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

1. THECONTRIBUTION OF THERMAL TOURISM TO HEALTH TOURISM, ITS STATUS AND IMPORTANCE

2. Dr. Dursun AYDIN President of “Association of ImprovingHealthTourism”

3. DEVELOPMENT OF TOURISM IN TURKEY NUMBER OF TOURISTS ACCORDING TO YEARS 1965 361.758 1975 1.540.904 1985 2.614.924 1995 7.726.886 2004 17.516.908 (Source: DİE)

4. ALTERNATIVE TOURISM TYPES • Winter tourism • Culture tourism • Health tourism • Belief tourism • Sports tourism • Mountain tourism • Congress tourism • Hunting tourism • Yacht tourism • Plateau tourism etc.

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

6. HEALTH TOURISM TOPICS • Planned Treatment • Health services out of insurance coverage (Laser Excimer, hair transplantation, plastic surgery) • Health services that insurance does cover (dialysis patients, immediate aid services, etc.) • Thermal Spring Treatment • Relaxation purposed thermal spring services (Wellness, Restness) • Treatment purposed thermal spring services (Cure Treatment) • Elderly and Handicapped Resorts (Holiday and care purposed)

7. SPA TOURISM

8. THERMAL SPRING TOURISM The trips to take advantages of the thermal springs • Going from one country to another for thermal spring treatments which of those medical necessities are determined with the certificates. • Taking advantages of the thermal springs with the broad hotel services in a comfortable environment in order to rest, relax and feel better. Mostly the limits of 1 and 2 may not be seperated from each other. Even these 2 may be served together.

9. THERMAL SPRING TOURISM IN THE WORLD • In European countries (especially East Europe) generally treatment purposed (cure therapy) thermal spring services are prevalent. • In USA, Canada and many Asian countries, the services are generally for vacation purposes (wellness, restness, relaxation)

10. THERMAL SPRING ENTERPRICES IN THE WORLD • In West European countries (Germany, France, Austria etc.) there are primarily treatment purposed centers. They are expensive. • In East European countries (Hungary, Greece, Italy, Czech Republic and Slovakia) there are luxurious thermal springs aimed both for thermal spring tourism and for treatment. They are cheap • In USA and Canada there are numerous SPA centers in luxurious, big hotels.

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

12. THERMAL SPRING TOURISM IN OUR COUNTRY b) Treatment purposed thermal spring tourism Includes the patients whom are diagnosed by the doctors in their own countries to come to our country for treatment and to take advantages of the thermal springs. They also have to be treated under doctor control, in the thermal springs, within the limits of the rules of medicine in Turkey. In this part, the quality of the thermal spring and its physical type become more important than luxury. Even modern small thermal spring centers can serve to this purpose.

13. THE LATEST STATUS OF THERMAL SPRING SERVICES IN OUR COUNTRY • It is not advertised and marketed well in our country and abroad. Actually the advertisement of the thermal springs have never been made in foreign countries. • The cure treatment indications were not settled in our country. • FTR recently has gained its importance and is the only clinic that gives referral to thermal spring. • Even with the diagnosed medical indications, the certified thermal springs that a patient could go, have not been widespread up to now. • The amount that social security organizations pay are far below the actual costs. • A serious study or research have not been made about the referrals of patients abroad for spa treatment by European Health Krankenkasses and their reimbursements.

14. EUROPEAN THERMAL SPRINGS IN FIGURES • Europe : 1100 thermal springs and cure centers available • Germany : 330 thermal springs, 350.000 employees, 950.000 bed capacity, 26.500 Million Euros income • Italy : 200 thermal springs, 6 million/year visitor • Hungary : 120 thermal springs • Bulgaria : 300 thermal springs • Czech Republic, Slovakia, Slovenia : 190 thermal springs and cure centers

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

16. EUROPEAN INSURANCES’ POINT OF VIEW ABOUT THE FOREIGN THERMAL SPRING SERVICES 1 Foreign cure providers have become more preferable in order to reduce the costs in cure treatment services. Although GKV pleases the insurance members, the German cure providers feel stressed and want that foreign expansion should be suppressed. They are emphasizing that at least an equal competition atmosphere should be created and stress that the opportunity should be given to the just cure providers which fit the German cure standards.

17. EUROPEAN INSURANCES’ POINT OF VIEW ABOUT THE FOREIGN THERMAL SPRING SERVICES 2 Since February 2005 approximately 20 BKK (betriebskrankenkassen) health insurance associations have made an agreement with Czech Republic cures and agreed on special discounts. For all the health insurances, expense (money) factor comes first. This cure is legally based on East European Countries’ Guarantee meeting expenses made in 2004. According to this law, the health insurance will cover all the expenses of its member in case the member travels to another EU country for the cure.

18. EUROPEAN INSURANCES’ POINT OF VIEW ABOUT THE FOREIGN THERMAL SPRING SERVICES 3 Barmer and AOK do not think of making that kind of an agreement. Barmer Spare Health Insurance indicated that they would be making agreements abroad when it was cought up with German health standards abroad. DKVA, the connection center of foreign insurances and German insurances, is seeking insurances and health system abroad. At the end of it, by the agreements with the insurances abroad treatments will be permitted. MDK which is German local quality research and health insurances association (medical service branch of health insurance associations) is taking care.

