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The purpose of this paper is twofold: First, it analyzes demand and supply-side factors that influence patient flows to and from Austria. Second, building on the empirical research and existing conceptualizations, the study offers a general extended framework to guide future comparative analysis.

The paper draws on multiple data sources including a literature review, secondary data, website analysis and semi-structured interviews with patients and health providers. Content analysis was carried out to identify common motives for seeking care abroad and providers' orientation towards medical travel.

Outbound medical travel is largely determined by factors of access, affordability and vicinity, while inbound medical travel is predominately driven by a lack of adequate medical infrastructure in source countries and quality, both in terms of medical and service quality. Providers distinguish themselves according to the extent they take part in medical travel.

The findings emerging from a single country case study approach cannot be generalized across settings and contexts, albeit contributing to a better understanding of current medical travel patterns in Europe.

Unlike most recent contributions, this study focuses both on inbound and outbound medical travel in Austria and investigates patient flows for distinctive treatments and drivers. While analysis of the supply-side of medical travel is often limited to tourism studies, this study provides a critical insight into developments in Europe from a health policy perspective, acknowledging that diverse medical travel patterns in Europe coexist.

The purpose of this study is to investigate the inbound and outbound medical tourism in the UK to determine if the UK can be considered as a net exporter of health services as well as the impact of the 2007 global economic crisis, diaspora populations and the number of UK expats on medical tourism figures.

Using microdata drawn from the International Passenger Survey (2000-2016), the authors estimate the flows, number of nights and expenditure of tourists looking for medical treatment who complete international visits of less than 12 months’ duration to and from the UK. The authors also analyse the main destinations of UK residents, the country of origin of overseas residents and the particular case of British expats.

The results show the upward trend of inbound and outbound patients, the strong seasonality in outbound patients, and the significant increase in the levels of expenditure of overseas residents since 2005. Poland, France, Hungary and India are the chosen countries by UK residents to be treated, whereas Irish Republic, Spain, France, Gibraltar and the United Arab Emirates are the main countries providing inbound health patients. However, the processes of migration explain full or partly the inbound and outbound flows found for some countries.

This study offers a critical insight into inbound and outbound medical flows, demonstrating both the scope for and limitations to market development in this area.

Is humanity heading to immortal living? If so, what areas of society are playing an active role in achieving this? In order to understand this, the study explores the relationship between immortality and the wellness and medical tourism industry to seek potential relationships between them and ultimately, asks difficult questions about the growth of these tourism sectors and the potential need for greater regulation of them.

Taking a pragmatic philosophical approach and through the examination of refined information from secondary sources and published material and reports, the study presents original theoretical knowledge and a model exploring tourism and human immortality.

This paper argues that continued growth in the wellness and medical markets today could lead to a world where transhumanists and cyborgs are present in our world, even taking over from Homo sapiens. The study presents a model highlighting the potential role of wellness and medical tourism markets, illustrating the potential for future consumer services that could further fuel the search for immortality. Thus, how such markets and consumer desires are (in)directly supporting humanities desire for (non-human) immortal existence.

Today, individuals are driven by wellness practices and medical and cosmetic desires and are willing to travel the globe in search of companies who are either capable of carrying out the desired procedures or seeking prices more affordable to them. This research offers novel insights into these complex relationships and maps the affiliation between wellness and medical practices and the concept of immortality.

Under the Directive 2011/24/EU, medical tourism and cross-border health are interrelated terms regarding the freedom to move to get the most accessible medical treatment into EU Member State within the defined procedures for reimbursement. Little known empirically regarding the efficiency of the cross-border health/medical tourism industry. This study aims to measure its efficiency in Europe for the years 2010-2014, by using Data Envelopment Analysis (DEA).

Data obtained from OECD and the European Core Health Indicators (ECHI), which is collecting the data through Eurostat. Eurostat collects data on health-care activities and provides data on hospital discharges, including the hospital discharges of non-residents and these include hospital discharges of in-patients and day care patients. The analysis uses “DEA.P, 2.1 for windows” by Coelli (1996).

The results show that the Members States health systems were very efficient in handling non-residents in-patients; however, when managing day cases/outpatients, the efficiency scores dropped.

The findings would have significant associations affecting intentions to revisit clinics and the destination country. In addition, will be useful to those seeking a better understanding of the cross-border health and medical tourism industry efficiency.

Extending the findings of the European Commission report (2015c) by examining how well medical tourists are informed about the decision they are making, would be of perceived value. These are important indicators at European level by helping each Member State to measure its medical tourism services.

The past decade has witnessed a tremendous and progressive growth in the number of Nigerians who engage in medical tourism from Nigeria to India. Various commentators have advanced diverse reasons for this trend. However, there is a dearth of research that has sought to provide empirical insights. This paper aims to investigate the decision-making process of Nigerian medical tourists and why they prefer medical tourism to India to medical care locally.

Eight Nigerian medical tourists are interviewed on a one-on-one basis with open-ended questions using purposive criterion sampling technique from an interpretivist mind-set.

