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Page 1: THE CONTRIBUTION OF THERMAL TOURISM TO HEALTH TOURISM, ITS STATUS AND IMPORTANCE

THETHE CONTRIBUTION OF THERMAL CONTRIBUTION OF THERMAL TOURISM TO HEALTH TOURISM, ITS TOURISM TO HEALTH TOURISM, ITS

STATUS AND IMPORTANCE STATUS AND IMPORTANCE

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Dr. Dursun AYDINDr. Dursun AYDIN

President of President of ““Association of Improving Health Tourism”Association of Improving Health Tourism”

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DEVELOPMENT OF DEVELOPMENT OF TOURISM IN TURKEY TOURISM IN TURKEY

19651965 361.758361.75819751975 1.540.9041.540.90419851985 2.614.9242.614.92419951995 7.726.8867.726.88620042004 17.516.90817.516.908

(Source: DİE)(Source: DİE)

NUMBER OF TOURISTS ACCORDING TO YEARS

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ALTERNATIVE TOURISM TYPESALTERNATIVE TOURISM TYPES

Winter tourismWinter tourism Culture tourismCulture tourism Health tourismHealth tourism Belief tourismBelief tourism Sports tourismSports tourism Mountain tourismMountain tourism Congress tourismCongress tourism Hunting tourismHunting tourism Yacht tourismYacht tourism Plateau tourism etc.Plateau tourism etc.

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HEALTH TOURISMHEALTH TOURISM

““Health tourism is going from one Health tourism is going from one country to another, because of the country to another, because of the waiting lists of hospitals, having waiting lists of hospitals, having more economical treatment or better more economical treatment or better quality health services abroad or quality health services abroad or desiring to take a vacation beside desiring to take a vacation beside the treatment or particularly going the treatment or particularly going abroad for treatment purposes.”abroad for treatment purposes.”

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HEALTH TOURISM HEALTH TOURISM TOPICSTOPICS

Planned TreatmentPlanned Treatment• Health services out of insurance coverage (Laser Health services out of insurance coverage (Laser

Excimer, hair transplantation, plastic surgery)Excimer, hair transplantation, plastic surgery)• Health services that insurance does cover (dialysis Health services that insurance does cover (dialysis

patients, immediate aid services, etc.)patients, immediate aid services, etc.) Thermal Spring TreatmentThermal Spring Treatment• Relaxation purposed thermal spring services Relaxation purposed thermal spring services

(Wellness, Restness)(Wellness, Restness)• Treatment purposed thermal spring services (Cure Treatment purposed thermal spring services (Cure

Treatment)Treatment) Elderly and Handicapped Resorts Elderly and Handicapped Resorts (Holiday (Holiday

and care purposed)and care purposed)

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SPA TOURISM

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THERMAL SPRING THERMAL SPRING TOURISMTOURISM

The trips to take advantages of the thermal springsThe trips to take advantages of the thermal springs

1.1. Going from one country to another for thermal Going from one country to another for thermal spring treatments which of those medical spring treatments which of those medical necessities are determined with the certificates.necessities are determined with the certificates.

2.2. Taking advantages of the thermal springs with Taking advantages of the thermal springs with the broad hotel services in a comfortable the broad hotel services in a comfortable environment in order to rest, relax and feel environment in order to rest, relax and feel better.better.

Mostly the limits of 1 and 2 may not be seperated from Mostly the limits of 1 and 2 may not be seperated from each other. Even these 2 may be served togethereach other. Even these 2 may be served together..

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THERMAL SPRING THERMAL SPRING TOURISM IN THE TOURISM IN THE

WORLDWORLD In European countries (especially East In European countries (especially East

Europe) generally treatment purposed Europe) generally treatment purposed (cure therapy) thermal spring services are (cure therapy) thermal spring services are prevalent.prevalent.

In USA, Canada and many Asian In USA, Canada and many Asian countries, the services are generally for countries, the services are generally for vacation purposes (wellness, restness, vacation purposes (wellness, restness, relaxation)relaxation)

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THERMAL SPRING THERMAL SPRING ENTERPRICES IN THE ENTERPRICES IN THE

WORLDWORLD In West European countries (Germany, In West European countries (Germany,

France, Austria etc.) there are primarily France, Austria etc.) there are primarily treatment purposed centers. They are treatment purposed centers. They are expensive.expensive.

