Original publication: June 2017
Authors: NHTV Breda University of Applied Sciences: Tomas Mainil, Eke Eijgelaar, Jeroen Klijs, Jeroen Nawijn, Paul Peeters
Acknowledgements: We would like to thank Prof. Dr. Olaf Timmermans, University of Antwerp, Belgium, and Dr. Sabina Stan, Dublin City University, Ireland, for their valuable comments on an early draft of this report.
Short link to this post: http://bit.ly/2jImGs3
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Background and definitions
Health tourism in the EU: a general investigation

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Health tourism is a subsector of general tourism that comprises medical, wellness, and spa tourism. Medical tourism involves people travelling expressly to access medical treatment. People travel for wellness tourism to maintain or enhance their personal health and well-being. Spa tourism focuses on healing, relaxation or beautifying of the body that is preventative and/or curative in nature.

The three forms of health tourism (medical, wellness, and spa) reside on two parallel continuums: ‘illness-health-wellness’ and ‘curative-preventative-promotive’. Medical tourism is associated with curing illness; wellness tourism promotes personal well-being and spa tourism is positioned in between, aiming to prevent illness and wanting to sustain health. Wellness and spa tourism are also associated with certain types of facilities offered at ‘wellness centres’ and spa destinations, while medical tourism focuses on (non-tourism) medical facilities. General tourism provides complementary amenities like accommodation with facilities for people who require medical care, are disabled or suffer from health problems. The objective of this report is to provide an overview of the statistics, knowledge, case studies and policies relating to health tourism.

Market size and growth of health tourism

Due to limited, fragmented and often unreliable data, as well as varying definitions of health tourism and its components, it is difficult to estimate the size and growth of health tourism as a market. Within the EU28, 56 million domestic and 5.1 million international trips in total were recorded for 2014. Health tourism’s share of these trips is small at 4.3% of all arrivals. Only 5.8% of all domestic arrivals and only 1.1% of all international arrivals are health tourism trips.

Health-tourism revenues total approximately €47 billion, which represents 4.6% of all tourism revenues and 0.33% of the EU28 GDP. The seasonality of health tourism differs from general tourism and tends to be less pronounced. Health tourism actually helps counter average seasonality in tourism as a whole. The share of health tourists arriving from outside the EU amounts to an estimated 6%.

Scientific and public sources point to a stable development of EU health tourism, whereas market reports indicate medium to strong growth in medical, wellness, and spa tourism. As discussed in this study, we expect that health tourism will develop at an average 2% growth per year, equal to overall EU28 tourism.

Medical tourism is a volatile market that is dependent on legislation and waiting lists in regular healthcare. Whereas, wellness tourism accounts for roughly two-thirds to three-quarters of all health tourism.

France, Germany, Italy, Sweden and Poland are economically important destinations for health tourism. Finland, Bulgaria, Germany, Spain and Ireland all have a relatively high supply of wellness facilities in their accommodations, while the highest geographical densities of health and wellness facilities are found in Central and Eastern Europe and the Spanish and southern Baltic coasts. Large source markets for health tourism include France, Germany and Sweden.

Case studies

In the 28 case studies analysed for this study, the UK, Italy, Germany, Belgium and Croatia were the most frequently referenced countries. Over 70% of the case studies were international. Several case studies highlighted issues with the goals of Directive 2011/24/EU (on the application of patients’ rights in cross-border healthcare) and national healthcare policies, where national governments have not always supported the free mobility of patients. The tourism industry does not appear to be actively involved in Directive 2011/24/EU, nor politically active in providing the hospitality and transportation services involved, even though opportunities to do so exist. In some case studies, e.g. Alpine Wellness and Nordic Wellness, health tourism is shown to better utilise environmental resources. Of the six case studies that were analysed in greater depth, the main factors for successful development of health tourism were policies, stakeholder cooperation, international approach, communication and promotion. However, there is a discrepancy between understanding customers’ needs on the continuum between health and wellness and what stakeholders in destinations believe these needs to be.


We reviewed European, national and regional policies on health tourism. Though the EU-level policy for patient mobility (Directive 2011/24/EU) provides opportunities for medical tourism, there are still substantial taxation, financial and legal differences between member states that could hamper the development of medical tourism. Wellness and spa tourism are not explicitly supported by EU policies. Health-tourism projects take advantage of EU funding, for instance through the ERDF. National and regional health-tourism policies are quite common in the member states and are either included as part of general tourism or part of health policies, but they are seldom integrated. These policies aim to improve or guarantee the quality of health tourism through supporting collaborations, promotional campaigns, regional specialisation, legislation, health- tourism projects and by using health tourism to reduce tourism seasonality. Based on our SWOT (Strengths, Weaknesses, Opportunities, and Threats) analysis we arrived at recommendations to better integrate health tourism into general EU tourism policies and to improve its connection to healthcare and the growing market for wellness at the workplace.

We explored three scenarios: a ‘Business As Usual’ (BAU) one and two policy scenarios. One scenario, ‘Health Tourism Growth Scenario’ (HTGS), aimed at obtaining the highest possible growth for all three forms of health tourism. The purpose of the second scenario is to achieve the optimal positive effects of health tourism on the health of the population (‘Health Tourism Vitality Scenario’, HTVS). Although the HTGS offers advantages for economic growth, it also poses certain risks for health costs. The HTVS is likely better positioned to reduce health costs while simultaneously generating additional growth in tourism.


From our study, we derived the following general policy recommendations (please see Section 7.5 for a more detailed list):

  • Regarding medical tourism, include more spa treatments in national healthcare systems, remove upfront payment for cross-border healthcare and more effectively promote the uptake of Directive 2011/24/EU in national health policies. Facilitate knowledge sharing and exchange of experiences between the hospitality and tourism industry and the health sector. Also, it is important to better regulate procedures in medical tourism to prevent incidents (e.g. in cosmetic surgery), as this generates negative press and a problematic image of all medical and health tourism.
  • For better understanding and promotion of health tourism improved data are necessary. This means that health tourism and its three components should be distinguished in national and EU statistics, tourism satellite accounts and the Tourism Observatory, and it should be based on a clear set of definitions.
  • Continue funding for health-tourism projects. Target such funds by using health tourism development to improve labour quality, sustainability and seasonality. Also, use funding to increase domestic tourism over international (departures) tourism as a way of reducing tourism’s dependence on less sustainable transport and to enhance the sustainable development of tourism. Also, there is scope for funding renovation and renewal projects of existing spas to better equip these for the national and international markets.
  • A policy scenario aiming at enhancing health in the EU through further developing and integrating health tourism and healthcare and using the opportunities for prevention rather than cure may have a better potential for the general good than a scenario aiming at just economic growth of the health-tourism market. The latter may provide benefits to the economy, but it may also come with a risk of increased cost for the regular healthcare systems. In a scenario where health policies prioritise improving health, there is a role for the tourism and hospitality sector to cooperate with the health sector by exchanging experiences and requirements for accommodation, transport, services, employee competences, etc. that help to facilitate accommodation and mobility for less-abled visitors or visitors requiring special treatments.

Link to the full study: http://bit.ly/601-985

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