The paper identifies two major motivators, namely, inadequate medical infrastructure and poor medical, and customer service from health workers in Nigeria, which spurred medical tourism from Nigeria to India. Further, it finds that first timers premise their decisions on advice from reference groups, while previous personal experiences guide decisions on subsequent medical travels. Findings are explained using the template provided by the theory of planned behaviour.

This exploratory nature of this research provides a useful basis to elucidate the course of decision-making of Nigerian patients so that appropriate marketing communication channels can be applied. It improves the process of recruiting and engaging Nigerian patients and nurturing wholesome relationships between Nigerian patients and hospitals.

The planning of massive vaccination campaigns often falls to nongovernmental organizations that have to face the critical challenge of vaccinating the largest number of people in the shortest time. This study aims to provide an easy tool for minimizing the duration of mass vaccination campaigns in rural and remote areas of developing countries.

This paper presents a linear mathematical model that combines location, scheduling and routing decisions that allows determining where to locate the vaccination centers, as well as the schedule/route that each medical team must follow to meet the target demand in the shortest time possible. In addition, the paper proposes an heuristic approach that can be integrated in a spreadsheet.

As the numerical experiments show, the proposed heuristic provides good solutions in a short time. Due to its simplicity and flexibility, the proposed approach allows decision-makers to analyze and evaluate several possible scenarios for decision-making by simply playing with input parameters.

The integration of the heuristic approach in a spreadsheet provides a simple and efficient tool to help decision-makers while avoiding the need for large investments in information systems infrastructure by user organizations.

Motivated by a real-life problem and different from previous studies, the objective of the planning is to reduce the length of the vaccination campaigns with the available resources and ensure a target coverage instead of planning for minimizing costs or maximizing coverage. Furthermore, for helping implementation to practitioners, the heuristic can be solved in a spreadsheet.

This study aims to analyse the factors that caused Indian tourists to avoid travelling abroad because of the recent outbreak of COVID-19 in 2020. It will also identify the relationship between the perceived risk of travelling and the probability of travel evading in India owing to COVID-19.

This study used an online structured questionnaire to collect data from Indian tourists to study six independent variables linked with their behavioural intentions (travel evading). The health belief model was used to examine tourist behaviour.

The results revealed a positive correlation between the perceived risk associated with COVID-19 and travel avoidance. Familiarity with COVID-19 was positively correlated with travel evading behaviours.

This study will assist stakeholders from around the world to adequately identify and thoroughly plan for logistical problems associated with travel such as travel insurance and pre-travel booking expenses to reduce travel evading behaviour and promote travel.

While a few studies have been conducted related to pandemics (Ebola, MERS-CoV, SARS), there is a paucity of literature that examines the factors which influence tourists’ travel evading behaviour owing to COVID-19. Moreover, most of the previous literature on pandemics is concentrated on American and European countries, whereas studies on the Indian sub-continent are very scarce. This study will fill this gap and will identify the factors which influence tourists in India to evade travel in response to COVID-19.

The purpose of this paper is to conceptually examine the phenomenon of wellness tourism under a holistic and systemic lens, focusing on the offer system and the main components necessary for the staging of wellness experiences. This approach to holistic wellbeing within the tourism sector has led to a broadening of the type of services and experiences that make up the value propositions that can positively contribute to people’s wellbeing.

This study identifies and defines the components of wellness tourism (including sectors not traditionally associated with it) through a review and analysis of the extant literature on “wellness tourism” and “wellbeing tourism” of the past two decades; the components were classified through an open coding process.

Wellness tourism, as a broad multidimensional concept, is composed by ten different components of the offer system: hot springs, spas, medical tourism, care of the body and mind, enogastronomy, sports, nature and environment, culture, spirituality and events. Each of these categories may represent a single touristic offer targeted to specific market segments, but they may also be one of several components within an integrated mix of tourism products proposed.

A holistic view of wellness tourism has implications for strategic marketing processes. Destination Management Organizations and company managers should segment their demand according to more innovative criteria than what has traditionally been adopted for wellness in terms of health care and medical procedures. Value propositions for tourists should be wellness-driven to satisfy the growing demand for wellness/well-being and should involve the participation of all the various actors and producers within the wellness tourism offer system at wellness destinations.

康养旅游及其组成元素：一个全方位的视角

此一论文会以全面和有系统的目光, 谈及康养旅游的现象, 并集中于康养旅游的供应系统和主要组成元素。此一以全面身心健康为目的的旅游行业, 使不同服务的覆盖范围和经验得以扩而充之, 提供有利条件正面地影响着人们的身心健康。

本研究会分辨和定义康养旅游的组成元素（以及其他在传统定义上被排除的行业）, 透过重新审视和分析近20年有关于康养旅游（Wellness tourism）和健康旅游（Wellbeing tourism）的现存文献。同时, 所有元素会以开放式译码 （open coding）来分类。

康养旅游, 作为一个多元概念, 基本上与十个不同的供应行业相关：温泉, 水療, 医疗旅游, 身心护理, 饮食, 运动, 自然环境, 文化, 灵修和特办活动。不同类别的行业可以在代表市场上不同供需关系的同时, 也可以代表供应上可以有一种混合套餐供应。

