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Tourism and Hospitality Marketing Research

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• Richard George 2  

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This chapter looks at the role of marketing research in tourism and hospitality marketing. It begins with a discussion of the importance of research to the tourism and hospitality marketer. The chapter then provides a definition of marketing research, and an explanation of the differences between marketing research and market research. Further, it discusses the reasons for doing marketing research and outlines different types of marketing research commonly used in tourism. The chapter then discusses the stages of the marketing research process. The chapter concludes with an analysis of the marketing research activities carried out by E ast Coast Rentals , a small car-rental company based in Australia.

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Further Reading

Brunt, P., Horner, S., & Semley, N. (2017). Research methods in tourism, hospitality, and events management . London: Routledge.

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George, R. (2021). Tourism and Hospitality Marketing Research. In: Marketing Tourism and Hospitality. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-030-64111-5_4

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Health Tourism—Subject of Scientific Research: A Literature Review and Cluster Analysis

Michał roman.

1 Department of Tourism, Social Communication and Consulting, Institute of Economics and Finance, Warsaw University of Life Sciences, Nowoursynowska 166, 02-787 Warsaw, Poland

Monika Roman

2 Department of Logistics, Institute of Economics and Finance, Warsaw University of Life Sciences, Nowoursynowska 166, 02-787 Warsaw, Poland

Monika Wojcieszak-Zbierska

3 Faculty of Economics, Poznań University of Life Sciences, Wojska Polskiego 28, 60-637 Poznań, Poland

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The purpose of this article is to identify main research areas in health tourism in scientific research. The data used in this analysis span from 2000 to 2022, was retrieved from the Web of Science database, and comprises a total of 1493 bibliometric records of publications. The paper includes both a quantitative and a qualitative analysis. The following four main research areas were identified based on the results: (1) patient satisfaction built upon trust; (2) health impacts of the destination (including the economic aspect, which plays a decisive role in choosing a tourism destination); (3) health behavior as a major part of human activity; and (4) traveling with a view to regain one’s health. Note that the limitations of this study—which mostly affect the methodological part—need to be taken into consideration. This is the consequence of the selected publication database and of the search criteria used, such as the publication year or language.

1. Introduction

Travel and tourism, which keeps evolving, is the world’s largest service industry [ 1 , 2 ]. It drives an increase in Gross Domestic Product (GDP) in destination countries, while also strongly contributing to their government’s tax income [ 3 ]. The travel and tourism sector is worth USD 7.6 trillion and accounts for more than 10% of the global GDP, 7% of total international trade, and 30% of service exports around the world. Income from tourism also provides an important currency exchange engine for countries worldwide, thus becoming an enabler of economic growth and investments in a number of other sectors. In 2016, tourism grew by 3.1%, which is 2.5% above the growth rate of the global economy [ 4 ].

As the third largest socioeconomic activity in the European Union, tourism is a major contributor to its gross domestic product and employment. While Europe is the world’s most popular tourism destination, it is not the fastest developing region at a global level. It has experienced a decline in its market share, measured by the visits of and income from international tourists [ 5 ]. In 2018, Europe had the world’s largest number of international visitors (713 million, i.e., more than half of the global total) and saw a growth rate of 6% [ 2 ].

Tourism is a sector whose income keeps increasing [ 6 ]. It forms a major part of many economies, while also having a considerable impact on human (including inter-generational) relationships and on global international connections. At a global level, tourism is viewed as a sector of extreme importance, as it brings crucial benefits to the economy [ 7 ]. Each year, it generates ca. 10% of the global GDP, making it the third largest sector of the economy [ 8 ]. In this context, it mostly performs a macroeconomic function, as it stimulates the socioeconomic development of a country by adding value, which translates into an increase in gross domestic product [ 9 , 10 ].

Tourism is among the largest and fastest developing sectors of the global economy [ 11 ]. By creating jobs, driving revenues from exports, and boosting investments and infrastructural development, tourism both directly and indirectly contributes in a significant way to socioeconomic processes. Note, however, that the COVID-19 pandemic had a disastrous effect on tourism development worldwide [ 12 ].

Even prior to COVID-19, global tourism was facing a number of crises. The main breakthrough events from 2000–2015 include the 9/11 terrorist attacks, the outbreak of the Severe Acute Respiratory Syndrome (SARS) in 2003, the global economic crisis in 2008/2009, and the Middle East Respiratory Syndrome (MERS) in 2015 [ 13 ].

However, none of the crises listed above resulted in a prolonged global decline in tourism development. Only SARS (−0.4%) and the global economic crisis (−4.0%) entailed a drop in the number of international airline travelers. This would suggest that tourism, as a system, is robust to external shocks. However, there is overwhelming evidence that the consequences of and recovery from the COVID-19 pandemic will be of an unprecedented nature. This is why health tourism has recently become increasingly popular. Society needs some rest and support in the physical, mental, emotional, and spiritual dimensions, which members can find in a number of locations, including rural areas [ 13 ].

Tourism has a series of important social functions [ 14 ]. Because of the number of purposes it serves, there are ten to twenty classifications of tourism traffic, which are additionally sub-divided into subtypes, kinds, or specific forms [ 15 ].

This includes health tourism, often referred to as therapeutic tourism. Różycki [ 16 ] identifies two more alternative terms: spa tourism and curative tourism (sometimes, in a broader sense, also referred to as health tourism). Although known for quite a long time, it has become particularly popular over the recent years, and is intended to recover and revitalize the body [ 17 ].

Indeed, as people are always in a hurry, they look for ways to alleviate the stress and take care of their mental and physical health [ 18 ]. The increased interest in healthy lifestyles, combined with physical and intellectual activity, has directly contributed to changing the existing patterns of spending free time [ 19 ]. Therefore, the purpose of this article is to identify main research areas in health tourism in scientific research based on the current literature review.

2. Literature Review on Health Tourism

Society demonstrates a growing health awareness [ 20 , 21 ]. Health is believed to be the most important and most precious thing for human life and development, and it can be neither purchased from nor sold to another person [ 22 ]. It represents individual wealth and a private value attributed to a particular human being [ 23 ]. In order for working people to maintain their health in physical, mental, spiritual (related to individual and social awareness), and social terms, they need to relax in their free time, because, otherwise, their bodies may become weaker and exposed to illnesses in the long run [ 24 ].

Claiming that “health is something you either have or do not have” is overly simplistic [ 25 ]. Health is something that needs to be taken care of on a continuous basis; people must seek their well-being, have their illnesses (if any) cured, make their bodies fitter, and—first of all—prevent diseases [ 26 ]. The increased interest in healthy lifestyles, combined with physical and intellectual activity, contributes directly to changing the existing patterns of spending free time. This means shifting from the 3S (Sun, Sea, Sand) model to the 3E (Entertainment, Excitement, Education) and 3A (Action, Amusement, Adventure) models [ 27 ].

As society ages, tourists look for diverse forms of active leisure that will improve their physical and mental condition while allowing their bodies to recover [ 28 ]. As today’s society becomes increasingly wealthy, people demonstrate greater demand for luxury goods and services related to improving their health condition. The increased interest in health tourism is viewed as one of the key developments witnessed in the market for tourism services [ 29 ]. Table 1 presents some selected definitions of health tourism.

Selected definitions of health tourism found in the relevant literature.

Source: [ 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 ].