In East European countries (Hungary, In East European countries (Hungary, Greece, Italy, Czech Republic and Slovakia) Greece, Italy, Czech Republic and Slovakia) there are luxurious thermal springs aimed there are luxurious thermal springs aimed both for thermal spring tourism and for both for thermal spring tourism and for treatment. They are cheaptreatment. They are cheap

In USA and Canada there are numerous SPA In USA and Canada there are numerous SPA centers in luxurious, big hotels. centers in luxurious, big hotels.

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THERMAL SPRING THERMAL SPRING TOURISM IN OUR TOURISM IN OUR

COUNTRYCOUNTRYa)a) Relaxation purposed thermal spring Relaxation purposed thermal spring

tourismtourism

Includes some of the tourists’ (especially Includes some of the tourists’ (especially the elderly) taking advantage of our the elderly) taking advantage of our country’s natural beauty and resting in country’s natural beauty and resting in geothermal resources. Here, the nature geothermal resources. Here, the nature where the thermal spring exists, the where the thermal spring exists, the quality of the geothermal and luxury quality of the geothermal and luxury environment will be very important. The environment will be very important. The main purpose is to rest and have fun and main purpose is to rest and have fun and the second is to relax and get well.the second is to relax and get well.

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THERMAL SPRING THERMAL SPRING TOURISM IN OUR TOURISM IN OUR

COUNTRYCOUNTRYb) Treatment purposed thermal spring tourismb) Treatment purposed thermal spring tourism

Includes the patients whom are diagnosed by the Includes the patients whom are diagnosed by the doctors in their own countries to come to our doctors in their own countries to come to our country for treatment and to take advantages of country for treatment and to take advantages of the thermal springs.the thermal springs.

They also have to be treated under doctor control, They also have to be treated under doctor control, in the thermal springs, within the limits of the in the thermal springs, within the limits of the rules of medicine in Turkey. In this part, the rules of medicine in Turkey. In this part, the quality of the thermal spring and its physical type quality of the thermal spring and its physical type become more important than luxury.become more important than luxury.

Even modern small thermal spring centers can Even modern small thermal spring centers can serve to this purpose.serve to this purpose.

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THE LATEST STATUS OF THE LATEST STATUS OF THERMAL SPRING SERVICES IN THERMAL SPRING SERVICES IN

OUR COUNTRYOUR COUNTRY It is not advertised and marketed well in our country and It is not advertised and marketed well in our country and

abroad. Actually the advertisement of the thermal springs abroad. Actually the advertisement of the thermal springs have never been made in foreign countries.have never been made in foreign countries.

The cure treatment indications were not settled in our The cure treatment indications were not settled in our country.country.

FTR recently has gained its importance and is the only FTR recently has gained its importance and is the only clinic that gives referral to thermal spring.clinic that gives referral to thermal spring.

Even with the diagnosed medical indications, the certified Even with the diagnosed medical indications, the certified thermal springs that a patient could go, have not been thermal springs that a patient could go, have not been widespread up to now.widespread up to now.

The amount that social security organizations pay are far The amount that social security organizations pay are far below the actual costs.below the actual costs.

A serious study or research have not been made about the A serious study or research have not been made about the referrals of patients abroad for spa treatment by European referrals of patients abroad for spa treatment by European Health Krankenkasses and their reimbursements.Health Krankenkasses and their reimbursements.

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EUROPEAN THERMAL EUROPEAN THERMAL SPRINGS IN FIGURESSPRINGS IN FIGURES

EuropeEurope : 1100 thermal springs and cure : 1100 thermal springs and cure centers availablecenters available

GermanyGermany : 330 thermal springs, 350.000 : 330 thermal springs, 350.000 employees, 950.000 employees, 950.000 bed capacity, bed capacity, 26.500 Million Euros income26.500 Million Euros income

ItalyItaly : 200 thermal springs, 6 million/year : 200 thermal springs, 6 million/year visitorvisitor

HungaryHungary : 120 thermal springs: 120 thermal springs BulgariaBulgaria : 300 thermal springs: 300 thermal springs Czech Republic, Slovakia, SloveniaCzech Republic, Slovakia, Slovenia : 190 thermal : 190 thermal

springs and cure centerssprings and cure centers

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THE LATEST STATUS OF THE LATEST STATUS OF THERMAL SPRING SERVICES THERMAL SPRING SERVICES