以全面的目光去看康养旅游可以为市场策略定下基础。目的地管理公司（DMO）和不同的公司经理应该在分辨服务需求的时候, 多采用新颖的标准, 摒弃只包括医疗的传统健康观念。为游客订立的价值主张（Value propositions）应以全面身心健康为主导, 以满足对康养（Wellness）和健康（Wellbeing）不断上升的需求; 亦应大力度地提升所有安康旅游工作人员与顾客的互动和参与。

El turismo de bienestar y los componentes de su sistema de oferta: una perspectiva holística

Este artículo examina conceptualmente el fenómeno del turismo de bienestar desde una perspectiva holística y sistémica, centrándose en el sistema de oferta y los principales componentes necesarios para la puesta en escena de experiencias de bienestar. Este enfoque de bienestar integral dentro del sector turístico ha propiciado una ampliación del tipo de servicios y experiencias que integran las propuestas de valor que pueden contribuir positivamente al bienestar de las personas.

Este estudio identifica y define los componentes del turismo de bienestar (incluidos los sectores no asociados tradicionalmente con él), a través de una revisión y análisis de la literatura existente sobre “turismo de bienestar” de las dos últimas décadas; los componentes se han clasificado mediante un proceso de codificación abierto.

El turismo de bienestar está compuesto conceptualmente por diez componentes diferentes de ofertas: aguas termales, spas, turismo sanitario, cuidado de cuerpo y mente, enogastronomía, deportes, naturaleza y medio ambiente, cultura, espiritualidad y eventos. Cada una de estas categorías puede representar una única oferta turística para segmentos de mercado específicos, pero también pueden ser uno de los varios componentes de una combinación integrada de productos turísticos.

Esta concepción holística del bienestar sugiere que, en el contexto de los procesos de marketing estratégico, las DMO y los gerentes de negocio deben segmentar la demanda con criterios innovadores respecto a los tradicionales de salud y médicos. Además, deben formular propuestas de turismo orientado al bienestar, valorizando los componentes de la oferta capaces de interceptar la creciente demanda de bienestar e implicando a los distintos productores del sistema de oferta de wellness que operan en los destinos de bienestar

The global Covid-19 pandemic is posing considerable challenges for governments throughout the world and has and will have a significant influence on the shape of peoples social and economic life and wellbeing in the short and longer term. This opinion paper discusses the current health policy response adopted in England to control or manage the epidemic and identifies the key sociological and political influences which have shaped these policies. Drawing on the theoretical approach set out in his recent book, which emphasises the interplay of powerful structural and economic interest groups, the author will consider the influence of the key players. Government policy has tied itself to scientific and medical evidence and protecting the NHS so the key roles of the medical profession, public health scientific community and NHS management and their respective and relative powerful influences will be discussed. The government needs the support of the public if their policies are to be successful, so how have the government addressed maintaining public trust in this “crisis” and how much trust do the public have in the government and what has influenced it? The strong emphasis on social distancing and social isolation in the national government policy response to Covid-19 has placed an increasing public reliance on the traditional and social media for sources of information so how the media has framed the policy will be considered. One policy aim is for an effective vaccine and the influence of the drug industry in its development is discussed. Finally, the role of the state will be discussed and what has shaped its social and economic policies.

This paper investigates the usage and trust of Chinese social media in the travel planning process (pre-trip, during-trip and post-trip) of Chinese tourists.

Through a combination of structured online survey (n = 406) and follow-up interviews, the research identifies the diversification of the demand-and-supply patterns of social media users in China, as well as the allocation of functions of social media as tools before, during and after travel.

Social media users are diverse in terms of their adoption of social media, use behaviour and scope; the levels of trust and influence; and their ultimate travel decisions and actions. Correlations between the level of trust, influence of social media and the intended changes in travel decisions are observed. Destination marketers and tourism industries should observe and adapt to the needs of social media users and potential tourist markets by understanding more about user segmentation between platforms or apps and conducting marketing campaigns on social media platforms to attract a higher number of visitors.

This paper demonstrated the case of social media usage in mainland China, which has been regarded as one of the fastest growing and influential tourist-generating markets and social media expansions in the world. This study further addressed the knowledge gap by correlating social media usage and travel planning process of Chinese tourists. The research findings suggested diversification of the demand-and-supply pattern of social media users in China, as well as the use of social media as tools before, during and after travel. Users were diversified in terms of their adoption of social media, use behaviour, scope, the levels of trust, influence and the ultimate travel decisions.

Destination marketing organizations should note that some overseas social media platforms that are not accessible in China like TripAdvisor, Yelp, Facebook and Instagram are still valued by some Chinese tourists, especially during-trip period in journeys to Western countries. Some tactics for specific user segments should be carefully observed. When promoting specific tourism products to Chinese tourists, it is necessary to understand the user segmentation between platforms or apps.

Social media is a powerful tool for tourism development and sustainability in creating smart tourists and destinations worldwide. In China, the use of social media has stimulated the development of both information and communication technology and tourism.