Keywords

1 Introduction

Medical tourism, alternatively defined as health tourism, is a domain and activity of the field of public health, which is either directly related to it, as in the choice of the individual to receive specific medical services abroad, or indirectly, while visiting another country and the need to receive emergency medical services arises. According to Helmy [1], medical tourism is travel that aims to achieve health and well-being, through appropriate health care which may include medical examinations, surgical and plastic procedures, beauty treatments, restoration and recovery, combined with recreation, entertainment and cultural activities in the visited tourist destination [2,3,4]. In conclusion, these two terms, health tourism and medical tourism, converge. It is considered that medical tourism is part of health tourism, a new form of covering health needs and a new global economic activity, which is in leaps and bounds growth trajectory. Nowadays, the afore-mentioned field is developing rapidly due to the worldwide increasing necessity for medical services of the highest standards in terms of medical technology and financial expenditure. The global medical tourism market size will be valued at $31.91 billion in 2023 and is expected to grow at a compound annual growth rate (CAGR) of 14% during 2023–2027. The adoption of medical tourism will be supported by affordable healthcare and reduced wait time in foreign countries, along with access to quality healthcare and advanced treatments [5]. The annual growth rate of the global medical tourism market is estimated to reach 25–35% [6]. According to a research study prepared by the consulting company Stochasis [7] (2018), for health and medical reasons, in 2017, 108.5 thousand travelers visited Greece, marking an increase for the fifth consecutive year, with the Average Annual Rate of Change (ARR) to equal 4.8% in the period from 2006 to 2017.

During the last decades there has been an increase in the number of people with some form of disability, who seek to receive general or specialized medical services outside the country in which they live. Tourism for the Disabled, or as it is often referred to in the literature “Accessible Tourism”, has begun to develop globally and is a specific category of tourism, which aims to cover all people—regardless of age, gender or disability—in terms of the choice of accessible destinations, specialized products and medical services. The World Tourism Organization—WTO, having become aware of the numerical size and the particular requirements, needs and desires, of “accessible tourism” prepared a Special Report on the characteristics of the market and a special manual with the title addressed to tourist destinations for “accessibility” [8]. The total number of people who have declared a serious disability ranges from 110 to 190 million and 80 million of them are European citizens [9]. Also, they use vacation packages that come from Social Security programs and prefer to make their reservations in advance and travel outside the peak season [10].According to Bowtell accessible tourism market is a distinct sector, possessing the capacity for extensive future growth, and thus presents major travel providers with a potentially substantial and lucrative market, generating potential revenues of €88.6 billion by 2025 [11].

Greece undoubtedly has a place and share in the ever-expanding global market of Medical Tourism [12]. According to Geitona and Sarantopoulos [13] medical tourism in Greece has comparative advantages and these advantages provide the possibility of exploiting the opportunities and promoting the country as a medical tourism destination.

2 Methodological Considerations

This article analyzes, the global approach in terms of providing medical tourism to disabled people, as well as the existing position of Greece towards this specific group. Furthermore, it sets out steps and actions that have been taken or need to be taken in the future out to this direction, in relation to the perspectives and the benefits for the Greek economy. To achieve the above objectives basic research systematic peer review of the accessible tourism literature of papers on subjects related to the areas of Social and Legal Sciences and Health Sciences published in Web of Science, Scopus, MEDILE PubMed, Googlescholar, and ProQuest (APA PsycInfo).

3 Medical Tourism and the Disabled People

According to Darcy and Dickson [14] accessible tourism is defined as: “Enabling People” with access requirements including mobility, vision, hearing and cognitive dimensions of access, to function independently and with equity and dignity through the delivery of universally designed products, services and environments. In 2014 the World Tourism Organization (WTO) created an “Accessible Tourism Guide” where it mentioned the obstacles faced by people with disabilities and how Tourism should be organized in the future with the aim of “Access for All” [15]. A significant number of such people choose to combine their holidays with receiving some treatment in a country other than their own, especially in the case where the desired medical services are provided at a significantly lower cost than in their own country. Many people with disabilities who have large incomes will spare no expense to travel to another country in order to receive a treatment that has been considered a medical breakthrough and has been significantly developed in that country with significant benefits for the patient.

Undoubtedly, the demand in the Medical Tourism market from people with disabilities, in other words with special needs, is very high, but is there a necessary and corresponding supply in order to cover it?

