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Medical tourism refers to the travel of people to another country for the purpose of obtaining medical treatment in that country. Traditionally, people would travel from less-developed countries to major medical centers in highly developed countries for medical treatment that was unavailable in their own communities;

Some people travel to obtain medical surgeries or other treatments. Some people go abroad for dental tourism or fertility tourism. People with rare genetic disorders may travel to another country where treatment of these conditions is better understood. However, virtually every type of health care, including psychiatry, alternative treatments, convalescent care and even burial services, is available.

Health tourism is a wider term for travels that focus on medical treatments and the utilization of healthcare services. It spans a wide field of health-oriented tourism ranging from preventive and health-conductive to rehabilitational and curative forms of travel; the latter being commonly referred to as Medical tourism. Wellness tourism is another related field. On the occasion of the 9th National Conference on Health Economy held in Rostock/Germany in 2013, it has been defined as (...) the branch of health and tourism economy that contributes to maintaining and restoring health and well-being in particular by using validated medical services.

Spa resorts

Hundreds of resorts and specialized rehabilitation centers are focused on patients' needs in the field of gaining more popular health tourism. Specialized services in the field of lung, bone and skin diseases, as well as beauty and spa centers are designed to help improve overall physical and mental state of those who benefit from their services.

The popular term Spa is one of the first associations that come to mind when it comes to relaxation, rehabilitation and beauty treatments. Spa tourism is known from ancient times, yet it is only one unit of the manifold of health tourism services offered in Bulgaria (and the world).

The term Spa is more of a modern popular definition, a single word that combines all possible alternatives of health, beauty and relaxation tourism and treatments. Spa is one of the most popular sections of health tourism worldwide today.

In this area find their place and alternative healing and rehabilitation practices such as yoga, sports and exotic massages, ultrasound therapy, mud therapy, acupuncture, hypnotherapy and many different methods.

Treatment with therapeutic mud is a procedure that is popular and preferred by many. It is proved that similar procedures have overall beneficial impact on various systems of the human body as well as detoxifying function, improving blood circulation and restoring the chemical balance in the body.

Medical, health and recreation tourism

According to its specialization and purpose Health tourism can be attributed to the sub-sector of sports and recreational tourism, and in view of the specific health needs, which serves to determine and specificity in the following sections:

• spa tourism;
• wellness tourism;
• recovery and rehabilitation tourism;
• climatic health tourism;
• climatic spa tourism;

General term "health tourism" aims to summarize a very broad term that includes a variety of services.

It comes to tourism with a strong preventive, restorative and healing effect which, however, is possible and even recommended not only for those with pre-existing health problem, but also for those who would like to keep fit and prevent various diseases and conditions. These may vary from lung conditions to bone-joint complications.

In the history of the development of health tourism in Europe 1963 is a turning point. Scientific and organizational foundations of health tourism are the subject of in-depth discussion for the first time in Opatia, Croatia.

In 1978, the WHO (World Health Organization) adopted an official document for planned development of health tourism, beginning with a proposal by the International Federation of Balneology and Climatology (FITEC). This document expands medical and social and economic content of this distinctive type of tourism.

Practicing health tourism is among the best ways to combine rest and pleasant experiences with what is good for your health in the long run. Bulgaria is one of the most attractive destinations for this type tourism in Europe, with excellent natural conditions and resources, centuries-old famous spas and superb mountain areas with fresh air.

Prophylactic health tourism is a suitable option for recreation aimed at physically healthy people at a young age. Using various medical and natural factors that help increase stamina and resistance of the organism contributes to better overall physical health, specialist say.

The active exercise regimen in combination with positive emotions and entertainment in specialized resorts helps promote relaxation and improve the overall condition of the body.

Preventive and wellness type health tourism focuses more on people who are predisposed to certain conditions and diseases. This type of prevention positively affects the overall performance of the individual and helps with diminishing negative factors and possible conditions with clinical signs not yet visible.

Bulgaria has a particularly rich natural resources that allows the development and practice of health tourism. Low prices, professional service and natural resources of mineral springs attract patients and tourists from around the world. The resources of Bulgaria determine the existence of many specialized spa resorts, most of which have long experience in obastta. Spas around which mainly concentrate asylum-service health tourism in Bulgaria are hundreds.

Health tourism and spa treatment with mineral water

In our mapped more than 1,000 mineral springs. Many are used for therapeutic activities since ancient times. Many of the most famous Roman baths and Turkish baths nowadays are famous spa resorts. Some of the most popular are Pavel Banya, Varna, Hisar, Velingrad, Sandanski, Varshets, Kyustendil.

