Medical tourism development trends in turkey: experience for Ukraine

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Medical tourism development trends in turkey: experience for Ukraine

Nataliya Pankiv, Ph.D in Biology, Associate Professor, Associate Professor of the Department of Tourism, Lviv Polytechnic National University

Krupina Anna-Maria, Student of the Department of Tourism, Lviv Polytechnic National University

Nataliya Pankiv, Ph.D in Biology, Associate Professor, Associate Professor of the Department of Tourism. Anna-Maria Krupina, a Student of the Department of Tourism, Lviv Polytechnic National University. Medical tourism development trends in Turkey: experience for Ukraine

Key words: medical services, medical tourism, medical industry, tourism industry, global segment.

Паньків Наталія Євгенівна, кандидат біологічних наук, доцент, доцент кафедри туризму. Крупіна Анна-Марія Сергіївна, студентка кафедри туризму, Національний університет "Львівська політехніка". Тенденції розвитку медичного туризму в Туреччині: досвід для України

У статті досліджено особливості та тенденції розвитку медичного туризму в Туреччині в умовах глобалізації медичного простору, а також в контексті імплементації даного досвіду в Україні. Проаналізовано сучасний стан, організаційні аспекти функціонування медичного туризму в Туреччині, як перспективного напряму туризму в Україні. Незважаючи на проведення бойових дій та анексію території, в Україні існує можливість розвитку туристичної галузі, що можна побачити під час дослідження світових тенденцій, а саме Туреччини, яка в останні роки страждає від терористичних та військових загроз. Туреччина є досить розвинутою туристичною країною із значними ресурсами та численними туристичними об'єктами й комплексами. Її керівництво намагається постійно нарощувати туристичний потенціал усіх регіонів держави завдяки пошуку нових стратегій туристичного та економічного розвитку території із залученням як вітчизняного капіталу, так і європейського. В сучасних умовах політико-економічного розвитку та епідеміологічної кризи Туреччина шукає нові шляхи виходу для стабілізації в туристичній сфері та виходу неї на світовий ринок. Вона має гарні передумови для розвитку нових і перспективних туристичних галузей обслуговування, які можуть притягувати значні потоки іноземних туристів. Туреччина входить до ТОП-10 лідерів медичного туризму за версією Medical Tourism Index [10]: щороку 750 тисяч іноземних пацієнтів обирають місцеві клініки. В Україні є напрацьована база і наявний потенціал у розвитку медичного туризму, проте залишаються невирішеними проблеми, які його гальмують. Системі медичного туризму потрібна реорганізація, для цього слід створити ефективну модель маркетингової політики в охороні здоров'я, покращити матеріальну базу та впровадити сучасні медичні технології, змінити законодавство, проходити міжнародні сертифікації, налагоджувати сервіс і покращити якість послуг. Отже, ефективний розвиток ринку медичного туризму не можна забезпечити без вирішення економічних, політичних, соціальних питань, реорганізації всієї системи надання медичної допомоги, зміни структури медичної освіти. Проведене дослідження підтвердило, що розвиток медичного туризму є перспективним сегментом конкурентного позиціонування медичної галузі в глобальному середовищі. medical tourism turkey

Ключові слова: медичні послуги, медичний туризм, медична індустрія, туристична галузь, глобальний сегмент.

Introduction

A qualitatively new form of manifestation of the transformation of national systems of medical services, clearly defined in the era of globalization, is international medical tourism, which involves obtaining medical services on an affordable basis outside the country of residence of the potential consumer of such services with maximum effectiveness. Its competitive advantages as a modern direction of providing medical services are innovative approaches to diagnosis, treatment of diseases and their prevention, therapeutic intervention on a painless and atraumatic basis, high professionalism of medical personnel, the latest material and technical support of medical institutions, and organizations, the uniqueness of medical services and their high performance, high-quality service, and maximum people-centeredness, an inclusive approach in taking into account the needs of consumers of medical services, in creating a favorable psychological climate for patients and their family members, modern marketing and logistical support for obtaining services within the framework of medical tourism.

