Health Tourism and Alternative Medicine: a Study on the Offer and Profile of Establishments nearby Two Hospitals in the City of Porto Alegre-Brazil

Introduction

“Health tourism” refers to traveling to another country for medical care (Centers for Deasease Control and Prevention [CDC], 2016). The segment can be divided into Wellness tourism and Medical tourism (Ministério do Turismo [MTUR],2010). As stated in the specifications of the Ministry of Tourism of Brazil on health tourism, the distinction between the segments can be difficult. Therefore, we will only use the term "health tourism" when referring to this tourism modality. It is understood as characteristic motivations of this type of tourism the promotion of health, health maintenance, disease prevention and cure of disease (MTUR 2010). The Health Tourism segment can be a positive response to the challenge of tourism seazonality, since it allows greater mobility of the promotion of preventive or curative health services unrelated to the times of the year typically destined for travel (MTUR 2010).

It is a growing market. In its report on the health tourism market, the Transparency Market Research website valued the market at USD 10.5 billion in 2012, with an expected CAGR (Compound Annual Growth Rate) of 17.9 % from 2013 to 2019, reaching an estimated value of USD 32.5 billion in 2019 (Transparency Market Research [TMR], 2013). Spain, through projects in the area of health tourism, from a budget of just 2.7 million euros, increased their turnover from 140 to 500 million euros and by 80% the number of health tourists (M.M. 2016).

In the Study of International Tourism Demand 2012-2016, a publication of the Ministry of Tourism of Brazil, health tourism is not listed individually under reasons for traveling to Brazil (MTUR 2017). We can assume that it is included under a more comprehensive index. Tourists that travel for reasons other than leisure, business, events or visiting family account for 3.3% of the total (around 208,092 tourists). In its assessment of the health tourism sector, BEMTUR 2014(Municipal Tourism Statistics Report for Porto Alegre 2014) ( Secretaria Municipal de Turismo [SMTur] 2014) reports that the number of patients treated in the city was 4,428 or 5% of the total tourists.

In the present study the focus was on alternative medicine. It is defined by the World Health Organization as follows: the terms “complementary medicine” or “alternative medicine” refer to a broad set of health care practices that are not part of that country’s own tradition or conventional medicine and are not fully integrated into the dominant health-care system (World Health Organization [WHO],2013). Alternative medicine includes yoga, chiropractic and osteopathic manipulation, meditation, massage therapy, acupuncture, relaxation techniques (National Center for Complementary and Integrative Health 2016)

According to an article published in the National Health Statistics Reports of 2015, about 33.2% of Americans over 18 years of age have used some form of alternative (or complementary) medicine in the year 2012 (Clarke et al. 2015). In Brazil, in a study conducted in a city in the countryside of the country, the number of users of alternative medicine was 70% (Rodrigues Neto, Faria & Figueiredo 2009).

The purpose of this study was to study the offer of alternative medicine services in the vicinity of two hospitals that receive health tourists in the city of Porto Alegre during a period linked to summer vacation in the country. We evaluated the services in relation to their functioning during the study period, the therapies offered, assistance to tourists from outside the city, knowledge about health tourism and the availability of the service page in a language other than Portuguese.

Methodology

The research was conducted in the city of Porto Alegre, the capital of the state of Rio Grande do Sul, from December 26, 2017 to January 8, 2018.

For the location of the establishments, a search was performed on the Google site, using the term "alternative medicine". We used as a center of research on the map two hospitals that are part of Porto Alegre Health Care (a cluster that brings together hospitals that receive international health tourists). These hospitals were chosen because they are in the most central area of the city, with the possibility of a greater number of services nearby. Establishments that offer care only in acupuncture and/or homeopathy were excluded, because they are recognized as medical specialties by the Federal Medical Council of Brazil. Establishments that offer these specialties together with other unrecognized ones have been included. The research area was also delimited using as a criterion the distance that can be walked on foot in up to 15 minutes (according to the same site).

Once the establishments were located, contact was made by telephone and, in those who were willing to respond, interviews were conducted through a questionnaire applied in person.

Results

We found 10 establishments related to alternative medicine. Of these, 01 was not in attendance, 03 did not attend, 01 establishment the address was not found/did not attend and 01 refused to respond.

Among the 04 establishments that responded to the questionnaire, the results were as follows: no service was in operation during the period between December 26, 2017 to January 1, 2018. All attend to patients from outside of Porto Alegre, 03 of them had patients from other states and countries and 01 was limited to other cities in the state of Rio Grande do Sul (predominantly the mountain areas). Movement related to out-of-town patients ranged from 0 to 10% in two of them and 31-40% in the other two. Of the 04 interviewees, 03 were unaware of health tourism and the other one knew about it from a television program dedicated to health promotion.

None of the establishments had their website in a language other than Portuguese.

The therapies most offered were chiropractic, Reike and Bach flower remedies. Other therapies included Orthomolecular Medicine, Chromotherapy, Aromatherapy and Phytotherapy.

Discussion

Health tourism is a market that moves billions of dollars worldwide, with forecasts of growth (TMR 2013). As stated above, it may be a response to the seasonality of tourism (MTUR 2010). This was the reason for choosing the summer period (in the southern hemisphere) to carry out this study. We checked the availability of services during a time that is traditionally associated with vacation and travel. In the period from 26 to 29 December 2017, none of the establishments were in operation. This is understandable because it is the period between Christmas and New Year. During the next study period, up to January 8, 2018, we found 05 services in operation, of which 01 refused to respond to the survey. The results showed that most of the interviewees were not aware of the sector, although the Ministry of Tourism of Brazil already published material on the sector in 2010. The fact that the only respondent who had knowledge of the sector, and having obtained the information from an unofficial source, may demonstrate that the sector is not receiving the necessary attention. As already reported by Ribeiro & Almeida (2017), one of the limitations to the arrival of international tourists to the city of Porto Alegre is the shortage of direct international flights. However, this can not be taken as a limitation on investments in the industry. We found that 70% of adults in a Brazilian city had already used some form of alternative medicine (Rodrigues Neto, Faria & Figueiredo 2009). This data shows that there is a latent market, which requires greater attention both by those responsible for its disclosure and those who offer the services. In relation to the latter, the fact that they do not have their websites in other languages limits the possibilities of expanding their service. We looked for services located near hospitals because, for the latter, there is no seasonality. Alternative medicine services could offer care to patients (national or international) as well as their companions. In the case of international tourists and their companions, a web page in other languages would be essential. Due to the location of the city, in the extreme south of Brazil, we believe that the pages should be available in Spanish as well as in English. We found two establishments where the movement related to people from outside Porto Alegre reached 40%, proving that this niche can be very profitable for the establishment. The fact that different modalities of alternative therapies have been found allows the services to be offered to a greater number of possible users.

Conclusion

Health tourism is still unknown by alternative medicine establishments, even though it is close to hospitals that receive foreign tourists and are part of a health cluster in the city of Porto Alegre. The fact that establishments do not provide a website in another language limits the access to information by foreigners, making it difficult to expand the service. There are a variety of therapies offered, which allows for more comprehensive care.

A limiting factor in this study is the small number of establishments visited. However, this number can be considered as important since one of the focuses of the work was to ascertain those who were operating in a period associated with vacations.

Strategies for the increase in the number of health care tourists include websites in other languages, operation during vacation times, greater dissemination of this type of tourism.

For the continuity of the research we have as points to be approached: to verify the impact of information on the health tourism segment (given during the current research) in the visited establishments, to increase the number of establishments visited, to check with the hospitals of the health cluster of the city if there is a demand for alternative medicine services (by their patients and/or their companions).

References