Health tourism is a combination of active leisure, prevention, and treatment [ 38 ]. Could it become an important driver of rural development? Indeed, it should develop on environmentally sound areas and has a direct impact on the economic development of the territory concerned [ 39 ].

The forms of health tourism are shaped and directly implied by the motives behind it, including [ 40 ]:

• post-illness and post-trauma recovery,
• the desire to remove the adverse consequences of stress,
• anti-ageing and beauty treatments (including plastic surgery),
• fighting addictions,
• the decision to improve one’s health condition by undergoing a specialized healthcare intervention or operation in a relaxed atmosphere in an environment not resembling a hospital,
• a way of accessing increasingly diverse complementary therapies related to preventive healthcare measures.

Health tourism can be divided into the following types, as shown in Figure 1 .

Division of health tourism. Source: [ 37 , 41 ].

Health tourism has become more popular in the post-2000 era [ 42 ] because society increasingly often needs physical and mental leisure. Furthermore, there is noticeable development in the market of services for disabled tourists.

3. Materials and Methods

3.1. research methodology.

The aim of the article was achieved on the basis of a review of the current literature on medical tourism based on the SotA procedure, as detailed by Barry et al. [ 43 ]. The study used bibliometric methods in order to facilitate the analysis of a large number of publications [ 44 ]. The authors relied on descriptive bibliometrics in analyzing the scientific research trends and in identifying the right scientists and research centers [ 45 , 46 ].

The following tools and techniques were used in the bibliometric analysis: analysis of changes in the number of publications; citation analysis; and the co-word method. The analysis of changes in the number of publications and citations allowed identification of the trends and determination of the levels of knowledge transfer and dissemination by representatives of different scientific centers. In turn, the co-word analysis enabled the identification of main thematic areas addressed in health tourism publications with the use of a cluster analysis method developed by Zhu et al. [ 47 ]. The clustering was estimated with VOSviewer (Visualising Scientific Landscapes) version 1.6.18 (2022) [ 48 ], a tool for building and visualizing bibliometric networks that is capable of handling large text files with descriptions of bibliographic records from well-known databases, including the Web of Science (WoS).

3.2. Data Collection and Research Tasks

The data used in this analysis were retrieved from the Web of Science database on November 15, 2022. Web of Science is one of the major search engines for scientific sources, and it offers a wide variety of documents. The fundamental issue in searching for records is to identify the keywords believed to be of relevance for the problem concerned [ 49 ]. The analysis covered papers with the following expressions in their titles: “health tourism,” “medical tourism,” “spa tourism,” and “spa and wellness.” Only articles that were grouped in the "title" section have been addressed.

This resulted in retrieving a set of 1533 publications, which were then subject to a refined selection process based on the following limitative criteria:

• (1) date published: the study took account of papers published between 2000 and 2022;
• (2) publication type: the study took account of papers published in reviewed scientific journals and books;
• (3) publication subject: the study took account of publications focused on selected keywords.

After applying the limitative criteria, the dataset comprised 1493 publications.

As the next step, the authors tried to discover the general trend in the number of publications and citations, and to identify the main researchers, centers, countries, journals, and research areas related to health tourism.

4.1. General Trend in Health Tourism Publications

Figure 2 presents the number of WoS publications addressing health tourism from 2000–2022. Note that the interest in the topic covered by this analysis follows a steady growth trend. Three sub-periods of development of health tourism publications can be identified: (1) small interest: 2000–2009; (2) medium interest: 2010–2018; (3) high interest: 2019–2022 (with an average of 140 papers per year). The significant growth in the number of publications over the last years can be explained by greater care in addressing health tourism issues.

Number of health tourism publications from 2000–2022. Source: own elaboration based on the dedicated database.

The growing interest in health tourism topics justifies the need for a review with a structured approach to the most recent literature and for identification of future areas of research in that domain.

The largest number of papers were written in English (1343). The database also included articles written in Spanish (68), German (21), Russian (10), Chinese (7), French (6), Croatian (6), Portuguese (6), Czech (5), and Italian (4).

Most publications addressed such research topics as social sciences, business economics, and public environmental occupational health ( Table 2 ).

Top ten research areas related to health tourism.

Source: own elaboration based on the dedicated database.

Table 2 suggests that the authors represented various fields of research. However, a large number of publications addressed topics related to medical sciences, e.g., public environmental occupational health, healthcare, and internal medicine.

4.2. Web of Science Categories

The next step consisted of dividing the scientific publications into Web of Science categories ( Table 3 ).

Web of Science categories.

Most publications (as many as 411) fell into the category of “Hospitality Leisure Sport Tourism”.

4.3. Analysis of Publication Sources

The most popular journals with health tourism papers include Sustainability, Tourism Management, International Journal of Environmental Research and Public Health, Iranian Journal of Public Health , and International Journal of Healthcare Management ( Table 4 ).

Scientific journals with the largest number of health tourism publications.

The most popular publishers include Taylor & Francis, Elsevier, Springer Nature, and Emerald Group Publishing ( Table 5 ).

Publishers with the largest number of health tourism publications.

The next step was to present publication authors, their countries of origin, and their affiliations.

4.4. Analysis of Publications by Country and Research Center

The greatest number of health tourism publications were authored by Jeremy Snyder ( Table 6 ).

Authors of health tourism publications.

Most authors of health tourism publications originate from the United States and China. Many other publications were related to authors coming from countries such as Malaysia, United Kingdom, and Canada ( Table 7 ).

Number of publications by country.

The next step focused on analyzing the research centers. Note that research on health tourism was highly dispersed, with the largest number of papers published by employees of Simon Fraser University ( Table 8 ).

Number of publications by research center.

The authors also represented the State University System of Florida, the Ministry of Education Science of Ukraine, and the University of London.

4.5. Analysis of Main Research Areas

The next step in identifying the research areas related to health tourism was the co-word analysis, which served as a basis for the subsequent cluster analysis. Note that the co-word or co-occurrence analysis is a technique that allows examining the actual content of a publication [ 50 ]. It uses words derived from the keywords defined by the author(s), and it can also be employed in analyzing words contained in the paper’s keywords, title, abstract, or index, and even in its full text [ 51 ]. As a consequence, a thematic relation can be established between frequently co-occurring words, which allows identifying thematic clusters and outlining the trends of future research areas.

The co-word analysis was performed as follows:

• Retrieving database records using criteria detailed in the Methodology section.
• Exporting data, including authors’ names, title, abstract, keywords, and references.
• Mapping the relationships that underpin the thematic clusters. The analysis of frequencies was carried out for a set of keywords that occurred in no less than ten phrases.
• Analyzing the results.

Figure 3 presents the visualization of keywords for the “health tourism” thematic area, with “travel”, “health-care”, “care”, “health”, “satisfaction”, “impact”, “model”, “quality” and “destination” as the most frequent occurrences.

Co-Word Cluster Map. Source: own elaboration based on the dedicated database.

The co-word analysis identified four research clusters related to the topic of health tourism ( Figure 3 ).

Cluster 1 (green): patient satisfaction built upon trust; Cluster 2 (yellow): health impacts of the destination; Cluster 3 (blue): health behavior as a major part of human activity; and Cluster 4 (red): traveling with a view to regain one’s health.

5. Discussion

5.1. cluster 1 (green): patient satisfaction built upon trust.

