• Ешқандай Нәтиже Табылған Жоқ

In dental tourism, the cost of treatment in the country of departure and the total budget (travel, accommoda- tion, catering, further travel expenses) in the host country have the most important role to make the decision.

In general, people can save 40-70 % of their money, depending on the nature and the location of the treat- ment. However, it is also a fact that under a certain threshold, below the savings amount, it is not «worth it»

for the patient to travel. The geographic distance of the healthcare provider plays an important role in differ- ent types of treatment. For «minor interventions», such as dental care, it is not worth for health tourists to travel to other continents; Western European dental tourists typically travel to Eastern Europe. In case of lar- ger, life-threatening surgeries, the necessity of intercontinental treatment is questionable firstly due to the long flight and, secondly, to the continuous post-treatment and possible complications. In scientific literature it is difficult to find accurate statistics about the relationship between the nature of treatments and the geo- graphical distance of the sending/receiving country. Another aspect of decision-making is whether a relative or friend of the health tourist can accompany them to the treatment, and if it is possible, how big the total will be including the costs of the accompanying person. Generally speaking, the patients arrive with an escort to the destination country who can provide spiritual support and also nurse them.

Keywords: dental tourism, health tourism, marketing trends, a provider of medical services, intercontinental treatment.

1. Introduction

According to the extent and structure of demand and supply European countries can be divided into 4 groups. Germany, Austria, and Switzerland have been significant destinations and source countries of health tourism for a long time. Germany utilizing its wide selection of thermal baths has specialized in spa tourism, while in Austria and Switzerland the so-called mountain wellness, anti-aging treatments, and clini- cal health tourism are considered significant. According to data by Euromonitor International (2015) the increase of this sector’s share is 11,1 % in Austria, while the same rate is 2,8 % in Germany. Wealthy, afflu- ent and quality-oriented guests from United Arab Emirates, Russia, Romania, Switzerland and Kazakhstan often visit Austria for health care purposes and it is estimated that 10 % of the clientele of Austria’s private clinics is made up by foreign patients. The reasons for such self-financed visits are primarily preventive med- icine, the reevaluation of diagnoses received at home, post-operative rehabilitation and the treatment of can- cerous tumours. While Austrian health care is considered excellent, the performance of its health sector is still behind that of Germany and Switzerland. Consequently, the country emphasizing wellness demonstrated by the «Austria the Well-being destination of Europe» motto, and lacking a relevant marketing strategy re- sponding to current needs still has a tremendous unexploited potential in health tourism. Naturally, Austrians do not have to give up this type of product or option, as health and wellness tourism presents an alternative for those enjoying winter vacations. Winter resorts counteracted or offset the declining visitor numbers due to the lack or unreliability of snow wth the building of wellness hotels and other resorts. The most successful spa-providers combine the classic spa options with innovative health treatments, fitness programs, exclusive lifestyle programs, culinary offers, and other cultural or leisure time attractions. Germany’s aging, yet afflu- ent population represents a significant internal demand for traditional spas and clinical tourism, while less well-off Germans seek cure for their illnesses in Asian countries. Since the German health care system is considered the best not only in Europe but globally as well, German hospitals and clinics among them Hei- delberg, Hamburg, and Stuttgart have been leading players in this sector. The high quality care, the highly trained doctors along with the short waiting lists attract wealthy patients from Eastern Europe, primarily, Romania, Bulgaria, and Russia, but also from the UK, North America, and the Arabian countries. The most often sought treatments are neuro and orthopedic surgery and cardiology. Furthermore, Switzerland’s famed mountain resorts and therapeutic baths including Leukenbad in the Alps and the more than 2000 year old Baden are favored locations for post-operative rehabilitation. At the same time more and more upper middle class guests arriving from Saudi Arabia and Eastern Europe take advantage of the innovative services

Dental tourism in Hungary

combinging traditional treatments with anti-aging and holistic programs. Swiss health tourism providers as- sign a high priority to healthy diets containing natural and organic ingredients provided by ecology- conscious farms meeting rigorous quality requirements. It is noteworthy to mention that due to the country’s traditionally high esteem of the private sphere, a certain controversial and rather macabre type of health related tourism developed in Switzerland, namely euthanasia tourism. Besides Switzerland this practice is only allowed in the Benelux countries and said service is mostly used by clients from Germany and Great Britain.