Medical tourism can be interpreted from different points of view: from a macroeconomic point of view - as an industry that works to multiply the gross added value, the contribution of which to the gross domestic product is estimated at 2-5%, as additional attracted investments to the country supported by the work of individual clinics, programs, innovative methods of treatment, as well as specialists with a world name, which, accordingly, will strengthen the fiscal capacity of the national economy; from the marketing point of view - as an opportunity to successfully position the country's competitive advantages, which provide for the support and promotion of resort areas with unique health opportunities and recreational potential on international markets; as promotion of the latest and unique methods of treatment of diseases; from social - as a tool for solving health problems with maximum efficiency and economy, since the population chooses the most comfortable conditions in terms of cost and quality.

Management of the development of medical tourism at the supranational level is carried out by the World Association of Medical Tourism (GHTC), and at the national level by the Ukrainian Association of Medical Tourism (UAMT) and the State Tourism Development Agency of Ukraine. However, in some countries of the world (primarily in the USA, Turkey, Israel, Germany, India, Thailand, South Korea, and Malaysia) state programs for the development of medical tourism are being developed with appropriate state investments in this area, then for Ukraine, this direction of public policy implementation is institutionally it is not fixed, as a direction of health care, it is not sufficiently monitored at the macroeconomic level. There are no state programs to support the development of medical tourism, a system of accounting for receipts from foreign consumers of these services, while it is the latter who prefer these services due to low prices and high quality.

Analysis of recent research and publications. In the scientific research of such domestic and foreign scientists as S. Halasiuk, V. Kyfyaka, V. Malimona, K. Didenko, M. Malska, V. Baeva, O. Bordun, V. Balaban, L. Burkett, L. Carabello, N. Lunt, H.H. Gray, V.C.S. Heung, R. Vijaya, I. Youngman, et al. the prerequisites and factors of the development of medical tourism are considered, its status as a basic competitive element of the economy of the country and individual regions is determined. At the same time, there is still no clear definition, interpretation, and classification of medical tourism destinations.

It is conditionally possible to define two main types of classifications of medical tourism, which are necessary for conducting scientific research in this field of knowledge: classification by medical tourism destinations; classification by types and organizational forms of medical tourism. The choice of a medical tourism destination depends primarily on the personal motivation of the tourist (patient). Further, the selection criterion is the availability of medical, health, or resort facilities, highly qualified specialized medical care, cost of service, and degree of recreation (treatment) facilities, which is determined by the level of development of the tourist infrastructure, namely: the system of transportation, accommodation facilities, food, entertainment, excursion service, etc. [11].

It is worth noting that the emphasis is on tying medical tourism to the development of recreational areas and developing the necessary program mechanisms to support the development of medical tourism in certain regions, and mechanisms for the sustainable development of medical tourism. More and more attention is paid to the development of medical tourism from the standpoint of creating the necessary legal basis, bringing the quality of medical tourism services closer to international standards. A special place is given to the issue of price support for the provision of medical services and control over the quality of their provision. However, for medical tourism to be realized as a separate vector of health care, it is necessary to develop a strategy for its development in Ukraine, to obtain resulting project initiatives in the latest treatment methods, the development of modern health centers in recreational regions, the creation of logistic medical centers that will promote such services in the global market.

Objectives of the article. The purpose of the work is to reveal the current state and organizational aspects of the functioning of medical tourism in Turkey in the conditions of globalization of the international medical space as a promising direction of tourism in Ukraine. By the set goal, tasks were formulated that determined the logical structure and sequence of their solution: to reveal the essence and modern approaches to the classification of medical tourism; carry out the classification of medical tourism in the conditions of globalization of the international medical space; highlight the peculiarities of the organization of medical tourism in the conditions of globalization of the medical space; to analyze the current state and development trends of medical tourism in Turkey and the world; identify problems and outline prospects for the development of medical tourism in Turkey in the context of the implementation of this education in Ukraine.