The development of accessible tourism and the equal participation of citizens with disabilities in terms of accommodation and activities, has little interest in the market of touristic agents. They recognize the specific category of Medical Tourism as a non—profitable one in order to include service packages for people with disabilities, in their framework of hotel businesses, often citing the high cost of adaptation [16]. Most problems have been observed and highlighted at international level, which act as deterrents for a person with special needs to choose of whether to go to another country for their holidays. Such are the lack of valid and sufficient information on hotel accessibility services, the inadequacy of all adapted rooms and the inadequacy of accessibility infrastructure in rooms and in all hotel facilities [17]. The criteria for the priorities and preferences of people with disabilities, regarding the choice of accommodation, depend on demographic characteristics, the nature of the disability, the degree of autonomy of the person, and the assistive equipment they use. Additionally, important factors, which determine the choices and ultimately the decisions of the PWDs, are undoubtedly the access and receipt of complete and correct information about the existing accessibility infrastructures, as well as the measures taken by the hotel units to serve the needs of the PWDs. Specifically, the accommodation criteria of disabled tourists are based, primarily, on the layout of the room and bathroom and, secondarily, on the common areas of the accommodations [16].

However, destinations and businesses active in medical tourism for people with special needs need to meet other, in addition to technical, specifications, which will concern the accessibility of the services and benefits offered and will be intertwined with the optimization of service to tourists with disabilities, but also the promotion of businesses and destinations. It is required on behalf of all entities that deal with and provide services to people with disabilities, primarily the promotion and advertising (marketing) of them, the provision of detailed information, mainly via the internet, but also competent state entities, regarding the characteristics of the business and the destination and the staff trained to serve the disabled.

Furthermore, travelers around the world are taking a keen interest in virtual tourism. According to an estimate by Market Data Forecast, the Global Virtual Tourism Market was valued at USD 301.5 million in 2021 and is expected to grow at a CAGR of 14.4%. from 2022 to 2030. During the forecast period is expected to reach approximately $ USD 1052 million by 2030 [18]. VR technology can create in the future a virtual environment that will simulate actual medical tourist spots worldwide as well as touristic spots for people with special needs. For instance, VR can help medical tourists with special needs to explore virtually a place before planning a trip. It would allow them to get familiar with the location's culture, know which things they should try, give them a better sense of what to expect, and increase their confidence in their choice. It can also be handy for marketing in the tourism sector and help travel guides attract more visitors. People with disabilities could potentially have the biggest utilization of virtual tourism. However, the success of virtual tourism depends on the acceptance of VR technology [19]. There is a need to recognize disabled travelers as autonomous and independent people who seek to escape from their daily routine, and who require certain specific supports to facilitate their tourist experience. Accessible tourism is valued as a good market opportunity, but its proper development requires greater staff awareness to promote co-creation in tourism, as well as the support of technological systems to create individualized tourist profiles detailing the needs of each person [20].

4 Possibilities for Medical Tourism for the Disabled People in Greece

Medical tourism in Greece, although it could have great potential for development as far as people with disabilities are concerned, however, one could say that it is still in its embryonic form. Larger financial investments are needed in relation to the services provided, infrastructure and access. Special facilities and technological equipment are the most basic condition for serving people with special needs, as well as the creation of tourist packages that will satisfy their own special needs and desires alongside those of their companions [17]. Accessibility is another very important element so that people with special needs can travel more often and more easily. The measures that should be taken concern categories such as means of transport, accommodation, information, staff behavior towards the special needs of medical tourists of this category. The environment that will be the pole of attraction for these individuals is also of particular importance. It should be a comfortable and pleasant environment, with acceptance towards diversity, with appropriate equipment and special treatment. Another factor that significantly affects the attendance of people with special needs in developed tourist destinations is the spatial dimension. Usually, the facilities are built around central cities providing quality medical/hospital care, accessible facilities with specialized services. In Athens, Thessaloniki, Rhodes, Crete there are businesses active in this type of tourism, while abroad, Spain, France and Italy make a significant contribution [21, 22]. Naniopoulosand coauthors [23] have cooperated in the frame of MEDRA project to assess their potential and set up a plan for developing accessible tourism is to develop accessible tourism in two areas of Greece and Turkey. The findings include, amongst others, the identification of needs of tourists with disabilities, and the relevant historical evolution, legislative framework, international good practices, policy-improvement proposals, accessibility assessment in Mersin and Drama, and suggestions for developing accessible infrastructure together with the training of stakeholders. Furthermore. the project results defend that the Greece although made a lot of progress regarding the issues of disability and accessibility still is not on the same level as many European countries, while Turkey has a lot to learn in order to deal with accessibility from a holistic point of view. Kasimati and Ioakeimidis research for accessible tourism product of Greece results show that, is not entirely satisfactory. Therefore, demand for accessible tourism in Greece remains low, as the Greek tourist destinations lack the appropriate infrastructure and easy access to public transport; and second the dynamics and size of the accessible tourist market is not fully understood by the Greek tourist industry [24].