The first cluster covered by the analysis dealt with medical sciences because it was related to patient satisfaction built upon trust in healthcare institutions. Highly interesting research on these matters was presented in a paper by Khodadad Hosseini and Behboudi [ 52 ]. Their goal was to examine the impacts of brand trust on a population of healthcare service users. Nowadays, healthcare managers and activists tend to increasingly rely on marketing and branding measures in order to attract and satisfy their customers. Hence, the study focused on a conceptual model designed to assess brand trust and the impact of brand image on customer satisfaction. Data were sourced from 240 survey questionnaires. The study found the following to be the most efficient aspects with the greatest impact on customer satisfaction and use of healthcare services: brand image; personnel’s sincerity in handling patients; and interactions and relationships with doctors. The authors believe that identifying important elements related to healthcare branding helps healthcare managers and operators create and protect their brands and, as a consequence, drives an increase in profitability due to greater consumer satisfaction.

Highly interesting findings on how to build patient satisfaction were brought by Liu, Ching-Yick Tse, and He [ 53 ]. The purpose of their study was to compare the impacts of health-related corporate social responsibility (CSR) factors on the intents of casual restaurant customers in the U.S. and China. They adopted an approach based on survey questionnaires to collect data in both countries. A total of 828 complete answers were used to validate the hypotheses through the modeling of structural equations. The results revealed some considerable differences in replies between the two countries. The research framework underpinning health-related CSR aspects, critical variables, and relationships among them was subject to a theoretical test and verification procedure. From a practical point of view, these findings allow the management to develop efficient (yet different) market strategies in order to promote CSR initiatives among consumers with a different cultural, political, and economic background (such as the U.S. and China) in order to increase financial benefits while building consumer satisfaction and loyalty. This is one of the few empirical studies on the impacts of consumer decision-making factors on culinary behaviors based on how the restaurants present their health-related CSR initiatives in countries with different market environments.

5.2. Cluster 2 (Yellow): Health Impacts of Holiday Destinations

In recent years, there has been a noticeable increase in the number of people traveling for health reasons [ 54 , 55 , 56 , 57 , 58 ]. Many scientists indicate that domestic and international health destinations are attractive mostly because of the differences in prices of products and services offered [ 59 , 60 , 61 , 62 ]. According to [ 62 , 63 ], a broad range of tourism services and products—combined with the patients and their accompanying persons having an enjoyable stay in a tourist destination—has a clear positive effect on their health. Another aspect of importance to tourists [ 63 ] is the destination itself and its surroundings.

One of the very few positive consequences of the COVID-19 pandemic is people becoming environmentally committed and interested in nature. An interesting study on this was presented by Allison Williams and Rannveig Ólafsdóttir (2022), who indicate that traveling has become possible again, and, thus, people can restart using healthcare tourism services based on natural assets viewed from a therapeutic perspective. Their research suggests that the COVID-19 pandemic contributed to drawing a number of conclusions. First, people realized that they can work remotely from any location (obviously depending on the nature of their work). Second, as they rely on innovative solutions to communicate with others (and for other purposes), they started to appreciate the benefits derived from modern technologies. Third, they started to value and pay particular attention to their health. The last aspect indicated by the researchers were natural values. The COVID-19 era saw a breakthrough in tourism because the traveling restrictions and social isolation made people appreciate nature and enjoy leisure in a natural environment. Similar conclusions were presented in a case study for Poland by Wojcieszak-Zbierska et al. [ 64 ], who demonstrated that at the time of the COVID-19 pandemic, many people decided to spend their free time on agritourism farms because they found it to be the right option for them and, most of all, to be a safe form of leisure. The study also highlighted that staying on agritourism farms had a beneficial impact on the visitors’ recovery and health. Another important aspect addressed by Xiang Yan and Shenjing He [ 65 ] is the way of financing a stay, which is expected to improve one’s physical and mental health. The authors noted that tourists increasingly often opt for staying in an attractive location, which is supposed to meet their specific individual needs related to maintaining a good physical and mental state while having a thrilling experience. The thing that matters to tourists is the destination, whereas financial resources are often a secondary concern.

As shown by the analysis of international papers, including by Aikaterini Manthiou, Volker G. Kuppelwieser and Phil Klaus; Agapito, D., Mendes, J. and Valle, P.; Cetin, G., Bilgihan, A. [ 66 , 67 , 68 ], respectively, the location of a tourist destination is of tremendous importance to the visitors’ health. This is mostly due to the growing value and importance of needs (especially including higher-order needs) and changes in the structure of the population’s needs and preferences that have been witnessed over the last ten to twenty years. These developments largely affect today’s social consumption model, which triggers changes in the service market and in the production and supply of goods. There is continuous growth in the capacity to meet a broad range of needs, and consumers keep changing their inclinations, preferences, and even habits. In turn, it follows from a study by Hung, W. L., Lee, Y. J., Huang, P. H.; Rodríguez Molina, M. Á., Frías-Jamilena, D. M., Castañeda-García, J. A. [ 69 , 70 ], respectively, that consumer expectations are no longer limited to having a place to rest. Visitors also want their destination to add value through positive emotions, experiences, education, and improved health.

5.3. Cluster 3 (Blue): Health Behaviors as an Important Part of Human Activity (Including the Economic Aspect, Which Plays a Decisive Role in Choosing a Tourism Destination)

Today’s lifestyle concept attracts constant interest from researchers around the world [ 71 , 72 , 73 , 74 , 75 ]. Its definition encompasses the whole range of an individual’s characteristic daily behaviors, which express his/her personality traits. The concept has strongly gained in popularity over recent years because of intense changes in two areas of human life: health and consumption of goods and services. As rightly noted in a number of studies, including by Han H. and Heung V., Kucukusta D., Song H. [ 76 , 77 ], respectively, currently, people can be observed to attach greater importance to their own safety and wellbeing when traveling and upon arrival at a holiday destination. This can be explained largely by the COVID-19 pandemic situation, which has certainly reinforced the changes in health habits related to the adherence to hygiene and sanitary standards at tourism destinations. Health behaviors mean those related to human health; the literature on the subject divides them into health-promoting and self-destructive actions. A number of researchers, including Hofer S., Honegger F., Hubeli J. and Hopkins L., Labonte R., Runnels V., Packer C. [ 78 , 79 ], respectively, emphasize that in order to discuss the changes in health-related behavior, it is necessary to gain in-depth knowledge of the underlying mechanisms. As there is growth in demand for diverse forms of health tourism (including medical tourism), there is also a restructuring of the tourism product offered. According to Białk-Wolf, A., Arent, M., Buziewicz, A. and Alejziak W. [ 27 , 80 ], respectively, many tourists today realize the positive role of physical activity. For a modern human, proper nutrition habits, a positive mental attitude (especially after the aggravation of the COVID-19 pandemic), reliable information, preventive healthcare, and physical activity itself play an important role in improving his/her living conditions. Hence, health behaviors are undoubtedly a major part of today’s human activity.