The object of the research is regularities, quantitative and qualitative indicators of the functioning of medical tourism in Turkey, Ukraine, and the world. The subject of the study is the organizational aspects of medical tourism and medical tourism products to increase the efficiency of the functioning of tourist enterprises. Research methods. The methods used in the work are: literary; historical, structural, and comparative analysis; synthesis; induction and deduction; systematization and generalization. The information base of the study consists of legislative and regulatory acts of Ukraine, international acts, materials ofthe World Tourism Organization, statistical information from the State Statistics Service of Ukraine, monographic studies, and scientific works of domestic and foreign scientists.

The main material of the study.

1. Assessment of the prospects and problems of the development of medical tourism in Turkey in the context of the implementation of this education in Ukraine.

Medical tourism is a director of tourism, the purpose of which is the organization of treatment of citizens abroad. In the conditions of globalization of health care, as one of the branches of the economy, more and more countries are investing in medical tourism. They train highly qualified specialists in the best medical schools in the world and build comfortable clinics equipped with the latest technologies [7]. As a rule, these are countries with a highly developed tourism industry (Turkey, India, Singapore, Thailand, and Latin American countries). Such a policy allows patients - guests of these countries not only to solve their health problems, fully using all the possibilities of the offered medical service but also to relax, get acquainted with local attractions, etc. [12].

Factors of the country's prospects for the development of medical tourism are: 1) the level of development of medicine, medical technologies, etc.; 2) cost of diagnosis and treatment; 3) development of transport and hotel sectors; 4) the level of linguistic integration in the country; 5) legislative framework; 6) image of the state; 7) localization of the country on the world map [3]. A number of authors draw attention to the fact that from the point of view of the UNWTO, treatment, and health are among the most important tourist motives [4].

Medical tourism gave birth to a new concept of modern health care. Not having the opportunity to solve a medical problem in his country, the patient chooses a country, a doctor, and a clinic where he can be offered the most modern examination and treatment. The motto of medicine of the 21st century is "Patients without borders!". In our opinion, the main factors that can serve as a so-called lure to Ukraine for potential foreign (and Ukrainian) patients are: high quality of medical services combined with low cost; natural, climatic, and geopolitical conditions of Ukraine, which create unique opportunities for medical tourism; reproductive technologies, dentistry, orthopedics and other medical areas of treatment at a competitive price and high quality; unique technologies - treatment with stem cells (Institute of Cell Therapy, Biostem International Biotechnology Center, EMCELL Clinic); highly qualified specialists; measures for informatization and promotion of both medical services and the image of Ukraine [9].

For example, tourism in Turkey also developed due to the implementation of state programs and the use of certain tools [16]: creation of the Ministry of Tourism in Turkey due to the analysis and identification of the priority sector as a separate political body for the comprehensive development of tourism; legislative support for tourism in obtaining preferential conditions during the payment of utility tariffs, state subsidies, receiving long-term loans under state support with a low interest rate, the creation of free economic zones, in our opinion, contributed to the reduction of the cost of tourist services and the increase of investments in the tourism industry of Turkey; transformation of the economy, privatization, tax, export-import policy, support of private entrepreneurship, transition to a free market economy contributed to the economic development of Turkey and the tourism industry, which has a leading role in the GDP structure; infrastructural and human resources policy contributed to the improvement of the quality of the provision of tourist services, as well as an increase in the number of tourist flows, which contributes to the growth of the country's competitive advantages; the marketing policy of promoting Turkey as a tourist country contributed to an increase in the number of inbound tourism, as a result of which the share of foreign currency in the country increased, which enables the strengthening of the national monetary unit; the creation of a program for the strategic development of tourism in Turkey, in our opinion, will contribute to the further attraction of investment, the development of state infrastructure, and the elimination of the factor of "seasonality" in tourism due to the introduction of modern medical tourism.