4.1 Barriers and Good Practices in Greece

According to Avgoulas Evangelo [25], ESAMEA Confederation of Persons with Disabilities today focuses mainly on actions concerning the health and financial security of the disabled (disability pensions, benefits). Another factor that creates difficulties in developing business activities related to Medical Tourism and PWDs is that the medical industry in Greece follows the medical model of approaching disability and not the social one. Public rehabilitation centers have major deficiencies in infrastructure, technology and are still understaffed. Private centers, on the other hand, although they have the infrastructure, do not always have the necessary certifications that they should and the quality of their services is not always proportional to their high financial costs. Another parameter that discredits our country as a Medical Tourism destination for the Disabled is the Greek athletes of the Paralympic games, who go to centers in Germany for their rehabilitation.

The correct and systematic organization of medical tourism for the disabled in the future may contribute to the strengthening of local economies and the national economy in general. The possibilities and perspectives that are opened must be based on coordinated actions to improve the attractiveness of the destination, the creation of new building infrastructures and the development of modern medical tourism services for the disabled, with the consequence of establishing Greek cities and towns as an ideal and friendly destination for that particular group of people. In 2021, Komotini received a European distinction for its accessibility by winning the award: “Special mention for the city that treated accessibility as an opportunity” at the European Accessible Cities Awards 2021 (Access City Award). The Access City Award recognizes a city's ability and efforts to become more accessible in order to improve the quality of life of its population and ensure that everyone—regardless of age, mobility or ability—has equal access to the urban environment. Cities such as Komotini are a great example of how a specific place can develop into a medical tourism destination in general and for the disabled in particular, by doing the self-evident initially, i.e. by creating or developing the infrastructure and conditions in public spaces, making them easily accessible by PWDs and thereby improving their standard of living. The entrepreneurs of a city should also start to realize that when their businesses such as hotels, dining and entertainment venues become accessible to all, they make more profit and at the same time enhance their social image.

5 Discussion and Conclusion

According to the WTO, for there to be a change in the mindset and the way of providing services for PWDs, laws and regulations should first be changed so that there is no discrimination regarding the access of PWDs to facilities, products and services, training of the respective staff involved with the specific group of people [26]. Based on the above data, it is demonstrated that Greece is slowly following international trends. The interest in the equal access of people with disabilities in all areas of social life and their easy access to specific medical services, mainly rehabilitation, is mainly theoretical and often ends up in proposals, debates and even sterile confrontations, which do not end in a positive result and do not promote the further development of medical tourism for the disabled in our country. Medical Tourism in our country could attract patients of all ages and income levels, who are in need of hospital care. Patients in need of medical monitoring and the creation of an appropriate atmosphere for recovery and rejuvenation of the body, but also from the existence of a multitude of activities to occupy themselves and their families and companions during their free time. But in order to have the right specifications, the stay should always be determined by the seriousness of the situation and the client's health problem. Parameters such as diet (a specific diet is recommended which the patient usually follows), movement (depends on the severity of the condition), but also activities, which may be directly related to a wide range of activities, such as treatments and prevention, using modern or traditional techniques and services, also play a catalytic role.

Based on what was mentioned, in relation to the development and promotion of medical tourism, it is considered important for people with special needs to fulfill the following conditions:

  • Partnership of the agencies and taking initiatives in order to carry out the necessary processes to promote medical tourism, in general, to vulnerable groups of our fellow human beings—the disabled—and to raise awareness in society.

  • Legislative framework, which concerns the appropriate formulation of the legislation, so that the personal medical confidentiality of the patients is guaranteed.

  • A transport network that is enhanced by informing transport providers and resulting in patient convenience.

  • Organization and management of standards-tools of high specifications, as well as obtaining international certification that is an indication of the organizations’ commitment.

  • Training of public and private service employees (public transport workers, hospitality service providers, health professionals, etc.) to respond to the needs of patients-tourists with special- Transformation of each city that will be a Medical Tourism destination into a friendly community. This possibility concerns both the level of planning and service provision, as well as the friendly design of cities and spaces that welcome tourists and patient’s needs.

  • Virtual reality (VR) can also be very useful in the industry of medical tourism in terms of visiting far-away places virtually and helping medical tourists to improve their actual experience when they get there.

However, in order to realize the vision of accessible tourism and to expand Medical Tourism for the Disabled, cooperation is required between the various involved persons and tourism agencies, so that people with disabilities and special needs can enjoy tourism products, services and the resources, since they will be designed for everyone. After all, considering the Preamble of the United Nations Convention on Persons with Disabilities, the importance of disability inclusion is absolutely necessary for sustainable development to take place.