IN EUROPEIN EUROPEWWhile European enterprices are raising the quality hile European enterprices are raising the quality and standards, they try to raise their share on the and standards, they try to raise their share on the market at the same time.market at the same time.On the other hand the insurances try to reduce On the other hand the insurances try to reduce the thermal spring treatment costs. They bring the thermal spring treatment costs. They bring limitations, raise the contribution margin and limitations, raise the contribution margin and search for cheaper markets. People do not give up search for cheaper markets. People do not give up the standards that they are used to.the standards that they are used to.As a result of the disagreement of these three As a result of the disagreement of these three parties, people tend to go to cheaper thermal parties, people tend to go to cheaper thermal springs by paying from their own pockets.springs by paying from their own pockets.There has been now a thermal spring tourism that There has been now a thermal spring tourism that moves to out of Europe.moves to out of Europe.

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EUROPEAN INSURANCES’ POINT OF VIEW EUROPEAN INSURANCES’ POINT OF VIEW ABOUT THE FOREIGN THERMAL SPRING ABOUT THE FOREIGN THERMAL SPRING

SERVICESSERVICES 1 1

Foreign cure providers have become more Foreign cure providers have become more preferable in order to reduce the costs in cure preferable in order to reduce the costs in cure treatment services.treatment services.

Although GKV pleases the insurance members, Although GKV pleases the insurance members, the German cure providers feel stressed and the German cure providers feel stressed and want that foreign expansion should be want that foreign expansion should be suppressed.suppressed.

They are emphasizing that at least an equal They are emphasizing that at least an equal competition atmosphere should be created and competition atmosphere should be created and stress that the opportunity should be given to the stress that the opportunity should be given to the just cure providers which fit the German cure just cure providers which fit the German cure standards.standards.

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EUROPEAN INSURANCES’ POINT OF VIEW EUROPEAN INSURANCES’ POINT OF VIEW ABOUT THE FOREIGN THERMAL SPRING ABOUT THE FOREIGN THERMAL SPRING

SERVICES SERVICES 22

Since February 2005 approximately 20 BKK Since February 2005 approximately 20 BKK (betriebskrankenkassen) health insurance (betriebskrankenkassen) health insurance associations have made an agreement with Czech associations have made an agreement with Czech Republic cures and agreed on special discounts.Republic cures and agreed on special discounts.

For all the health insurances, expense (money) factor For all the health insurances, expense (money) factor comes first.comes first.

This cure is legally based on East European Countries’ This cure is legally based on East European Countries’ Guarantee meeting expenses made in 2004.Guarantee meeting expenses made in 2004.

According to this law, the health insurance will cover According to this law, the health insurance will cover all the expenses of its member in case the member all the expenses of its member in case the member travels to another EU country for the cure.travels to another EU country for the cure.

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EUROPEAN INSURANCES’ POINT OF VIEW EUROPEAN INSURANCES’ POINT OF VIEW ABOUT THE FOREIGN THERMAL SPRING ABOUT THE FOREIGN THERMAL SPRING

SERVICES SERVICES 33

Barmer and AOK do not think of making that kind Barmer and AOK do not think of making that kind of an agreement.of an agreement.Barmer Spare Health Insurance indicated that Barmer Spare Health Insurance indicated that they would be making agreements abroad when it they would be making agreements abroad when it was cought up with German health standards was cought up with German health standards abroad.abroad.DKVA, the connection center of foreign DKVA, the connection center of foreign insurances and German insurances, is seeking insurances and German insurances, is seeking insurances and health system abroad.insurances and health system abroad.At the end of it, by the agreements with the At the end of it, by the agreements with the insurances abroad treatments will be permitted.insurances abroad treatments will be permitted.MDK which is German local quality research and MDK which is German local quality research and health insurances association (medical service health insurances association (medical service branch of health insurance associations) is taking branch of health insurance associations) is taking care.care.

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THERMAL SPRING TOURISM IN THERMAL SPRING TOURISM IN EUROPEAN PRESS 1EUROPEAN PRESS 1

May 2005. Newspaper: (“Der Gelbe Dienst” vom May 2005. Newspaper: (“Der Gelbe Dienst” vom 25.04.2005):25.04.2005):

German cure execution association (DHV) and cure German cure execution association (DHV) and cure pension execution association (VdKB) were displeased pension execution association (VdKB) were displeased with the insurance companies and sent a complaint with the insurance companies and sent a complaint letter to German Health Minister, Ulla Schmidt telling letter to German Health Minister, Ulla Schmidt telling that choice of foreign countries put German providers in that choice of foreign countries put German providers in a difficult position. They said that they were ready for a difficult position. They said that they were ready for competition but that kind of unfair competition was competition but that kind of unfair competition was wrong.wrong.