Geographically, Turkey borders Ukraine and has similar climatic features. All of the above factors can be applied in Ukraine, which has no less recreational and touristic potential than Turkey. The state policy of tourism development in Turkey is based on comprehensive support from the government. In our opinion, the main problem that slows down the development of tourism is the lack of political will, the fact that the political system is aimed at the development and enrichment of certain financial and industrial groups, and the absence of civil society. A negative factor restraining the development of tourism in Ukraine is the conduct of hostilities on the territory of the country. Similar is the historical experience of Turkey, which experienced a similar aggressive situation with the annexation of a certain territory.

Since the beginning of the reform of the medical system in Turkey, increasing the level of technological equipment and service in state medical institutions and the salary of doctors, they have simultaneously fought against the illegal market of providing medical services. Medical tourism, the development of which has been taken seriously in the country since 2007, has also become an impetus for the development of medicine in the country. This direction is taken care of by the specially created Medical Tourism Council of Turkey. The Ministry of Economy has developed and implemented a program to stimulate medical tourism, according to which part of the costs of participation in international exhibitions, conferences, educational programs, and conducting advertising tours is covered by the state [12].

Turkey implements public-private partnership projects particularly successfully in the medical field. These are large-scale projects, research and hospital complexes, and medical cities within cities. An example that has already attracted the attention of the Ukrainian government is the city hospital of Ankara, as an example of cooperation between the state and private business. Our government plans to implement something smaller in scale, but no less effective, in Ukraine. During the visit of the head of the Ukrainian government to Turkey at the end of last year, it was agreed to study the experience of the implementation of the city hospital project in Ankara, since the reform of the health care system in Ukraine involves the construction of hospitals according to new principles. Ankara City Hospital is the third largest city hospital in the world, it has become the flagship of the fight against COVID-19, the development and testing of the vaccine against the coronavirus [12].

The experience of Turkey shows that the development of medicine for its citizens stimulates the development of medical tourism in a separate direction. With the development of its own medicine, specialists who worked abroad began to return to the country. The best Turkish clinics, as well as the names of leading specialists, are known far beyond the borders of Turkey. Customer focus is the main approach in medical tourism, and UNESCO World Heritage sites, golf courses, blue flag beaches, a variety of winter and summer sports, traditional Turkish cuisine, grand bazaars, and their modern counterparts - shopping malls - are an unchanged set of bonuses for any trip to Turkey, even if you go for treatment [5].

The main strategic stages of the development of medical tourism in Ukraine were highlighted by the President of the Inbound Medical Tourism Club "in Ukraine", director of the company "JK Consulting Group", Yuliya Khomych [16]: first of all, it is necessary to determine the directions of medicine, on which it is necessary to emphasize; secondly, to choose target international markets for Ukraine; thirdly, it is necessary to conduct internal work with market subjects regarding their readiness to implement international standards; fourthly, cross-cultural marketing of medical services and the creation of the brand "Ukraine - a medical tourism destination" should be implemented; and the last is to develop insurance medicine. According to Y. Khomich, insurance medicine will be introduced in Ukraine faster if medical institutions start cooperating with international insurance companies, which will invite foreign patients to be treated in our country.

In general, the conceptual foundations of the development of medical tourism in Ukraine include its step- by-step development, in particular: informational support of clinics and sanatorium complexes; expert study of their activities; analytical studies; analysis of the efficiency of medical facilities, development of competitive strategies; Marketing researches; conducting specialized industry business events; support of foreign patients in medical institutions; information support; conducting training and educational seminars [2; 16].

Ukraine has a powerful potential in the field of medical tourism development, but at an early stage, this sector needs financial support from the state. Recently, more and more scientists are proposing to create tourism clusters, as it has a significant economic and social impact [8]: use of products of one branch of the region for the needs of another; reduction of financial and operational risks of cluster members; limiting the impact of unfair competition on the group's sphere of activity; inflow of investment resources in the sphere of economic activity and the sphere of cluster accommodation; simplifying access to exclusive factors of production; increase in tax revenues to the budget; inflow of foreign currency; reducing the transaction costs of its participants and obtaining additional benefits from them; support for the development of innovative technologies; expanding the investment potential of cluster members through joint participation in grant programs; increasing the level of competitiveness of the region; significant reduction of barriers for access to the markets of goods and supplies of raw materials, labor force [8].