In turn, another issue was addressed by Forgione DA, Smith PC.; Bagozzi, R. P., Gurhan-Canli, Z. and Priester, J. R.; Lam, T. and Hsu, C. H. C.; March, R. and Woodside, G. [ 81 , 82 , 83 , 84 ], respectively. who found that demand- and supply-side changes in today’s tourism market are driven by changes to the tourist’s purchasing behavior. According to them, there is change in the forms of travel organization; in the quality, duration, and frequency of traveling; and in the ways and forms of spending free time. Consumers increasingly often opt for leisure scenarios that involve physical activity. Many researchers also focused their attention on one more aspect. Namely, according to Hudson S., Xiang R.L.; Heather Hartwell, Alan Fyall, Cheryl Willis, Stephen Page, Adele Ladkin, Ann Hemingway; Allison Drinkert, Neha Singh; Ediansyah, Mts Arief, Mohammad Hamsal, Sri Bramantoro Abdinagoro; Yingru Li, Lin Liu, Jianguo Chen, Jiewen Zhang [ 85 , 86 , 87 , 88 , 89 ], respectively, despite society becoming increasingly aware of the importance of healthcare, there still is need for social education on how to take care of one’s health condition. In turn, Chihiro Morito and Sunildro LS Akoijam, Tabassum Khan [ 90 , 91 ], respectively, note that building adequate levels of awareness of one’s own health behaviors is of key importance, as it drives health-promoting attitudes. Health behavior is also related to a social and cultural context [ 91 ]. Culture has an impact on a number of aspects, including the standards of living and lifestyle of a community, how much they know about their health habits, and how they perceive their health [ 92 , 93 , 94 ]. The use of media in shaping health-promoting attitudes also plays an important role. The technological and technical development, combined with state-of-the-art social messengers, is what makes media an important stream of information, including about health. Hence, social campaigns ran on the TV, radio, FB, and Instagram are designed to make the information reach a wide audience [ 95 , 96 , 97 , 98 , 99 ].

5.4. Cluster 4 (Red): Traveling with a View to Regain One’s Health

Tourism is a form of physical activity [ 100 , 101 , 102 , 103 , 104 , 105 ] that consists in traveling away from one’s place of permanent residence to rest or explore. It includes business trips, as well as holiday, health, and other travels with accommodation away from home. According to the literature on the subject, health tourism means curative tourism, spa and wellness tourism, and medical tourism [ 106 , 107 ]. As shown in a study by Kachniewska [ 108 ], it develops in response to today’s social and demographic changes (including needs related to diseases of affluence and ageing societies), while also triggering the potential for new consumer needs and trends. An interesting aspect was also presented in studies by Saint-Pierre, C.; Herskovic, V.; Roberts, F.S.; Darbellay, F.; Stock, M.; Neil Lunt, Percivil Carrera; Tze-Jen Pan, Wen-Chang Chen [ 109 , 110 , 111 , 112 , 113 , 114 ], respectively, who indicated a new trend emerging in health tourism. It suggests that in addition to products and services, tourists also buy the accompanying experiences, emotions, and sensations when traveling. According to the researchers, the consumers’ health-oriented trips should be connected to a holiday destination that offers appropriate values (e.g., environmental benefits: clean air, favorable climate, mineral waters, etc.), while also delivering some components that affect emotions. Traveling is supposed to be interesting, pleasant, and engaging. Therefore, studies by Pearce, P.L; Buda, D. [ 115 , 116 ], respectively, reveal yet another crucial factor that guides health-oriented trips. The authors mostly focused on explaining the roles and importance of sophisticated technologies and techniques, which make it possible for today’s consumers to travel long distances with the use of state-of-the-art tools.

Nowadays, people expect to be able to relax in a healthy and active way in urban and rural areas. The tourism sector is currently focused on offering a customized portfolio composed of medical, spa, wellness, and other services [ 117 , 118 , 119 ]. People travel to clinics, spa resorts, and sanatoriums (go on therapeutic trips) for different reasons and want to improve their health status by undergoing professional rehabilitation or treatment programs [ 120 ]. An important topic addressed by Neil Lunt and Percivil Carrera was the context of how medical tourists finance their travels. According to them, some tourists rely on social health programs, while others use their own resources (pay out of pocket for accessing dentist, beauty, and programmed treatments). The authors indicate that as a consequence of administrative and legal regulations, tourists very often rely on their own funds in paying for medical services (especially in Europe), which can be viewed as a financial disharmony. They also note that there is still confusion as to the rights of patients who travel abroad, e.g., in order to receive a treatment.

6. Conclusions

The recent years have seen growing interest in and importance of health tourism. A healthy lifestyle, as currently developed around the globe, is at the very core of today’s social changes. It promotes physical and mental fitness; determines the condition of an individual’s body; affects people’s pace of work, efficiency, and mental capacity; and conditions their creativity and ability to take action.

This paper was a review of the current literature on medical tourism. It provided a basis for identifying four research clusters spanning the following content: patient satisfaction built upon trust; health impacts of the destination (including the economic aspect, which plays a decisive role in choosing a tourism destination); health behavior as a major part of human activity; and traveling with a view to regain one’s health. This study provides grounds for some conclusions. First, health tourism contributes to improvements in individuals’ mental and physical health; in that context, an important role is played by the behavioral and emotional dimension and by the experience lived in a tourism destination. Another important aspect to humans is the destination itself and its surroundings, where visitors can undergo a variety of medical and curative procedures and—first of all—take care of their health and recover their vitality. Health-oriented trips, especially in the era of the COVID-19 pandemic, changed the way tourists behave when their own safety is concerned. It means that they expect their hosts to guarantee a safe and peaceful experience during their stay.

The authors realize certain restrictions affecting this study, but believe that a further analysis would provide valuable grounds for continued in-depth scientific research. Indeed, there is a great need for more research on health tourism based on knowledge resources shared between tourism and related sciences.

Funding Statement

This research received no external funding.

Author Contributions

Conceptualization, M.R. (Michał Roman) and M.R. (Monika Roman); methodology M.R. (Monika Roman); software, M.R. (Michał Roman) and M.R. (Monika Roman); validation M.R. (Monika Roman); formal analysis, M.R. (Michał Roman) and M.R. (Monika Roman); investigation, M.R. (Michał Roman) and M.R. (Monika Roman); resources, M.R. (Michał Roman) and M.R. (Monika Roman); data curation, M.R. (Michał Roman) and M.R. (Monika Roman); writing—original draft preparation, M.R. (Michał Roman), M.R. (Monika Roman), and M.W.-Z.; writing—review and editing, M.R. (Monika Roman); visualization, M.R. (Michał Roman), M.R. (Monika Roman), and M.W.-Z.; supervision, M.R. (Monika Roman); project administration, M.R. (Michał Roman); funding acquisition, M.R. (Michał Roman), M.R. (Monika Roman), and M.W.-Z. All authors have read and agreed to the published version of the manuscript.

Institutional Review Board Statement

Informed consent statement, data availability statement, conflicts of interest.

The authors declare no conflict of interest.

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Event tourism: Definition, evolution, and research

2008, Tourism management

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sonia amrizal

Edited by two leading scholars in the field, this is the first title in a new Routledge Major Works series, Critical Concepts in Tourism. It is a four-volume collection of canonical and cutting-edge research in event tourism. The origins of event tourism as a topic of serious academic interest are comparatively recent. The subject is largely a postwar development which began especially to unfold in the 1970s, not least in response to a growing interest and recognition of the potential value of events to economies, societies, and their cultures, as well as to environmental regeneration. In part, the continued evolution of the subject has arisen from the development of convention and exhibition management as cognate areas but, through time, policy-makers, planners, and destination managers became aware of the potentially significant and wide role of events in specific localities, ranging in scale from the Olympic Games to community festivals. Event tourism is now a vibrant and dynamic field of study and research, and the sheer scale of the growth in its output makes this Routledge collection especially timely. A wide range of social-science journals have published material about event tourism and this new Major Work makes available foundational pieces of scholarship—as well as cutting-edge research—from these disparate, and sometimes less accessible sources, as well as from the leading UK, European, and North American tourism journals, and from other hard-to-find publications. As well as bringing together the key studies and journal articles that have shaped serious thought about event tourism, the collection will be welcomed as the first mapping of an area that to date has lacked an interdisciplinary synthesis. The thematic organization of the collection, together with the editors' introductions and their commentaries on the collected texts, will make sense of the wide range of approaches, theories, and concepts that have informed event tourism, and will review the history of the subject and the rise of its identity and research agenda. It is an essential collection destined to be valued as a vital research resource by all scholars and students of the subject.