They indicated that the foreign cures are below German They indicated that the foreign cures are below German quality standards and blamed the insurances for not quality standards and blamed the insurances for not making the essential quality control for the patients but making the essential quality control for the patients but foregrounding just the cheap prices.foregrounding just the cheap prices.

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THERMAL SPRING TOURISM IN THERMAL SPRING TOURISM IN EUROPEAN PRESS 2EUROPEAN PRESS 2

Newspaper: Augsburger Allgemeinen Zeitung vom 12.04.2005:Newspaper: Augsburger Allgemeinen Zeitung vom 12.04.2005:While in 90s approximately 580.000 cures were While in 90s approximately 580.000 cures were

registered, these days this number was decreased to registered, these days this number was decreased to 110.000.110.000.

Beside AOK pioneer H.Platzer, other insurances and Beside AOK pioneer H.Platzer, other insurances and cure providers emphasized that, an equal competition cure providers emphasized that, an equal competition atmosphere should be formed. It was pointed out that East atmosphere should be formed. It was pointed out that East Europe was drawing attention with its favourable prices.Europe was drawing attention with its favourable prices.

DHV cure execution pioneer Kirchner said that the DHV cure execution pioneer Kirchner said that the education/training standards should be equal and pointed education/training standards should be equal and pointed out that a group of contractors were establishing a massage out that a group of contractors were establishing a massage auditorium after a 8 weeks of massage training in Poland.auditorium after a 8 weeks of massage training in Poland.

In addition to that, AOK pioneer Platzer emphasized In addition to that, AOK pioneer Platzer emphasized that, if the foreign cures do not catch up these standards that, if the foreign cures do not catch up these standards and get certified, AOK insurance members would not be able and get certified, AOK insurance members would not be able to pay the cure prices.to pay the cure prices.

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THERMAL SPRING TOURISM IN THERMAL SPRING TOURISM IN EUROPEAN PRESS 3EUROPEAN PRESS 3

NEWSPAPER:Vogtland-Anzeiger vom 11.04.2005:NEWSPAPER:Vogtland-Anzeiger vom 11.04.2005:

The future policy of Germany left the The future policy of Germany left the question, whether they take legal measures for question, whether they take legal measures for the insurances approving Czech Republic and the insurances approving Czech Republic and Polland’s cures or not, unanswered.Polland’s cures or not, unanswered.

By emphasizing that quality ISO-standards By emphasizing that quality ISO-standards should be used in this matter, Europe should be used in this matter, Europe commission pioneer of German cure association commission pioneer of German cure association Kirchner said that until the year 2007 Kirchner said that until the year 2007 approximately 22 European countries would approximately 22 European countries would catch up these ISO German cure standards and catch up these ISO German cure standards and got the ISO certificate.got the ISO certificate.

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THERMAL SPRING TOURISM IN THERMAL SPRING TOURISM IN EUROPEAN PRESS 4EUROPEAN PRESS 4

NEWSPAPER:Vogtland-Anzeiger vom 11.04.2005:NEWSPAPER:Vogtland-Anzeiger vom 11.04.2005:

Bayern state cure pioneer said that, the cure patients Bayern state cure pioneer said that, the cure patients became conscious and while the %70 of them were became conscious and while the %70 of them were insured patients and %30 were the ones came by their insured patients and %30 were the ones came by their own pocket eight years ago, now these percentages own pocket eight years ago, now these percentages were turned upside down. Now %70 of them were were turned upside down. Now %70 of them were coming by their own pockets and %30 of the expenses coming by their own pockets and %30 of the expenses were paid by the insurance.were paid by the insurance.

If the standards of the cures in Europe weren’t be If the standards of the cures in Europe weren’t be raised as expected, German cure providers would be raised as expected, German cure providers would be facing big problems. In last 10 years, German cure facing big problems. In last 10 years, German cure providers spent 450 million Euros in order to raise the providers spent 450 million Euros in order to raise the cure quality.cure quality.