The implementation of public-private partnerships in the country will also contribute to the development of health tourism. This system will allow medical institutions to obtain greater economic freedom and tools to improve the quality of their services. Clinics will be able to increase the level of comfort in medical institutions, transport services, possible purchase of modern equipment, etc. State and private institutions will have equal opportunities and will be able to compete not only among themselves but also with foreign enterprises in their field [8].

The introduction of public-private partnerships will contribute to minimizing the gap between public and private medical institutions. Foreign tourist patients will be able to receive a service that will satisfy them and pay for it, and the funds received from such tourists will fill the country's budget. Therefore, for Ukrainian medical tourism to be systematic and coordinated, it is necessary to introduce public-private partnership mechanisms, transfer international certificates, introduce services, and raise the quality and standards of services to a higher level. Recently, it became clear outside our country that Ukraine is the owner and provider of medical services with a high level of price-quality ratio. Enough tourists already come to us exclusively for a few types of treatment: stem cells (due to the ban in their own countries), dentistry (due to their high level of quality at relatively low costs), and reproductive clinics for assistive technologies. Spas with mineral waters and healing mud also have significant potential for the development of foreign and domestic medical tourism [8].

Foreign patients are also interested in the field of restorative medicine (for example, the International Rehabilitation Clinic - "Elita" rehabilitation center in Truskavets), ophthalmology, cardiology (Kyiv Heart Center and Children's Heart Surgery Center in Kyiv) [13]. Patients from France, England, France, Italy, the USA, Germany, and Israel most often come to receive medical services in Ukraine.

Experts say that after the victory, tourism should become one of the drivers of the economic development of Ukraine, including inbound medical tourism: interested clinics, which are trying to rise to the international level, conducted marketing campaigns and travel agencies offered bonus/promotional attractive packages. Supporting medical and wellness tours in Ukraine will be an effective tool for extending the tourist season, which is especially important for the southern regions of Ukraine and the Carpathian medical centers.

The Ukrainian Association of Medical Tourism (UAMT) was also founded in Ukraine [1]. It is a not-for- profit organization that works with leading healthcare facilities and medical clinics, the Ministry of Health, medical staff, healthcare operators, travel companies, insurance companies, and other affiliated companies that work together to ensure patient safety by promoting quality medical services, assistance to patients in a global environment, as well as the development of medical tourism as one of the most promising areas of health care in Ukraine.

The activity of the Medical Tourism Society "Medical Tour Ukraine", which operates in Lviv, received first place in providing an example of the mechanism of organization of attractiveness and reception of foreign tourists in Ukraine. "Medical Tour Ukraine" acts as a provider of affordable high-quality medical services in Ukraine to provide its clients with the maximum level of comfort at each stage of cooperation. The association cooperates with Ukrainian clinics that are leaders in their field, with professionals whose professionalism and experience are recognized in Ukraine and abroad. The main task is to serve foreign guests at all stages of cooperation (treatment) [14]: medical consultations by phone and on the Internet; preparation of a treatment plan, calculation of its costs and conditions before arrival in Lviv; assistance in preparing travel documents, booking a hotel or apartment; meeting at the airport and coordination of the accommodation program; organization of trips and recreation during a visit to Lviv.

European countries, like the rest of the Western world, are facing some serious healthcare challenges: an aging population, reduced working hours for medical personnel, an increasing labor force compared to retirees, chronic diseases, rapidly increasing healthcare costs, and long waiting periods that delay and complicate the treatment process. Various European countries have changed their health care policies due to existing economic problems, excluding medical services such as dental treatment, cosmetic surgery, excimer laser eye surgery, and prostate surgery from insurance coverage. For these reasons, Europeans began to seek treatment in countries where the cost of medical services is relatively lower. In particular, the countries of Central Europe will benefit from the services provided by the countries of Eastern Europe.

