Perspectives for Medical Tourism Development in Portugal's Central Region: The View of Healthcare Stakeholders

Introduction

The growth of travel for health purposes had its beginning in the late 1990s, with an increasing number of individuals traveling, within and outside their countries of origin, pursuing specific medical treatments or any other therapies, as well as engaging in complementary and leisure activities (Connell, 2008). In fact, this type of travel can be traced back to the ancient times, namely the Roman period, due to the proliferation of thermal facilities and public baths throughout the entire empire (Jakšić- Stojanović, Janković, & Šerić, 2019). Nevertheless, the product known as health tourism, as well as its subcategories, is still a recent phenomenon.

Dunn (1959) stated, more than fifty years ago, the need for developing a new health paradigm in line with demographic, social, economic and policy changes. More recently, the widening of the “travel motivation basis” (Cunha, 2006, p. 79), as well as higher life standards, which generate new health challenges and, consequently, the need for improved physical, mental and psychological states/conditions, led to the multiplication or branching of tourism forms (Cunha, 2006), namely health tourism. In some way, these needs led to the globalization of healthcare, which, in turn, generated differentiated patterns of consumption and production of healthcare services (OECD, 2014). Due to an extended globalization process, the health industry started to generate visitors (patients) traveling from their origin country to the destination in pursuit of medical and non-medical (or prevention) treatments (Freitas, 2010; Henama, 2014; OEDC, 2014). Although being a secular activity, the increasing interest in healthy lifestyles (Charity, Walter, Forbes, Kumbirai, & Margaret, 2013) recently promoted the development of several concepts linked to health tourism, that “collide or cross with other pre-existing forms, giving rise to scenarios of conflict” (Cunha, 2006, p. 79). Charity et al. (2013) found that the term medical tourism was used to refer to both dimensions of health tourism (Lee & Spisto, 2007, cited in Charity et al., 2013) or, in a different approach, as a specific term meaning medical treatments (Pollock & Williams, 2000, cited in Charity et al., 2013). The health tourism concept is, however, in the great majority of the cases, established in the same theoretical framework and understood as a unifying concept from which two other crucial terms emerge: medical tourism and wellness tourism (Cunha, 2006; Mueller & Kaufmann, 2000; Smith & Puczkó, 2009; Yoong, Sulaiman, & Balday, 2013).

The health tourism sector has been growing due to the rising costs of medical treatments and healthcare in developed countries (Martins, Lunt, Freitas, Ribeiro, & Klein, 2014), long waiting lists, higher incomes, and improved human and technological resources and services in developing countries (Connell, 2008)¹. This is clearly a great opportunity for developing countries, given that the globalization of healthcare services becomes obligatory (Martins et al., 2014).

Maybe because its poorly defined boundaries, it is difficult to measure the health tourism market. Nonetheless, it is estimated that 3-4% of the world population travels internationally for medical treatment and, in the European context, health motivation accounted for a total of 9.4 million trips in 2011 (IPK International, 2012). In terms of revenue, Martins et al. (2014) estimate a share of 20% for medical tourism and 80% for health tourism. SRI International (2010) has developed a model of the wellness industry that includes nine industry sectors, estimating that this cluster represents a market of nearly US$ 2 trillion dollars globally, revealing that the wellness tourism market has reached US$ 106 billion, more than double the size of the medical tourism market at US$ 50 billion.