.

Accreditation is one of the most important factors that give health institutions a reputation on an international scale and increase their brand value. In particular, the Joint Commission International (JCI), which is the first accreditation institution in health services, gives a roadmap for health institutions to reach an excellent structure and ensures that the success of the health institution is recognized by the public (Avcıl and Uslu, 2022). As of May 2024, Türkiye has 40 internationally accredited healthcare providers by JCI (JCI, 2024). Hospital accreditation, which is believed to be effective in the selection of health facilities in the countries planned to be visited, can be seen as an indicator of how ready the countries are for international medical tourism. From the point of view of medical tourism, one of the most striking advantages of Türkiye is the abundance of accredited health facilities.

As of 2021, Türkiye has been ranked 30th in the Medical Tourism Index (MTI), which ranks countries according to their potential in the field of health tourism, by the Medical Tourism Association, one of the leading authorities in the global medical tourism sector. Among the European countries where Spain ranks first, Türkiye has found itself in the eighth place (MTA, 2024).

Another important advantage that Türkiye has in medical tourism compared to other countries is the affordability of the prices of medical procedures. The prices of medical tourism services in Türkiye are 50 % to 80 % cheaper than in the United States and the United Kingdom. For example, while the cost of a dental implant in the United States is 3,000 dollars, it is 540 dollars in Türkiye. It is possible to have five implants in Türkiye for the same price as one implant in the United States. The prices of dental, orthopedic, and aesthetic procedures in Türkiye, the UK and the USA are compared in the Table 1.2 below (Medical Center, 2023):

In general, the difference between costs and service quality are effective and decisive in people’s departures abroad. In this context, it is seen that Türkiye has a lower cost in many medical procedures, especially in developed countries, and it is thought that it can gain a place in the medical tourism market with this advantage (Binler, 2015). Although price is not the only determining factor in the destination selection of health tourists, an affordable price policy that meets quality criteria has the potential to offer very attractive opportunities, as in the case of Türkiye.