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Conceptual Framework

Tourism is a slippery (Eden 2000; Wincott 2003) and fuzzy concept (Markusen 1999). It is relatively easy to visualize yet difficult to define with precision because it changes the meaning depending on the context of its analysis, purpose, and use. Tourism, therefore, is a concept that, while initially looking very easy to define, is actually quite complex.

This confusion of concepts is also valid for thermal tourism. Kozak and Bahpe (2009) argue that the types of tourism related to health are numerous and that the definition and contents of each one are different. According to Bennett et al. (2004), while thermal tourism, health tourism, spa, and medical tourism are defined in different ways, in reality they serve the same purpose, enabling people to gain or protect their health. While Garcia and Besinga (2006) and Genpay (2007) separate health tourism into three areas which are medical tourism, thermal and spa-wellness tourism, and tourism for senior citizens and the disabled, Ergfiven (2012) indicates that there are significant differences between the concepts of spa and wellness. Yirik et al. (2015) classify health tourism in five categories which are thermal, spa, wellness, senior citizens (geriatrics), disabled, and medical tourism. §ahin and Tuzlukaya (2013) draw attention to the needs and expectations of the tourists in the target market, forms of treatment, and the differences in the resources used for health tourism and separate thermal tourism from spa and wellness tourism. They also divide medical tourism into four varieties: thermal tourism, elderly care tourism, disabled care tourism, and spa-wellness tourism. All these interpretations lead to the conclusion that a common opinion in the classification of health tourism has not been reached yet. However, literature reveals that there is a common view that thermal tourism is a sub-branch of health tourism which is an alternative type of tourism.

In the broadest sense of the word, health tourism means people traveling from their places of residence to other places for health reasons. In the present day, this definition also covers cosmetic/aesthetic surgeries and complementary treatments in addition to traditional health services (Huff-Rousselle and Shepherd 1995).

There is no doubt that the most ancient form of health tourism is thermal tourism carried out with natural thermal waters. Although this type of tourism is more readily developed in regions with hot underground waters, it can also be developed artificially in regions without these characteristics. While hot springs are mainly used for health purposes in contemporary times, during Roman times, historical sources indicate that they were used mainly for entertainment purposes (Kozak and Bah?e 2009).

In 1993, the Ministry of Tourism prepared a study titled “Health Tourism and Tourism Health" in which health tourism is defined as follows: “a tourism activity comprising of health care applications which are carried out in an environment comprising of mineralized thermal waters and mud together with appropriate climate factors with coordinated supplemental treatments such as physical therapy, rehabilitation, exercises, psychotherapy, diets under the supervision of specialist physicians to make a positive contribution to human health.” According to Cockerell (1996), those participating in thermal tourism form two different groups:

  • 1. Those who visit for health tourism areas as a tradition: This activity is particularly popular with aging tourists who enjoy the natural beauty while they relax in the geothermal waters. For these tourists, the quality of the natural environment, geothermal waters, and facilities are important. The essential aim is to rest and have fun, while the second aim is to relax and stay healthy.
  • 2. Those who visit for health reasons: This activity is comprised of tourism activities for the purpose of treatment and recuperation at the springs for the treatment of ailments which have been diagnosed by doctors.

Thermal tourism has seen a very rapid development across the world owing to the increase in personal incomes and free time as well as to changes in lifestyle. Compared with mass tourism, thermal tourism is considered more sustainable because it is less dependent on seasons and because, being generally found in rural areas, has a stronger impact on local economies (Alen et al. 2006).

Thermal waters can be used for a number of therapeutic procedures: the treatment of various diseases, hydrotherapy, aqua therapy, physical therapy, exercise and movement, mud therapy, skin and body care, and curing practices (Didaskalou and Nastos 2003). In addition to health reasons, visitors are drawn to thermal tourism because the number of resort facilities have increased, because services are of high quality, because thermal waters have a relaxing effect on the body and because thermal tourism is often combined with other types of tourism. Furthermore, the extreme density and pollution in coastal tourism areas have steered people to more serene and clean venues. In fact, visitors prefer thermal facilities even though they are costly.

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