Event Tourism and Cultural Tourism

Larry Dwyer

Paulo Duarte

In the last decades, the effect of globalization on world tourism has led to increased competition between destinations in search for the optimal positioning. In this scenario events have become an essential element in the tourism development of destinations, attract visitors, encourage investment, improve image and boost the local economy. This article’s main objective is to expand the knowledge of this phenomenon from a theoretical and conceptual viewpoint based on an extensive review of the literature. The findings help to strengthen and synthetize the basic knowledge on events, the influence on destination image and positioning strategies, being valid for both researchers and destination managers.

Sonja Zlatanov

IAR Consorium

IARCON Journals

The social sub-areas of leisure and tourism not only have similarities in their origins, but also similar motives for pursuing them. The increasing interest of the population in both areas as well as the urge for experiences and adventures and the change from a material-to a post-material-oriented society, finds its satisfaction in leisure time as well as in tourism. Due to the new experience society, events in tourism are becoming more and more important in order to offer something artificial, short-term and special in addition to the permanent, long-term tourist offer. The aim of this study is to make a comprehensive inventory of the relationship between leisure, tourism and events in order t o create recommendations for action. The method used in this study was a review of the relevant literature. In analysing various research findings, it was discovered that in the past, leisure time served to regenerate, to restore one's full working capacity. Today it is the other way round, work and its accompanying wages are needed to finance leisure time and to achieve and maintain economic security. As a result, the use of leisure time becomes the purpose of life, people no longer define themselves exclusively by the job they do and the work they have done, but also seek success and recognition through the experiences they have in their leisure time. People find the self-experience they are looking for in their leisure time. They contribute several elements to the emergence of tourism through their complex and comprehensive synergy. Holidays and travel remain one of the most important leisure activities for citizens. T he experience orientation and the increasingly lifestyle-oriented society point to a positive future for tourism. Due to the new experience society, events are becoming increasingly important in tourism. Events are crowd pullers. T hey are an important touristic and economic factor for cities and regions-but only if they convince through perfectly staged worlds of experience and high entertainment value. Factors that have had an impact on tourism and its development can be summarised as follows: social development and the resulting change in values, the general increase in leisure activities, and the increase in tourism-motivated travel.

Frederic Dimanche

Nhat Nguyen

DR. Andriani Kusumawati

The importance of events for urban development is discussed by many experts. This paper emphasizes the event tourism industry and its impact on the economy and local communities. In this article, some cases from the literature of event tourism and their findings were reviewed. This paper examines the important factors affecting the role of event tourism and its progress and prospects for the tourism and hospitality industry. Specifically, this paper aims to investigate the importance of tourism events to promote urban development. A model is proposed based on the concept of shared economy as well as shared values related to the tourism and hospitality industry. The overall conclusion is that city events affect the host community primarily by increasing the sharing economy. The cash addition is important but not at the level that could trigger city development. Thus, the impact on the local people must be central to event management for promoting destination development. Further rese...

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UN Tourism | Bringing the world closer

UN standards for measuring tourism

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Glossary of tourism terms

Tourism is a social, cultural and economic phenomenon which entails the movement of people to countries or places outside their usual environment for personal or business/professional purposes. These people are called visitors (which may be either tourists or excursionists; residents or non-residents) and tourism has to do with their activities, some of which involve tourism expenditure.

A B C D E F G H I J K L M N O P Q R S T U V W Y Z

Activity/activities : In tourism statistics, the term activities represent the actions and behaviors of people in preparation for and during a trip in their capacity as consumers ( IRTS 2008, 1.2 ).

Activity (principal): The principal activity of a producer unit is the activity whose value added exceeds that of any other activity carried out within the same unit ( SNA 2008, 5.8 ).

Activity (productive): The (productive) activity carried out by a statistical unit is the type of production in which it engages. It has to be understood as a process, i.e. the combination of actions that result in a certain set of products. The classification of productive activities is determined by their principal output.

Administrative data : Administrative data is the set of units and data derived from an administrative source. This is a data holding information collected and maintained for the purpose of implementing one or more administrative regulations.

Adventure tourism : Adventure tourism is a type of tourism which usually takes place in destinations with specific geographic features and landscape and tends to be associated with a physical activity, cultural exchange, interaction and engagement with nature. This experience may involve some kind of real or perceived risk and may require significant physical and/or mental effort. Adventure tourism generally includes outdoor activities such as mountaineering, trekking, bungee jumping, rock climbing, rafting, canoeing, kayaking, canyoning, mountain biking, bush walking, scuba diving. Likewise, some indoor adventure tourism activities may also be practiced.

Aggregated data : The result of transforming unit level data into quantitative measures for a set of characteristics of a population.

Aggregation : A process that transforms microdata into aggregate-level information by using an aggregation function such as count, sum average, standard deviation, etc.

Analytical unit : Entity created by statisticians, by splitting or combining observation units with the help of estimations and imputations.

Balance of payments : The balance of payments is a statistical statement that summarizes transactions between residents and non-residents during a period. It consists of the goods and services account, the primary income account, the secondary income account, the capital account, and the financial account ( BPM6, 2.12 ).

Bias : An effect which deprives a statistical result of representativeness by systematically distorting it, as distinct from a random error which may distort on any one occasion but balances out on the average.

Business and professional purpose (of a tourism trip): The business and professional purpose of a tourism trip includes the activities of the self-employed and employees, as long as they do not correspond to an implicit or explicit employer-employee relationship with a resident producer in the country or place visited, those of investors, businessmen, etc. ( IRTS 2008, 3.17.2 ).

Business tourism : Business tourism is a type of tourism activity in which visitors travel for a specific professional and/or business purpose to a place outside their workplace and residence with the aim of attending a meeting, an activity or an event. The key components of business tourism are meetings, incentives, conventions and exhibitions. The term "meetings industry" within the context of business tourism recognizes the industrial nature of such activities. Business tourism can be combined with any other tourism type during the same trip.

Business visitor : A business visitor is a visitor whose main purpose for a tourism trip corresponds to the business and professional category of purpose ( IRTS 2008, 3.17.2 ).

Central Product Classification : The Central Product Classification (CPC) constitutes a complete product classification covering goods and services. It is intended to serve as an international standard for assembling and tabulating all kinds of data requiring product detail, including industrial production, national accounts, service industries, domestic and foreign commodity trade, international trade in services, balance of payments, consumption and price statistics. Other basic aims are to provide a framework for international comparison and promote harmonization of various types of statistics dealing with goods and services.

Census : A census is the complete enumeration of a population or groups at a point in time with respect to well defined characteristics: for example, Population, Production, Traffic on particular roads.

