A Hybrid Fuzzy MCDM Approach for Sustainable Health Tourism Sites Evaluation

Introduction

Since the first definition of the phenomenon of tourism was revealed at the beginning of the 20th century, various definitions have continued to be given by many institutions and organizations over the years (Netto, 2009). It is possible to explain tourism as traveling for a certain period of time (Franklin, 2003). Tourism has become to express a broader meaning than these definitions due to its strong economic and social impacts (Song et al., 2012). Today, tourism is one of the largest industries in the world, with numerous employment opportunities and the huge economy it creates directly or indirectly. Factors such as the changing socio-economic structure of the world population, increasing urbanization and the formation of tourism culture have contributed to the development of tourism (Beeton, 2006). Moreover, the cheaper, easier, and more convenient travel opportunities form one of the driving forces in the growth of the tourism economy (Medlik, 2012). Tourism and travel provided an economy of $ 9170 billion and jobs for 334 million people worldwide in 2019 (WTTC, 2021).

In order to categorize the concept of tourism, many different parameters can be considered. For instance, it can be classified according to destination, number of people and season (Tureac & Turtureanu, 2010). Tourism can also be divided into many types according to the purpose of the participants such as sea tourism, congress tourism, yacht tourism, golf tourism, cultural tourism, etc. (Becken & Simmons, 2002). One of them is health tourism, which is one of today's tourism trends.

Health (or healthcare) tourism is a rapidly growing field all over the world. It is defined by World Tourism Organization (UNWTO, 2018) as “…tourism which have as a primary motivation, the contribution to physical, mental and/or spiritual health through medical and wellness-based activities which increase the capacity of individuals to satisfy their own needs and function better as individuals in their environment and society.” There is another definition (Hudson, 2012) as “...traveling overnight away from the normal home environment for the express benefit of maintaining or improving health, and the supply and promotion of facilities and destinations which seek to provide such benefits.” Although wellbeing and medical tourism are often used instead of health tourism, it has a content that encompasses both of these (Carrera & Bridges, 2006). It is also an inclusive concept that includes medical, preventive and truth tourism (Izadi et al., 2012).

In 2019, it is estimated that the economy created by health tourism activities was $ 65-87.5 billion (Salehi-Esfahani et al., 2021). Many countries are working on strategies that prioritize health tourism opportunities in their country promotions and increase their share in the health tourism market by serving a large number of people (Khan et al., 2020). In order to achieve this trend, countries emphasize and advertise their natural resources (spa, thermal water, etc.) and climate advantages (Mrčela et al., 2015). Since traveling for diagnosis, treatment and surgery is also included in health tourism, health investments and workforces such as doctors are also highlighted (Connell, 2006).

The expectation of high economic returns provided by mass tourism activities caused the issue of sustainability to remain in the background. It is known that natural resources are negatively affected in destinations such as coastlines, islands and riversides where tourism activities are generally very intense (Weaver et al., 1999). Furthermore, these activities cause widely economic, social, and cultural damages. Sustainable tourism practices make tourism continue by conducting protective planning and activities in the destination and the region where it is located (Swarbrooke, 1999). The concept of sustainable health tourism has emerged to maintain activities without damaging resources that provide health tourism (Liu, 2003).