However, Turkey has become an alternative among these countries, especially with the current decrease in the cost of air tickets. Some European countries welcome wealthy tourists to their countries and provide treatment at higher prices while sending their insured patients to safe countries where the cost of medical services is lower. However, in reality, their waiting period is much longer. Turkey has great potential for medical tourism, with around 20 million tourists visiting Turkey every year, 4.5 million Turks living abroad, and thousands of foreigners living in Turkey.

2. Assessment of opportunities for the development of medical tourism in Ukraine and ways of its further development.

Last year was the most difficult for Ukraine in its modern history, both in terms of political and economic aspects of development. Despite this, the medical industry continued to develop dynamically due to the following factors: the level of quality of medical services, the cost of diagnosis and treatment, the development of the transport and hotel sectors, the level of linguistic integration, the legal framework and the localization of the country on the world map.

It is important that Ukraine currently has a favorable legislative framework in the field of reproductive health and cell therapy, which, in synergy with modern equipment of clinics and the high professionalism of doctors, leads to the significant interest of foreigners in obtaining this medical service in Ukraine. Also, there is an interest in international medical patients receiving oncology care in private oncology clinics in Ukraine. The cost of medical services in Ukraine, in most cases, is much lower than the cost of similar treatment in other countries. This leads to the fact that many foreigners or the Ukrainian diaspora prefer to treat their teeth or correct their vision in Ukraine. Many doctors speak foreign languages, and in clinics that accept foreign patients, this is the norm for the average medical staff as well.

To date, the following promising regions for the development of medical tourism are distinguished in Ukraine - Kyiv, Kharkiv, and Lviv regions. The Odesa, Mykolaiv, Zaporizhzhya, and Kyiv regions, as well as Transcarpathia, are also popular resorts. All of them have a huge potential for development, but the problem is the lack of state funding. Most medical facilities are self-supporting, but cannot yet offer domestic tourists an affordable combination of quality and price. Inbound medical tourism in Ukraine is becoming increasingly popular. Our country attracts citizens of other countries as interesting tourist regions. For many patients, the purpose of their visit is a combination of treatment in specialized clinics and the opportunity to visit popular tourist attractions [6].

Ukrainian doctors are highly qualified, and the level of our private medicine is not inferior to the world. The absence of queues to highly specialized doctors and the opportunity to receive quality treatment from the first days of contacting a specialist makes the practice of international medical tourism more popular every year. According to the vice-president of the Ukrainian Medical Tourism Association, Ihor Torskyi, one of the reasons why foreigners are increasingly considering Ukraine as a region for treatment and recovery is the low cost of medical services. At the same time, their quality remains at a high level, and the price is 30-70% lower compared to global specialists. Most foreigners who come to our country for treatment spend an average of 7 times more than ordinary tourists. Taking into account the average check that patients from other countries leave for medical tourism services, their stay brings the budget at least $125 million per year, and this figure is constantly growing [18]. Patients visit interesting tourist places, and use the services of transfers and translators - all this has a positive effect on the logistics and transport systems of the country, as well as on the economy in general. Another important aspect of why it is profitable for Ukraine to develop medical tourism is the increasing competition among clinics, which leads to the acceleration of the process of transformation of domestic medicine. In Ukraine, medical tourism services are conventionally divided into the following categories: reproductive health; dentistry; cardiac surgery; sanatorium-resort treatment, rehabilitation; ophthalmology; cell engineering [15].

- Reproductive health. Over the past few years, the trust of foreign tourists in Ukrainian reproductive specialists has increased. The number of people who want to go to Ukraine for examination is constantly growing. Perhaps this is due to good indicators in the field of artificial insemination or the fact that egg donation and surrogate motherhood are not as prosecuted by law in Ukraine as in neighboring countries.