Coastal, maritime and inland water tourism : Coastal tourism refers to land-based tourism activities such as swimming, surfing, sunbathing and other coastal leisure, recreation and sports activities which take place on the shore of a sea, lake or river. Proximity to the coast is also a condition for services and facilities that support coastal tourism. Maritime tourism refers to sea-based activities such as cruising, yachting, boating and nautical sports and includes their respective land-based services and infrastructure. Inland water tourism refers to tourism activities such as cruising, yachting, boating and nautical sports which take place in aquatic- influenced environments located within land boundaries and include lakes, rivers, ponds, streams, groundwater, springs, cave waters and others traditionally grouped as inland wetlands.

Coherence : Adequacy of statistics to be combined in different ways and for various uses.

Competitiveness of a tourism destination : The competitiveness of a tourism destination is the ability of the destination to use its natural, cultural, human, man-made and capital resources efficiently to develop and deliver quality, innovative, ethical and attractive tourism products and services in order to achieve a sustainable growth within its overall vision and strategic goals, increase the added value of the tourism sector, improve and diversify its market components and optimize its attractiveness and benefits both for visitors and the local community in a sustainable perspective.

Consistency : Logical and numerical coherence.

Country of reference : The country of reference refers to the country for which the measurement is done. ( IRTS 2008, 2.15 ).

Country of residence : The country of residence of a household is determined according to the centre of predominant economic interest of its members. If a person resides (or intends to reside) for more than one year in a given country and has there his/her centre of economic interest (for example, where the predominant amount of time is spent), he/she is considered as a resident of this country.

Country-specific tourism characteristic products and activities : To be determined by each country by applying the criteria of IRTS 2008, 5.10 in their own context; for these products, the activities producing them will be considered as tourism characteristic, and the industries in which the principal activity is tourism-characteristic will be called tourism industries ( IRTS 2008, 5.16 ).

Cultural tourism : Cultural tourism is a type of tourism activity in which the visitor's essential motivation is to learn, discover, experience and consume the tangible and intangible cultural attractions/products in a tourism destination. These attractions/products relate to a set of distinctive material, intellectual, spiritual and emotional features of a society that encompasses arts and architecture, historical and cultural heritage, culinary heritage, literature, music, creative industries and the living cultures with their lifestyles, value systems, beliefs and traditions.

Data checking : Activity whereby the correctness conditions of the data are verified. It also includes the specification of the type of error or of the condition not met, and the qualification of the data and their division into "error-free data" and "erroneous data".

Data collection : Systematic process of gathering data for official statistics.

Data compilation : Operations performed on data to derive new information according to a given set of rules.

Data confrontation : The process of comparing data that has generally been derived from different surveys or other sources, especially those of different frequencies, in order to assess and possibly improve their coherency, and identify the reasons for any differences.

Data processing : Data processing is the operation performed on data by the organization, institute, agency, etc., responsible for undertaking the collection, tabulation, manipulation and preparation of data and metadata output.

Data reconciliation : The process of adjusting data derived from two different sources to remove, or at least reduce, the impact of differences identified.

Destination (main destination of a trip): The main destination of a tourism trip is defined as the place visited that is central to the decision to take the trip. See also purpose of a tourism trip ( IRTS 2008, 2.31 ).

Destination management / marketing organization (DMO) : A destination management/marketing organization (DMO) is the leading organizational entity which may encompass the various authorities, stakeholders and professionals and facilitates tourism sector partnerships towards a collective destination vision. The governance structures of DMOs vary from a single public authority to a public/ private partnership model with the key role of initiating, coordinating and managing certain activities such as implementation of tourism policies, strategic planning, product development, promotion and marketing and convention bureau activities. The functions of the DMOs may vary from national to regional and local levels depending on the current and potential needs as well as on the decentralization level of public administration. Not every tourism destination has a DMO.

Documentation: Processes and procedures for imputation,  weighting,  confidentiality  and suppression rules, outlier treatment and data capture should be fully documented by the  survey provider.  Such documentation should be made available to at least  the body financing the survey.

Domestic tourism : Domestic tourism comprises the activities of a resident visitor within the country of reference, either as part of a domestic tourism trip or part of an outbound tourism trip ( IRTS 2008, 2.39 ).

Domestic tourism consumption : Domestic tourism consumption is the tourism consumption of a resident visitor within the economy of reference ( TSA:RMF 2008, figure 2.1 ).

Domestic tourism expenditure : Domestic tourism expenditure is the tourism expenditure of a resident visitor within the economy of reference, (IRTS 2008, 4.15(a)).

Domestic tourism trip : A domestic tourism trip is one with a main destination within the country of residence of the visitor (IRTS 2008, 2.32).

Domestic visitor : As a visitor travels within his/her country of residence, he/she is a domestic visitor and his/her activities are part of domestic tourism.

Durable consumer goods : Durable consumer goods are goods that may be used repeatedly or continuously over a period of a year or more, assuming a normal or average rate of physical usage. When acquired by producers, these are considered to be capital goods used for production processes, as is the case of vehicles, computers, etc. When acquired by households, they are considered to be consumer durable goods ( TSA:RMF 2008, 2.39 ). This definition is identical to the definition of SNA 2008, 9.42 : A consumer durable is a goodthat may be used for purposes of consumption repeatedly or continuously over a period of a year or more.

Dwellings : Each household has a principal dwelling (sometimes also designated as main or primary home), usually defined with reference to time spent there, whose location defines the country of residence and place of usual residence of this household and of all its members. All other dwellings (owned or leased by the household) are considered secondary dwellings ( IRTS 2008, 2.26 ).

Ecotourism : Ecotourism is a type of nature-based tourism activity in which the visitor's essential motivation is to observe, learn, discover, experience and appreciate biological and cultural diversity with a responsible attitude to protect the integrity of the ecosystem and enhance the well-being of the local community. Ecotourism increases awareness towards the conservation of biodiversity, natural environment and cultural assets both among locals and the visitors and requires special management processes to minimize the negative impact on the ecosystem.

Economic analysis : Tourism generates directly and indirectly an increase in economic activity in the places visited (and beyond), mainly due to demand for goods and services thatneed to be produced and provided. In the economic analysis of tourism, one may distinguish between tourism's 'economic contribution' which refers to the direct effect of tourism and is measurable by means of the TSA, and tourism's 'economic impact' which is a much broader concept encapsulating the direct, indirect and induced effects of tourism and which must be estimated by applying models. Economic impact studies aim to quantify economic benefits, that is, the net increase in the wealth of residents resulting from tourism, measured in monetary terms, over and above the levels that would prevail in its absence.

Economic territory : The term "economic territory" is a geographical reference and points to the country for which the measurement is done (country of reference) ( IRTS 2008, 2.15 ).

Economically active population : The economically active population or labour force comprises all persons of either sex who furnish the supply of labour for the production of goods and services as defined by the system of national accounts during a specified time-reference period (ILO, Thirteenth ICLS, 6.18).

Economy (of reference): "Economy" (or "economy of reference") is an economic reference defined in the same way as in the balance of payments and in the system of national accounts: it refers to the economic agents that are resident in the country of reference ( IRTS 2008, 2.15 ).

Education tourism : Education tourism covers those types of tourism which have as a primary motivation the tourist's engagement and experience in learning, self-improvement, intellectual growth and skills development. Education Tourism represents a broad range of products and services related to academic studies, skill enhancement holidays, school trips, sports training, career development courses and language courses, among others.

