1. “7th International Balkan Forum” has been held productively in Edirne on 6-7 November 2014 with a broad participation and great deal of attention. Forum, which is organized by Turkish Asian Center for Strategic Studies (TASAM) and Ministry of Health collaboratively, was hosted by Governorship of Edirne and focused on main theme of “Health Diplomacy and Tourism”. Statesmen and politicians, bureaucratic/diplomatic representatives from relevant ministries, representatives of diplomatic missions, representatives of NGOs and think tanks, private sector representatives of health and tourism fields, academicians, representatives of media from Balkan countries, European countries and Turkey have attended the meeting. During Forum, strengthening health and tourism cooperation among Balkan countries with proactive approaches and transforming diversities into wealth topics were examined with all components and exhaustively.
2. During Forum, “International Health Perspective” (Moral Ethical Values, Health Law), “Essential Factors of Health Diplomacy” (International State Investments, Private Sector, Red Crescent and Red Cross Organizations, NGOs), “Successes in Health Sector and Health Tourism” (Conventional Health Care Centers, Alternative Health Care Centers, Health Education, New Inventions), “Bilateral and Multilateral Cooperation in Health Tourism” (State Supports and Actions, Mutual Agreements, Joint Movement Areas in International Organizations), “Non-Governmental Actors in Tourism: Proactive Suggestions” (Local Administrations, Civil Society, Private Sector, Media) topics were talked in sessions.
3. Tourism is an integrated service industry that contributes many industries. Tourism is not just travel as well as tourist is not only traveller. As an alternative tourism, health tourism is an industry that generates income and employment. International patients are went through passport check during country entrance and exit and registered as tourists. To develop new terminology, definitions and works of United Nations World Tourism Organization and World Travel & Tourism Council should be revised.
4. There are economic and cultural ties among Balkan countries that take their source from the history. Deepening sectoral and financial values based on mutual interdependence among Balkan countries is required. The health tourism is one of the phenomena that strengthen those ties.
5. The health diplomacy has an important role in international relations. Deepening tourism with Balkan countries, that have 400 years joint history with us, is supportive for understanding and knowing each other and cultural deepening rather than economic benefits. When health tourism is reviewed, two approaches are observed. The first one is based on health tourism among Balkan countries while the second one is based on health tourism from other countries to Balkan countries.
6. Establishing “Balkan Capital” concept for Edirne will be a starting point for developing health tourism works and vision by Turkey. Edirne has important tangible and human resources in terms of health tourism. History, cultural and architecture structure of the city as well as having human resources in health field show that Edirne has the potential of being health tourism capital of Balkans. Health services and administration of health services that are provided by Trakya University contribute health tourism resources of the city. Being preeminent in health indicators in Turkey provides important advantage to Edirne. Required works should be expedited to make Edirne take part in UNESCO’s “Age-Friendly Cities”.
7. Balkan countries’ alternative opportunities that offers health tourism infrastructure make Balkans attractive in the world. In this sense, comprehensive strategies, policies and plans that are shaped according to those strategies are needed to improve the region’s attractiveness as a whole.
8. Today, health sector is changing in a dynamic structure like in other fields. To develop health tourism within the change, all parties should take initiative and contribute it. Health diplomacy is significant to sustain global stability. As a matter of fact, health is a substantial factor within interactions among countries. Establishing cooperation among countries will serve keeping themselves healthy as well as economic development and cultural integration via health tourism
9. To offer a proper health tourism service, committees like ethic committee and law committee have been established under Global Healthcare Travel Council, which has been founded by 12 countries like USA, UK and Turkey. Council reclaims that Wellness and Third Age Tourism will leave medical tourism behind in the upcoming days. Similar projects can be successful in Turkey and Balkans with vertical and horizontal clustering.
10. Health tourism and Third Age Tourism that serves seniors are in need of improvement. Growth should be increased, medical expertise and travel expertise should be brought together and environment friendly touristic services should be provided. Each country should evaluate its capacity, possibilities, pros and cons and utilize experience of each other. Delegations as well as knowledge and experience should be exchange and there should be direct interaction among the organizations. In this way, a deepening synergy can be achieved among Balkan countries.
11. There is not legal harmony in health tourism in both national and international level. In this field, differentiation of concepts and confusion are experienced. Legal concepts and definitions about health tourism should be clear and intelligible.
12. Legal regulations are limited. Current legal structure should be improved and all relevant concepts and definitions should be uniform. In legal regulations, initially a structure that pays regard to risks in planning, diagnosis - treatment, invoicing and collection issues should be established. For resolutions of disputes after health tourism, arbitrations should be defined in national and international level. Patient confidentiality is another issue that is required legal regulations. Use of technology for diagnosis - treatment process should be promoted to support international cooperation for consultation.
13. Visa barriers that prevent individual movement among Balkan countries are limiting integration, growth and development of health tourism like in other economic fields. For the purpose of increasing cooperation among Balkan countries, visa barriers should be abolished.
14. In Turkey, the Ministry of Health serves health tourism with themes of international patient treatment and tourist health. In this field, call centers for 24 hours and city hospitals with improved infrastructure are being established. Treatments of foreign patients are dealt separately within advancing service offer. Accredited medical personnel that know foreign language will be assigned in international patients floors in which special teams will work.