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THE THERMAL SPRING PACKAGES THAT THE THERMAL SPRING PACKAGES THAT CAN BE PROVIDED IN OUR COUNTRYCAN BE PROVIDED IN OUR COUNTRY

Classic SPA packagesClassic SPA packages Additional city tours in case of requestAdditional city tours in case of request Basic medical support, general doctor control, Basic medical support, general doctor control,

immediate aidimmediate aid Extra health servicesExtra health services Dental careDental care Excimer laserExcimer laser Hair transplantation Hair transplantation Check-upCheck-up Oxygen therapyOxygen therapy

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WHAT SHOULD WE DO WHAT SHOULD WE DO 11

We should decide if we are going to incline We should decide if we are going to incline thermal spring tourism with the purpose of thermal spring tourism with the purpose of treatment or the purpose of relaxation. Of course treatment or the purpose of relaxation. Of course relaxation purposed thermal spring tourism is relaxation purposed thermal spring tourism is more easier and practical for our country. But more easier and practical for our country. But further, many of our facilities should be further, many of our facilities should be completed in terms of medical infrastructure and completed in terms of medical infrastructure and be prepared for treatment purposed thermal be prepared for treatment purposed thermal spring tourism.spring tourism.

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WHAT SHOULD WE DO WHAT SHOULD WE DO 22

The infrastructure and standards of the The infrastructure and standards of the thermal springs should be determined and put thermal springs should be determined and put into practice.into practice.

We should increase thermal spring We should increase thermal spring investments in the country.investments in the country.

We should skip our tourism experience and We should skip our tourism experience and potential to thermal spring tourism, especially in potential to thermal spring tourism, especially in winter.winter.

In the process of joining the EU, we should In the process of joining the EU, we should prepare our thermal springs to EU standards and prepare our thermal springs to EU standards and accredit them.accredit them.

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WHAT SHOULD WE DOWHAT SHOULD WE DO 3 3

A commission, consisting Ministry of A commission, consisting Ministry of Tourism, Ministry of Health, Ministry of Labor Tourism, Ministry of Health, Ministry of Labor and Social Security, Ministry of Energy and and Social Security, Ministry of Energy and Natural Resources and concerned CSA and Natural Resources and concerned CSA and thermal spring providers should be established.thermal spring providers should be established.

Advertisement; our country’s thermal Advertisement; our country’s thermal spring potential, should be promoted and spring potential, should be promoted and marketed by a serious cooperation with domestic marketed by a serious cooperation with domestic and foreign operators, primarily through this and foreign operators, primarily through this commission.commission.

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WHAT SHOULD WE DO WHAT SHOULD WE DO 44

Studies related with treatment purposed Studies related with treatment purposed thermal spring tourism should be done.thermal spring tourism should be done.

Qualified staff should be trained (doctors, Qualified staff should be trained (doctors, health staff, support team)health staff, support team)

Medical infrastructure and certification Medical infrastructure and certification should be made for the thermal springs.should be made for the thermal springs.

Accreditation on par with the world Accreditation on par with the world standards should be performed.standards should be performed.

In the framework of international In the framework of international agreements, the fact that the use of expatriates’ agreements, the fact that the use of expatriates’ thermal spring should be , facilitated (with thermal spring should be , facilitated (with referral from SSK, they can get served from BUT referral from SSK, they can get served from BUT prices)prices)

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WHAT SHOULD WE DO WHAT SHOULD WE DO 55

SUPPORTSUPPORT

Thermal spring intended trips should be Thermal spring intended trips should be made like the government authorities do made like the government authorities do businessmen trips on various times. For example, businessmen trips on various times. For example, a team consisting of ministry authorities, CSA a team consisting of ministry authorities, CSA authorities and thermal spring providers may authorities and thermal spring providers may examine East Europe thermal springs and these examine East Europe thermal springs and these kinds of trips should be often. kinds of trips should be often.

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CONCLUSIONCONCLUSIONWe should not forget We should not forget

that we own the most potential thermal spring resources that we own the most potential thermal spring resources but we can not market them, but we can not market them,

that Europe searches for the cheap but high quality that Europe searches for the cheap but high quality standardized thermal springs in order to reduce the costs, standardized thermal springs in order to reduce the costs,

that we should move altogether with the providers, CSAs that we should move altogether with the providers, CSAs and the government authorities for publicity,and the government authorities for publicity,

that we must carry our thermal spring reserves to be on that we must carry our thermal spring reserves to be on par with the world standards, to promote them and to have par with the world standards, to promote them and to have trainings to have qualified stafftrainings to have qualified staff

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THANK YOU FOR YOUR CONCERN THANK YOU FOR YOUR CONCERN AND PATIENCEAND PATIENCE

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