Employees : Employees are all those workers who hold the type of job defined as "paid employment" (ILO, Fifteenth ICLS, pp. 20-22).

Employer-employee relationship : An employer-employee relationship exists when there is an agreement, which may be formal or informal, between an entity and an individual, normally entered into voluntarily by both parties, whereby the individual works for the entity in return for remuneration in cash or in kind ( BPM6, 11.11 ).

Employers : Employers are those workers who, working on their own account with one or more partners, hold the type of job defined as a "self-employment job" and, in this capacity, on a continuous basis (including the reference period) have engaged one or more persons to work for them in their business as "employee(s)" (ILO, Fifteenth ICLS, pp. 20-22).

Employment : Persons in employment are all persons above a specified age who, during a specified brief period, either one week or one day, were in paid employment or self-employment (OECD GST, p. 170).

Employment in tourism industries : Employment in tourism industries may be measured as a count of the persons employed in tourism industries in any of their jobs, as a count of the persons employed in tourism industries in their main job, or as a count of the jobs in tourism industries ( IRTS 2008, 7.9 ).

Enterprise : An enterprise is an institutional unit engaged in production of goods and/or services. It may be a corporation, a non-profit institution, or an unincorporated enterprise. Corporate enterprises and non-profit institutions are complete institutional units. An unincorporated enterprise, however, refers to an institutional unit —a household or government unit —only in its capacity as a producer of goods and services (OECD BD4, p. 232)

Establishment : An establishment is an enterprise, or part of an enterprise, that is situated in a single location and in which only a single productive activity is carried out or in which the principal productive activity accounts for most of the value added ( SNA 2008, 5.14 ).

Estimation : Estimation is concerned with inference about the numerical value of unknown population values from incomplete data such as a sample. If a single figure is calculated for each unknown parameter the process is called "point estimation". If an interval is calculated within which the parameter is likely, in some sense, to lie, the process is called "interval estimation".

Exports of goods and services : Exports of goods and services consist of sales, barter, or gifts or grants, of goods and services from residents to non-residents (OECD GST, p. 194)

Frame : A list, map or other specification of the units which define a population to be completely enumerated or sampled.

Forms of tourism : There are three basic forms of tourism: domestic tourism, inbound tourism, and outbound tourism. These can be combined in various ways to derive the following additional forms of tourism: internal tourism, national tourism and international tourism.

Gastronomy tourism :  Gastronomy tourism is a type of tourism activity which is characterized by the visitor's experience linked with food and related products and activities while travelling. Along with authentic, traditional, and/or innovative culinary experiences, Gastronomy Tourism may also involve other related activities such as visiting the local producers, participating in food festivals and attending cooking classes. Eno-tourism (wine tourism), as a sub-type of gastronomy tourism, refers to tourism whose purpose is visiting vineyards, wineries, tasting, consuming and/or purchasing wine, often at or near the source.

Goods : Goods are physical, produced objects for which a demand exists, over which ownership rights can be established and whose ownership can be transferred from one institutional unit to another by engaging in transactions on markets ( SNA 2008, p. 623 ).

Gross fixed capital formation : Gross fixed capital formation is defined as the value of institutional units' acquisitions less disposals of fixed assets. Fixed assets are produced assets (such as machinery, equipment, buildings or other structures) that are used repeatedly or continuously in production over several accounting periods (more than one year) ( SNA 2008, 1.52 ).

Gross margin : The gross margin of a provider of reservation services is the difference between the value at which the intermediated service is sold and the value accrued to the provider of reservation services for this intermediated service.

Gross value added : Gross value added is the value of output less the value of intermediate consumption ( TSA:RMF 2008, 3.32 ).

Gross value added of tourism industries : Gross value added of tourism industries (GVATI) is the total gross value added of all establishments belonging to tourism industries, regardless of whether all their output is provided to visitors and the degree of specialization of their production process ( TSA:RMF 2008, 4.86 ).

Grossing up : Activity aimed at transforming, based on statistical methodology, micro-data from samples into aggregate-level information representative of the target population.

Health tourism : Health tourism covers those types of tourism which have as a primary motivation, the contribution to physical, mental and/or spiritual health through medical and wellness-based activities which increase the capacity of individuals to satisfy their own needs and function better as individuals in their environment and society. Health tourism is the umbrella term for the subtypes wellness tourism and medical tourism.

Imputation : Procedure for entering a value for a specific data item where the response is missing or unusable.

Inbound tourism : Inbound tourism comprises the activities of a non-resident visitor within the country of reference on an inbound tourism trip ( IRTS 2008, 2.39 ).

Inbound tourism consumption : Inbound tourism consumption is the tourism consumption of a non-resident visitor within the economy of reference ( TSA:RMF 2008, figure 2.1 ).

Inbound tourism expenditure : Inbound tourism expenditure is the tourism expenditure of a non-resident visitor within the economy of reference ( IRTS 2008, 4.15(b) ).

Innovation in tourism : Innovation in tourism is the introduction of a new or improved component which intends to bring tangible and intangible benefits to tourism stakeholders and the local community, improve the value of the tourism experience and the core competencies of the tourism sector and hence enhance tourism competitiveness and /or sustainability. Innovation in tourism may cover potential areas, such as tourism destinations, tourism products, technology, processes, organizations and business models, skills, architecture, services, tools and/or practices for management, marketing, communication, operation, quality assurance and pricing.

Institutional sector : An aggregation of institutional units on the basis of the type of producer and depending on their principal activity and function, which are considered to be indicative of their economic behaviour.

Institutional unit : The elementary economic decision-making centre characterised by uniformity of behaviour and decision-making autonomy in the exercise of its principal function.

Intermediate consumption : Intermediate consumption consists of the value of the goods and services consumed as inputs by a process of production, excluding fixed assets whose consumption is recorded as consumption of fixed capital ( SNA 2008, 6.213 ).

Internal tourism : Internal tourism comprises domestic tourism and inbound tourism, that is to say, the activities of resident and non-resident visitors within the country of reference as part of domestic or international tourism trips ( IRTS 2008, 2.40(a) ).

Internal tourism consumption : Internal tourism consumption is the tourism consumption of both resident and non-resident visitors within the economy of reference. It is the sum of domestic tourism consumption and inbound tourism consumption ( TSA:RMF 2008, figure 2.1 ).

Internal tourism expenditure : Internal tourism expenditure comprises all tourism expenditure of visitors, both resident and non-resident, within the economy of reference. It is the sum of domestic tourism expenditure and inbound tourism expenditure. It includes acquisition of goods and services imported into the country of reference and sold to visitors. This indicator provides the most comprehensive measurement of tourism expenditure in the economy of reference ( IRTS 2008, 4.20(a) ).

International Standard Industrial Classification of All Economic Activities : The International Standard Industrial Classification of All Economic Activities (ISIC) consists of a coherent and consistent classification structure of economic activities based on a set of internationally agreed concepts, definitions, principles and classification rules. It provides a comprehensive framework within which economic data can be collected and reported in a format that is designed for purposes of economic analysis, decision-taking and policymaking. The classification structure represents a standard format to organize detailed information about the state of an economy according to economic principles and perceptions (ISIC, Rev.4, 1).

International tourism : International tourism comprises inbound tourism and outbound tourism, that is to say, the activities of resident visitors outside the country of reference, either as part of domestic or outbound tourism trips and the activities of non-resident visitors within the country of reference on inbound tourism trips ( IRTS 2008, 2.40(c) ).