Mediterranean countries (France, Italy, Spain, and Greece) have also recognized the advantages of health tourism and they aim to reduce the negative consequences of mass tourism by the development of wellness resorts and Thalasso therapy centres. While Great Britain and the countries of Northern Europe primarily participate in therapy-oriented medical or health tourism on the sender side, countries of Central and Eastern Europe take advantage of the available therapeutic and natural cure factors to present curative or medical tourism options [1]. Hungary is the leader in the dental and cosmetic surgery tourism market. Pri- vately owned dental and cosmetic surgery clinics are significant and well-performing actors in the Hungarian health tourism sector. Yet, cardiovascular surgery, orthopedic surgery, opthalmology, onkology, gynecology, and urology present promising potential as well. Internationally acclaimed physicians, the cost effective ap- plication of innovative medical technology by famous surgeons (Hangody knee mosaic surgery method, Papp heart surgery approach) the continuous training, the increased size of the medical staff, the great Hun- garian medical advances including the Bioptron lamp, Avemar, Béres drops, Taxalbin, deuterium-free water along with the internationally famous medical training institutions (Pethő Institute, medical universities) function as guarantees for the success of the Hungarian health tourism sector. As the private dental clinics in Budapest [2], and such towns at the country’s western border as Sopron, Mosonmagyaróvár, and the vicinity of Győr are frequented by British, Irish, French, Scandinavian, and naturally, Austrian patients, Hungary is often referred to as the Mecca of dental care tourism. Dental tourism to Hungary makes up more than 40 % of the European market while its 21 % global share ranks it above Mexico (20 %) and India (15 %). Accord- ing to a 2017 report of the Central Bureau of Statistics visitors from Slovakia and Austria representing 50 and 20 % of daily border crossing traffic respectively took advantage of the health, primarily dental care ser- vices in addition to VFR and shopping options. More than half of the aggregate day-based tourism receipts (87 billion HUF) were provided by Austrians, and one third came from Slovakian visitors. Dental care re- lated expenditures are significant in both cases, with almost 50 % represented by Austrians.

2. Changing demands in health tourism, the emergence of new target groups

Market research focuses on the tourist or guest personifying demand and acting as a subject of thesys- tem. His or her needs, motivations and consumption habits provide the foundation for the development of a satisfactory supply.

While researchers tend to assign a crucial role to motivation, leisure time, and discretionary income in impacting demand, the concept of socialization [3], manifested in such impulses as treatment or prevention of disease, acquisition of medicine, or undergoing medical intervention along with seeking natural healing factors [4] should be focused upon as well. Unlike one’s general health or susceptibility to diseases health consciousness or the willingness to participate in health-related travel is not genetically coded but results from a learning process. The role or significance of the family and later as a result of the broadening social context that of the school, peer groups and work place demonstrated among others by on the job health pro- grams is undebatable. Last but not least as in consumer societies overall, prestige and the respective fashion trends can determine the demand for health-oriented travel as well [3].

The main features and motivations of the participants of health tourism have been only sporadically re- searched. Until now research programs focused on the typization of consumers based upon age and the utili- zation of the respective services [5]. While these factors play a definitive role, we must consider the signifi- cance of motivation since previously medical tourism was associated with older age groups and wellness with the younger generations. However, today, all age groups are represented in all product categories. Re- gardless of age group these customers spend a longer time at the locations where they receive the intended treatment, thus they demand comfortable, friendly atmosphere, personal touch, and special experience-based programs.