Each of the resorts with mineral water specializes in treating different conditions, depending on the chemical composition of the water.

Bulgaria is an extremely attractive international center for treatment, recreation and tourism with its numerous resorts, favourable climate, over 1000 hydro mineral springs. In the uniqueness, variety and abundance of hydrothermal, bioclimatic, mud treatment, sea cure, and other health resources, Bulgaria ranks among the first in Europe. Bulgarian traditions in climatic and balneo treatment date back to ancient times.

The Bulgarian mineral waters are known for their greatly varied chemical composition and, respectively, their mineralization and type of dissolved mineral salts, curative gases and biologically active micro components. Scientists agree that all kinds of known mineral waters around the world find their counterpart in Bulgaria. Bulgaria has exceptional diversity of Medicinal Herbs with excellent curative properties.

Healthcare

Bulgaria relies on good traditions in healthcare:

• The health sector in Bulgaria relies on experienced professionals (doctors, dental technicians, nurses, therapists, pharmacists, researchers).
• Internationally recognized medical doctors in various specialities such as heart disease, orthopaedics, oncology, dentistry and others
• Low prices of medical procedures
• Established private health insurance funds
• Opportunity to build private medical centres to make use of the existing workforce, adequate legislation, manufacturing of medical supplies, devices and pharmaceuticals

Bulgaria is among the top countries in Europe by the number of hospitals per 100 000 of the population.

[Data source]

Types of hospitals and medical centers according to the National Statistical Institute:

• 52.4% of hospitals in Bulgaria are multi-profile (general) hospitals
• The largest number of beds is in university hospitals
• 14 specialized hospitals for continuous treatment, prolonged treatment and rehabilitation operate in the country
• 22 specialized hospitals for rehabilitation

Medical Tourism

Some of the most popular procedures offered in Bulgaria

Ophthalmic Surgery
• Laser treatment of cataracts and glaucoma
• Laser correction of nearsightedness, farsightedness, astigmatism
• Keratoplasty (corneal transplant)
• Strabismus (cross-eyed)
• Retinal detachment; Cryotherapy
• Laser treatment for diseases of the retina
• Pterygium (exterior cataract)
• Chalazion, entropium, ectropium, ptosis
• Dacryocystorhinostomy etc.

Plastic Surgery, Dermatology and Cosmetology

• Breasts enlargement, shaping, lifting, reducing etc.
• Botox and Mesotherapy
• Abdominal, face, nose, eyelids, hands, ears plastic surgery, liposuction
• Plastic correction of the thighs, buttocks
• Gynecomastia; Andrology
• Gastric ring, etc.
• Facial mesotherapy
• Chemical peeling; Dermabrasion and microabrasion
• Filing - Facial Line Filling; Botox; Vaposone
• Collagen rejuvenation; Iontophoresis
• PTF technology photoepilation and photorejuvenation
• Treatment of acne, dilated capillaries, rosacea, telangiectasias

Spine Surgery

• Treatment of diseases of the spine and spinal cord
• Disc degenerative disease
• Herniated discs
• Spinal stenosis
• Osteoarthritis of the sacroiliac and intervertebral joints
• Trauma, tumours and in fl ammatory diseases of the spine and spinal cord

Orthopaedic surgery

• The most advanced computer navigation with infrared cameras and 3-D imaging is used for joint replacement operations
• Knee and hip replacement
• Knee arthroscopy
• Shoulder arthroscopy
• Operation of the shoulder muscles; shoulder joint angioplasty
• Surgical joining of vertebrae
• Surgery in spinal stenosis
• Tendon repair - Achilles tendon, folding muscle

Aesthetic Dentistry and Implantology

• Therapy - in caries, pulpitis, gangrene
• Aesthetic procedures - whitening, crowns, cosmetic dental surgery
• Orthodontic treatment - brackets etc.
• Dental technician’s services – dentures

Assisted reproduction

• Intrauterine insemination with partner or donor sperm
• Follicular puncture
• Embryo donation
• Embryo transfer
• In vitro fertilization of ova
• Testicular Sperm Aspiration
• Microsurgical Epididymis Sperm Aspiration , etc.