15. The Ministry of Health is planning “Free Health Areas” near to airports and easy to reach for international patients to develop health tourism in Turkey. In this sense, establishment of Free Health Area in Edirne continues due to its geographic position to Balkans. International medical personnel will serve in those areas in which high quality and low prices will be provided. Tourism oriented other services like hotels as well as medical services will be provided in Free Health Areas. Centers that serve foreigners will work with certification of Health Tourism Accreditation.
16. Important contributions of two significant organizational regulations in health sector of Turkey (Directorate of Turkey Health İnstitutions and University Health Sciences) are expected in national health issues and health tourism. Turkish doctors are serving in many countries. The Ministry of Health is targeting cooperation with and benefiting experience of Turkish Doctors Associations, which will be founded under guidance of those doctors. Doctors from Turkic Republics are receiving education and working in hospitals in Turkey. Similar implementations can be designed and practiced for doctors from Balkans.
17. Transnational patient transfer and legal harmony and coordination should be ensured. Most important pillars of legal harmonization are on regulation of third party financial organizations (insurance companies and social security institutions). On the other hand, language and health tourism education of medical and administrative personnel that take part in provided service will contribute process of harmonization and coordination.
18. Tourism should be seen as not only a sector but also an “industry”. Compatibility between Balkan countries should be ensured, that is possible by 3 steps of legal harmonization between patient sender country and patient receiver country, harmonization of social security regulations, and harmonization of development of medical and administrative personnel
19. Although tourism policies and plans have the concept of “sustainability”, there are difficulties in implementation. In terms of regional development public sector, private sector and non-governmental organizations (parties) must work together coordinately (Ministry of Health, Ministry of Culture and Tourism, Ministry of Economy). To become a health tourism destination, clustering is needed.
20. Laws and regulations of health and tourism sectors should be dealt coordinately. For instance, in Turkey in accordance with law concerning Association of Travel Agencies operations of group A travel agencies are made by other intermediary firms. Either laws should be changed or joint formulas should be found.
21. In Turkey, public hospitals are serving patients that have bilateral agreement, buying their flight tickets and return them to their home countries. International patients services that have personnel speak foreign language should be increased and private hospitals also should be encouraged towards that direction.
22. Publishing scientific works of Balkan countries on health tourism in medicine magazines and media like Romania’s works on balneology, which studies on effects of thermal spring and healing bath on various disease, will be helpful for publicity. Moreover, international campaigns and symposia on health tourism can be organized and joint publicity projects for Balkans can be realized.
23. Health tourism and tourism should not be thought separately. Although everybody is disabled potentially, disability friendly facilities are inadequate. In this context, it is possible to take support from other Balkan countries for senior and disabled tourism. Doctors and administrators should come together. Patient security is highly important, after turn back their home country everything should work out all right.
24. To advance in health tourism, it is also important to reach out health professionals of target countries as much as patient centered publicity. Health professionals have a great influence on patients in terms of choosing country and health center where treatment will be implemented. İncreasing contributions to medicine literature, sharing experiences in international congresses, organizing trainings and courses on the basis of country will be helpful to be recognized as “known, reliable, preferable country” by the professionals of target country.
25. Screening protocols about endemic diseases should be established according to risk analysis of each country and kept under tight control. Also diseases that are unseen or not common in the country should be prevented from infecting patients or healthcare personnel.
26. Health expenditures exceed the level of development of countries and everyday its burden becomes heavier. Solution is managing the situation well rather than increment in health budget. Especially, it should be taken into consideration that restrictive attitudes of reimbursement institutions are affecting doctors’ decisions and consumable materials are not used.
27. Health law understanding should be developed without inculpating health workers. Otherwise, problems like insults, violence etc. cause “defensive medicine” and it becomes hard to find a health personnel makes decisions or treats in emergency cases. If this is achieved, health tourism will be more realistic and concrete improvements will occur.
28. Between Balkan countries, health networks can be established with doctors. Project of Advanced Technology Support and Education Center, which is aiming to protect patients’ data, found technological centers and promote use of technology in Bosnia-Herzegovina, can be improved and Balkan Virtual Hospital can be founded with “hospital without papers” approach.
29. “Integrated” health tourism destination should be set to publicize and develop several countries in Balkans. However, divided and tattered destination cannot advance and compete. Many destination and cooperation stay at the same level they started without any improvement due to lack of integration. On that point, institutionalization and administration are the most crucial elements. To highlight health tourism in Balkans, a union like Balkan Tourism Council should be founded, investors and investee countries should come together.
30. As much as branding and being preferable country, protecting those status is also important. Well-grounded controls and regulations will help our country to protect its position in health tourism. However, integrated and joint working of the government and non-governmental actors is vital.
31. Both Balkan countries and Turkey (parallel with 2023 Vision) should do research on health effectively, evaluate their own resources and create strong brands, prioritize sectoral and financial deepening based on interdependence. Huge budgets spent for seniors by big countries, to increase young population fertility should be increased, many people that travel abroad for in vitro fertilization due to legal barriers of their own countries are just couple of examples that have potential of being source of inspiration.
7 November 2014, Edirne
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