20. THERMAL SPRING TOURISM IN EUROPEAN PRESS 1 May 2005. Newspaper: (“Der Gelbe Dienst” vom 25.04.2005): German cure execution association (DHV) and cure pension execution association (VdKB) were displeased with the insurance companies and sent a complaint letter to German Health Minister, Ulla Schmidt telling that choice of foreign countries put German providers in a difficult position. They said that they were ready for competition but that kind of unfair competition was wrong. They indicated that the foreign cures are below German quality standards and blamed the insurances for not making the essential quality control for the patients but foregrounding just the cheap prices.

21. THERMAL SPRING TOURISM IN EUROPEAN PRESS 2 Newspaper: Augsburger Allgemeinen Zeitung vom 12.04.2005: While in 90s approximately 580.000 cures were registered, these days this number was decreased to 110.000. Beside AOK pioneer H.Platzer, other insurances and cure providers emphasized that, an equal competition atmosphere should be formed. It was pointed out that East Europe was drawing attention with its favourable prices. DHV cure execution pioneer Kirchner said that the education/training standards should be equal and pointed out that a group of contractors were establishing a massage auditorium after a 8 weeks of massage training in Poland. In addition to that, AOK pioneer Platzer emphasized that, if the foreign cures do not catch up these standards and get certified, AOK insurance members would not be able to pay the cure prices.

22. THERMAL SPRING TOURISM IN EUROPEAN PRESS 3 NEWSPAPER:Vogtland-Anzeiger vom 11.04.2005: The future policy of Germany left the question, whether they take legal measures for the insurances approving Czech Republic and Polland’s cures or not, unanswered. By emphasizing that quality ISO-standards should be used in this matter, Europe commission pioneer of German cure association Kirchner said that until the year 2007 approximately 22 European countries would catch up these ISO German cure standards and got the ISO certificate.

23. THERMAL SPRING TOURISM IN EUROPEAN PRESS 4 NEWSPAPER:Vogtland-Anzeiger vom 11.04.2005: Bayern state cure pioneer said that, the cure patients became conscious and while the %70 of them were insured patients and %30 were the ones came by their own pocket eight years ago, now these percentages were turned upside down. Now %70 of them were coming by their own pockets and %30 of the expenses were paid by the insurance. If the standards of the cures in Europe weren’t be raised as expected, German cure providers would be facing big problems. In last 10 years, German cure providers spent 450 million Euros in order to raise the cure quality.

24. THE THERMAL SPRING PACKAGES THAT CAN BE PROVIDED IN OUR COUNTRY • Classic SPA packages • Additional city tours in case of request • Basic medical support, general doctor control, immediate aid • Extra health services • Dental care • Excimer laser • Hair transplantation • Check-up • Oxygen therapy

25. WHAT SHOULD WE DO 1 We should decide if we are going to incline thermal spring tourism with the purpose of treatment or the purpose of relaxation. Of course relaxation purposed thermal spring tourism is more easier and practical for our country. But further, many of our facilities should be completed in terms of medical infrastructure and be prepared for treatment purposed thermal spring tourism.

26. WHAT SHOULD WE DO 2 The infrastructure and standards of the thermal springs should be determined and put into practice. We should increase thermal spring investments in the country. We should skip our tourism experience and potential to thermal spring tourism, especially in winter. In the process of joining the EU, we should prepare our thermal springs to EU standards and accredit them.

27. WHAT SHOULD WE DO 3 A commission, consisting Ministry of Tourism, Ministry of Health, Ministry of Labor and Social Security, Ministry of Energy and Natural Resources and concerned CSA and thermal spring providers should be established. Advertisement; our country’s thermal spring potential, should be promoted and marketed by a serious cooperation with domestic and foreign operators, primarily through this commission.

28. WHAT SHOULD WE DO 4 Studies related with treatment purposed thermal spring tourism should be done. Qualified staff should be trained (doctors, health staff, support team) Medical infrastructure and certification should be made for the thermal springs. Accreditation on par with the world standards should be performed. In the framework of international agreements, the fact that the use of expatriates’ thermal spring should be , facilitated (with referral from SSK, they can get served from BUT prices)

29. WHAT SHOULD WE DO 5 • SUPPORT Thermal spring intended trips should be made like the government authorities do businessmen trips on various times. For example, a team consisting of ministry authorities, CSA authorities and thermal spring providers may examine East Europe thermal springs and these kinds of trips should be often.

30. CONCLUSION We should not forget that we own the most potential thermal spring resources but we can not market them, that Europe searches for the cheap but high quality standardized thermal springs in order to reduce the costs, that we should move altogether with the providers, CSAs and the government authorities for publicity, that we must carry our thermal spring reserves to be on par with the world standards, to promote them and to have trainings to have qualified staff

31. THANK YOU FOR YOUR CONCERN AND PATIENCE