- Dentistry. This service is the most popular among tourists who come to Ukraine to improve their health. One of the reasons is the low cost of the procedure. Because insurance does not cover dental bills abroad. And secondly, our doctors have more experience with problem teeth and in most cases, the patient manages to save the tooth, and sometimes the entire jaw. Whereas Western doctors would remove a damaged tooth.

- Cardiac surgery. Services in this field of medicine are no less popular among foreigners than dentistry. This is with the availability of the most powerful medical devices and the cost of the operation. It is also worth adding that Ukrainian doctors take on even hopeless cases. And 90% of these operations are successful.

- Ophthalmology. The Odesa Center for Post-Burn Eye Pathology has no analogs in the world. Throughout his career, he has received thousands of foreign patients and helped restore sight to people from more than 50 countries. At the same time, the working conditions of unique Ukrainian specialists wish for better. The development of medical tourism will help the clinic to improve the living conditions of patients and purchase good equipment to save the sight of both Ukrainian and foreign patients.

- Cell engineering. The development of cell therapy in the domestic market of medical services successfully competes with Western analogs. Ukraine operates the world's only innovative storage service for mesenchymal stromal cells. The Kyiv Institute of Cell Therapy was opened in 2003. The material stored here helps patients from all over the world recover from injuries and surgeries. Also, thousands of foreign patients come to Ukraine for the rejuvenation of the body with stem cells and blood plasma.

- Sanatorium-resort treatment, rehabilitation. Ukraine is famous for its medical resorts. The main part of all health and wellness enterprises are sanatoriums, the largest of which are in the Lviv region - 15%, Odesa region - 10%, Transcarpathia region - 7% and Khmelnytskyi region - 6% of the total number. The largest number of recreational enterprises is located in the Black Sea regions: in Odesa - 23%, which is almost 1/4 of all recreational enterprises in the country; Zaporizhia - 17%, Mykolaiv - 14% and Kherson - 12%. 2/3 of all recreational enterprises in the country are concentrated in these 4 regions [17].

1. Lack of interdepartmental coordination of the participants in the state regulation of the medical tourism market from the point of view of both regulatory and legal support of the process of providing tourist services about the standards of providing medical care in certain areas such as prevention, diagnosis, and treatment of chronic and infectious diseases, as well as the division of responsibilities in the context of control activities and social and professional accreditation.

2. Insufficient number and low level of development of targeted programs and strategies for the development of medical tourism, which would take into account both the need for the provision of quality medical services and the prospects for the development of tourism and recreation at the national and regional levels.

3. Absence of a comprehensive system of personnel training, specializing not only in the provision of medical and related services but also capable of making competent management decisions from the point of view of the organization of tourist flows of an inbound and internal nature, taking into account the specifics of the consumer, including the culture of business and personal communications, traditions and ethnic characteristics of behavior and psycho-emotional reaction to certain medicinal actions.

4. Low innovative activity of the domestic sector of private and state medicine, lack of mechanisms for its improvement at the regional and state level [17].

Therefore, the effective development of the medical tourism market cannot be ensured without solving economic, political, and social issues, reorganizing the entire system of providing medical care, and changing the structure of medical education. The conducted research confirmed that the development of medical tourism is a promising segment of the competitive positioning of the medical industry in the global environment. Under these conditions, it is necessary to support its strong components (dental, ophthalmological, cardiology, neurological reproductive medical services, rehabilitation, and recovery services), as well as to develop the newest directions of medical tourism (transplantology, beauty tourism, etc.) with the corresponding creation of regional health and rehabilitation clusters. An obvious advantage is the combination of high-quality human resources, medical, health, and recreational resources with an appropriate affordable price policy, the desire to achieve process maturity in the provision of such services, and obtaining an international medical quality certificate for the growth of inbound medical tourism. At the institutional level, it is important to ensure a balance between the commercial interest of medical tourism participants and the protection of the interests of consumers of such services.

References