The increasingly health conscious middle aged and senior population includes relatively healthy, high spending custormers emphasizing the perservation of beauty, healthy diets, and age-specific exercise. Treat- ing health as a value and striving for the long term maintenance of a high quality of life these people are will-

ing to pay for the pleasant environment, the special relaxation experiences, and top quality services. They prefer resort spas providing all inclusive wellness and fitness services and thalasso therapy centres. The ris- ing prevalence of anti-aging medicine, originating form the USA in the 1980s and appearing in Hungary in 2001 under the name of age-control provided by the Quintess Healthy Aging Club, is a recent development of Western medical science impacting the health tourism sector as well. The system oriented, preventive, evidence-based life-style medicine offers special opportunities for the preservation of physical and intellec- tual strength and sexual attraction guaranteeing high quality of life in the Third Ageor third stage of life both for the individual and society. Researchers revealed increasing interest towards these services among younger age groups as well. A survey launched in the spring of 2007 by the author of this essay questioned a sample of 284 university students. It can be concluded that 62 % of the respondents assign a high priority to prevention and want to lead a more health conscious life than their parents did

Those in need of rehabilitation primarily come from the middle or older age groups, but primarily seek- ing treatment for sports-related injuries, the younger population is represented as well. Guests requiring post- operative treatment prefer quite, tranquil surroundings not frequented by tourists and seek facilities offering wellness and spa options with special hospital, sanatorium or therapeutic hotel atmosphere.

Members of the health conscious Y generation, that is those in the early middle aged groups primarily arrive without children and desire regeneration. A large proportion of this clientele is made up by profes- sional, highly qualified women, mostly singles. Such high paying guests seeking physical, psychological and mental, regeneration insist on facilities with a tranquil atmosphere while spiritual and creative programs en- joy growing popularity as well. Such customers favour medical-wellness facilities, holistic and yoga centres and represent a special type of health tourism, namely the selfness movement gaining popularity in Hungary as well. Visitors don’t insist on thermal or therapeutic baths but prefer insititutions with special activity swimming pools and such wellness services as sauna, indoor, outdoor sports facilities, and beauty treatment services.These groups seek the so-called contrast therapies combining adrenalin increasing activities with relaxation or frequent festivals focusing on health and well-being, such as the Wanderlust. Furthermore, workplace wellness programs could be specially offered to them as well. In a 2010 research program Smith and Puczkó identified 450 tour operators targeting this segment in the United Kingdom, Spain, Greece, Tur- key, and in such emerging Asian markets as Thailand and India [5].

An increasingly high number of middle agedpatients from Western Europe and the United States travel to countries and health centres providing medical treatment combined with tourism options. Depending on the given treatment they require leisure time services and programs. As it was mentioned earlier they arrive with their families and frequently more members of the family seek medical treatment, thus there is a great need for human resources with appropriate professional and personal competence in such areas as treatment coordination and activity arrangement.

Young and middle aged families seek services simultaneously providing rest and relaxation opportuni- ties both for parents and children. Consequently, they place a special emphasis on recreational spas offering entertainment, physical and general relaxation opportunities with unique experiences in a family-friendly atmosphere.

Furthermore, the members of the Z and Alpha generation, those born between 1996-2009 and after 2010 respectively, deserve mention as well. In the health tourism sector a younger segment emerged in the past 15 years prioritising wellness tourism options. Hungarian young adults assign high prestige to wellness tourism services [3], thus offering a potential continuation of the wellness tourism client group. Unfortu- nately, unhealthy diets, childhood stress, and a sedentary lifestyle have become prevalent among children and adolescents too. In Spafinder Magazine under the title «Serious Spa & Wellness for Kids» such pro- grams are offered as meditation for children, child-oriented yoga and fitness, massages, sports camps, and organic diets.Furthermore, «Wellness and Health for Teens» [6] programs emphasize healthy lifestyles, in- cluding diets, fitness, and elimination of harmful passions or addictions along with beauty treatments and counseling on personal relationships, sexuality, and issues related to approaching adulthood. A 2017 ques- tionnaire-based survey administered to a sample of 268 young adults in Hungary between age 14-28 con- cluded that despite being familiar with the requirements of a healthy lifestyle and the preservation of health, not enough attention is paid to such concerns. However, the special emphasis assigned to psychological well- being, happiness, and a balanced life can justify the development of programs emphasizing spirituality. Since these people specialize in festival attendance life-style related events to be discussed later can be of interest for them. It was also revealed that this age group makes travel decisions after carefuly considering the web-

Dental tourism in Hungary

sites of the respective destinations and service providers instead of word of mouth on social media. This tar- get group prefers cultural and gastronomical programs along with excursions and trips, thus nature and ecot- ourism or gastrotourism could be a potential cross-selling product.