Physiotherapy and Rehabilitation

• Rehabilitation and relaxation with mud and lye treatment
• Quitting smoking through acupuncture
• Treatment in a hyperbaric chamber with 100% oxygen under high pressure to maintain a young and healthy body and improve natural defense mechanisms
• Healing spa packages, etc.
• The combination of hospitals (medical centres) in climatic and spa resorts in Bulgaria provides an extremely suitable combination of surgical procedures and subsequent physiotherapy and rehabilitation

Diagnostics and Prophylaxis

• Full clinical examination
• Ultrasonography of the prostate (for men)
• Ultrasonography of the abdomen
• ECG
• Ultrasonography of the breast (women)
• Laboratory tests - complete blood count
• Ophthalmic examination, funduscopic examination and others.
• Bulgaria provides all necessary procedures - prevention, diagnosis and outpatient treatment of gynaecological diseases in women of all ages

Some of the cases in which patients seek treatment or rehabilitation abroad are:

1. diagnosis and treatment of ophthalmic diseases
2. dental procedures
3. plastic and cosmetic surgery
4. diagnosis, treatment and monitoring of joint and bone diseases
5. diagnosis, treatment and rehabilitation of lung diseases
6. treatment of traumatic and orthopedic diseases
7. diagnosis and treatment of degenerative and inflammatory joint diseases
8. treatment of vertebral (originating from the spine) disease changes
9.treatment of disorders of the central nervous system
10. treatment and rehabilitation in acute conditions after burns (i.e. keloids, etc.)

Patients seeking medical care and services abroad have various needs and requirements. The decision and the choice where to get treatment is often dictated by the specifics of the disease that is being treated. Therefore, there is no definite answer as to which diseases health tourism responds best. This fairly broad concept incorporates a multidisciplinary approach that aims to meet the individual requirements and needs of the individual patient.

However, globally among the most sought health services in this segment are:

• cosmetic surgery
• dental medicine and dentistry (general, restorative, cosmetic)
• cardiovascular disease (angioplasty, transplants)
• orthopedic (joints and spine, sports medicine)
• oncology
• reproductive medicine (treatment of infertility, women's health)
• reducing the weight orslabvane (LAP-BAND, gastric bypass surgery and other procedures)
• research, testing second opinion from medical specialists
• cosmetic, preventive and beauty treatments
• spa
• other

The overall factors that help a country become a preferred destination for health tourism are numerous. Among the key factors are major investments in health care by the state apparatus or by the private sector. Experienced staff and good infrastructure are essential factors.

The leading destinations for health tourism worldwide are similar in several factors - there is continuous improvement and control of quality of service, guaranteed and supervised health services, operating internationally. You can tell if that a country is recognized as a good destination for medical procedures when most of the following factors are met:}

• saving potential costs of medical procedures
• general political atmosphere of transparency and social stability in the country
• excellent tourist infrastructure
• lasting reputation and history of health tourism
• availability of sustainable international flow of patients
• participation in global health events (congresses, symposiums, scientific exchanges)
• innovations and achievements in the field of medicine and healthcare
• successful adoption and implementation of best practices
• utilization of the most modern medical technology
• presence of internationally trained and experienced medical staff
• compliance with internationally recognized standards of good practice

What are the most popular countries and health tourism destinations in the world?

Market shares in the fields of healthcare are measuring the primacy of some of the most successful aspects of leadership in health tourism. These numbers are changing fast and are very dynamic, but sustainable places among the top destinations are:

• India
• Thailand
• Brazil
• Singapore
• Malaysia
• Israel
• USA
• Mexico
• Turkey
• Hungary

A recent study of Patients Without Borders shows a relative comparison of the prices of health services in the United States and some of the preferred destinations for medical tourism. The following data/percentages (provided by Patients Without Borders) show how much an average American patient can save if he or she chooses to be treated in one of the following countries.

• Brazil: 20-30%
• Costa Rica: 45-65%
• India: 65-90%
• Malaysia: 65-80%
• Mexico: 40-65%
• Singapore: 25-40%
• South Korea: 30-45%
• Taiwan: 40-55%
• Thailand: 50-75%
• Turkey: 50-65%

Hydro- and Balneo-therapy (lat. Balneum, bath) is a form of treatment and rehabilitation of various medical conditions through the healing power of water.

Balneotherapy include procedures with hot or cold water, as well as massage and stimulation with water. Some resorts offer treatments with mineral water rich in silicon, sulfur, selenium, radium and others. These elements help in different conditions and are recommended for bone, skin or other problems. In balneology different types of healing clay are also used.

Balneological treatment is recommended for a wide range of diseases such as arthritis, skin disorders and fibromyalgia. As with any medical treatment, spa treatment should be recommended or prescribed by a doctor. In some cases, such as cardiovascular diseases and pregnancy spa treatment can be counterproductive and lead to adverse effects.

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