At the same time new segments and new concepts have appeared on the health tourism market as well.

Smith-Puczkó [5] defines holistic tourists as those who possess certain experience regarding the se- lected activity such as yoga, pilates, or reiki and they pursue it regularly, but they do not travel to wellness centers for improving their skills, but to find attractive and pleasant environments for their exercises. At the same time there are guests who have little knowledge about the given sessions, but they are eager to partici- pate in such workouts. The holistic health perspective emphasizes the whole lifespan and combines the mind, the body, the emotions and all aspects of spiritual life. Providers of this type of product aimed at the achievement of physical, psychological, intellectual, and mental health offer personalized, integrated thera- pies promoting the appropriate life style including diet, exercise and the elimination of stress. The largest sending market is the Americans whose increasing belief in and support of alternative and holistic medicine is substantiated by the studies of Harvard Medical School and the American Holistic Health Association (AHHA).

The so-called New Age tourists traveling to locations or events connected with cultural attractions or re- ligious significance journey for spiritual reasons. Spiritual tourists’ belief in a supernatural force is coupled with a search for tranquility and internal peace. Consequently, they tend to participate in rituals striving to achieve the balance of body, spirit, and soul. They require «slow down» programs at so-called «anthropo- logical» wellness resorts such as Temas’kal and attempt to increase their knowledge of themselves along with the resolution of internal conflicts.

In addition to segmenting the health tourism market according to age and life stages researchers place an increasing emphasis on consumer behaviour, socialization,lifestyle [7], and the correlation between living conditions [3] and personal interests towards health-oriented travel [5]. The significance and role of lifestyle in consumer decisions have already been investigated in the 1960s. The respective models AIO - Activities, Interest, Opinion – and VALS - Values, Attitudes, Life-style explore, explain and analyze consumer behav- iour by the help of sociological models.

Regarding the representation of health tourism’s target groups, we can conclude that while in medical or curative or therapeutic tourism both sexes are represented, the wellness sector is dominated by women over 30. Thus during marketing both product development and communication efforts have to take their needs into consideration. Although fundamental social changes including female emancipation and the de- cline of the traditional family model contributed to the increasing role of women and has influenced tourism, men as new consumers of health tourism can be reached as well. As a result of «masculine emancipation» [8]

today’s men are not expected to act continuously tough and display strength and masculinity towards women and other men. Men are increasingly conscious of their appearance and their health. Male clientele can be reached via female readers. Moreover, this target group can be addressed with such call words as «stress re- lief, rest and relaxation, adventure, and sport» and via the combination of such activities as golf and skiing and wellness. The Spa Europa Luxury Spa & Anti-Aging Center in Calgary [9], the Nickel Spa in New York [10] or the Refinery of London (the-refinery.com/) offer exclusively «Only Man» programs via selling «For Him» packages. It must be admitted that the young age group, although presently at a small number but be- coming an important potential market, cannot be attracted with any reference to diseases as they are inter- ested in entertainment, rest and relaxation, and gaining experience and adventure as reported by The Global Spa & Wellness Summit’s «SPA4U» concept [11].

Since all age groups can be targeted by service providers motivation becomes the most important crite- rion of marketing segmentation.

3. Research in dental tourism

It is interesting to note that on the diagram of Dental Tourists’ Distribution of the World, there are more European countries than other countries, which also shows that Europe is the world's number one recipient of dental tourism.

But it is also worth mentioning that countries outside Europe are developing fast, such as India and Thailand, and with this the status of Europe and our country is getting difficult. Many will not travel this far if there are other non-European countries nearby which can provide services of similarly high quality.

As it is shown in Figure 1, Hungary is the top destination for European dental tourism among European countries.