International visitor : An international traveller qualifies as an international visitor with respect to the country of reference if: (a) he/she is on a tourism trip and (b) he/she is a non-resident travelling in the country of reference or a resident travelling outside of it ( IRTS 2008, 2.42 ).

Job : The agreement between an employee and the employer defines a job and each self-employed person has a job ( SNA 2008, 19.30 ).

Measurement error : Error in reading, calculating or recording numerical value.

Medical tourism : Medical tourism is a type of tourism activity which involves the use of evidence-based medical healing resources and services (both invasive and non-invasive). This may include diagnosis, treatment, cure, prevention and rehabilitation.

Meetings industry : To highlight purposes relevant to the meetings industry, if a trip's main purpose is business/professional, it can be further subdivided into "attending meetings, conferences or congresses, trade fairs and exhibitions" and "other business and professional purposes". The term meetings industry is preferred by the International Congress and Convention Association (ICCA), Meeting Professionals International (MPI) and Reed Travel over the acronym MICE (Meetings, Incentives, Conferences and Exhibitions) which does not recognize the industrial nature of such activities.

Metadata : Data that defines and describes other data and processes.

MICE : See meetings industry.

Microdata : Non-aggregated observations, or measurements of characteristics of individual units.

Mirror statistics : Mirror statistics are used to conduct bilateral comparisons of two basic measures of a trade flow and are a traditional tool for detecting the causes of asymmetries in statistics (OECD GST, p. 335).

Mountain tourism : Mountain tourism is a type of tourism activity which takes place in a defined and limited geographical space such as hills or mountains with distinctive characteristics and attributes that are inherent to a specific landscape, topography, climate, biodiversity (flora and fauna) and local community. It encompasses a broad range of outdoor leisure and sports activities.

National tourism : National tourism comprises domestic tourism and outbound tourism, that is to say, the activities of resident visitors within and outside the country of reference, either as part of domestic or outbound tourism trips ( IRTS 2008, 2.40(b) ).

National tourism consumption : National tourism consumption is the tourism consumption of resident visitors, within and outside the economy of reference. It is the sum of domestic tourism consumption and outbound tourism consumption ( TSA:RMF 2008, figure 2.1 ).

National tourism expenditure : National tourism expenditure comprises all tourism expenditure of resident visitors within and outside the economy of reference. It is the sum of domestic tourism expenditure and outbound tourism expenditure ( IRTS 2008, 4.20(b) ).

Nationality : The concept of "country of residence" of a traveller is different from that of his/her nationality or citizenship ( IRTS 2008, 2.19 ).

Non-monetary indicators : Data measured in physical or other non-monetary units should not be considered a secondary part of a satellite account. They are essential components, both for the information they provide directly and in order to analyse the monetary data adequately ( SNA 2008, 29.84 ).

Observation unit : entity on which information is received and statistics are compiled.

Outbound tourism : Outbound tourism comprises the activities of a resident visitor outside the country of reference, either as part of an outbound tourism trip or as part of a domestic tourism trip ( IRTS 2008, 2.39(c) ).

Outbound tourism consumption : Outbound tourism consumption is the tourism consumption of a resident visitor outside the economy of reference ( TSA:RMF 2008, figure 2.1 ).

Outbound tourism expenditure : Outbound tourism expenditure is the tourism expenditure of a resident visitor outside the economy of reference ( IRTS 2008, 4.15(c) ).

Output : Output is defined as the goods and services produced by an establishment, a) excluding the value of any goods and services used in an activity for which the establishment does not assume the risk of using the products in production, and b) excluding the value of goods and services consumed by the same establishment except for goods and services used for capital formation (fixed capital or changes in inventories) or own final consumption ( SNA 2008, 6.89 ).

Output (main): The main output of a (productive) activity should be determined by reference to the value added of the goods sold or services rendered (ISIC rev.4, 114).

Pilot survey : The aim of a pilot survey is to test the questionnaire (pertinence of the questions, understanding of questions by those being interviewed, duration of the interview) and to check various potential sources for sampling and non-sampling errors: for instance, the place in which the surveys are carried out and the method used, the identification of any omitted answers and the reason for the omission, problems of communicating in various languages, translation, the mechanics of data collection, the organization of field work, etc.

Place of usual residence : The place of usual residence is the geographical place where the enumerated person usually resides, and is defined by the location of his/her principal dwelling (Principles and recommendations for population and housing censuses of the United Nations, 2.20 to 2.24).

Probability sample : A sample selected by a method based on the theory of probability (random process), that is, by a method involving knowledge of the likelihood of any unit being selected.

Production account : The production account records the activity of producing goods and services as defined within the SNA. Its balancing item, gross value added, is defined as the value of output less the value of intermediate consumption and is a measure of the contribution to GDP made by an individual producer, industry or sector. Gross value added is the source from which the primary incomes of the SNA are generated and is therefore carried forward into the primary distribution of income account. Value added and GDP may also be measured net by deducting consumption of fixed capital, a figure representing the decline in value during the period of the fixed capital used in a production process ( SNA 2008, 1.17 ).

Production : Economic production may be defined as an activity carried out under the control and responsibility of an institutional unit that uses inputs of labour, capital, and goods and services to produce outputs of goods or services ( SNA 2008, 6.24. ).

Purpose of a tourism trip (main): The main purpose of a tourism trip is defined as the purpose in the absence of which the trip would not have taken place ( IRTS 2008, 3.10. ). Classification of tourism trips according to the main purpose refers to nine categories: this typology allows the identification of different subsets of visitors (business visitors, transit visitors, etc.) See also destination of a tourism trip ( IRTS 2008, 3.14 ).

Quality of a tourism destination : Quality of a tourism destination is the result of a process which implies the satisfaction of all tourism product and service needs, requirements and expectations of the consumer at an acceptable price, in conformity with mutually accepted contractual conditions and the implicit underlying factors such as safety and security, hygiene, accessibility, communication, infrastructure and public amenities and services. It also involves aspects of ethics, transparency and respect towards the human, natural and cultural environment. Quality, as one of the key drivers of tourism competitiveness, is also a professional tool for organizational, operational and perception purposes for tourism suppliers.

Questionnaire and Questionnaire design : Questionnaire is a group or sequence of questions designed to elicit information on a subject, or sequence of subjects, from a reporting unit or from another producer of official statistics. Questionnaire design is the design (text, order, and conditions for skipping) of the questions used to obtain the data needed for the survey.

Reference period : The period of time or point in time to which the measured observation is intended to refer.

Relevance : The degree to which statistics meet current and potential users' needs.

Reliability : Closeness of the initial estimated value to the subsequent estimated value.

Reporting unit : Unit that supplies the data for a given survey instance, like a questionnaire or interview. Reporting units may, or may not, be the same as the observation unit.

Residents/non-residents : The residents of a country are individuals whose centre of predominant economic interest is located in its economic territory. For a country, the non-residents are individuals whose centre of predominant economic interest is located outside its economic territory.

Response and non-response : Response and non-response to various elements of a survey entail potential errors.

Response error : Response errors may be defined as those arising from the interviewing process. Such errors may be due to a number of circumstances, such as inadequate concepts or questions; inadequate training; interviewer failures; respondent failures.

Rural tourism : Rural tourism is a type of tourism activity in which the visitor's experience is related to a wide range of products generally linked to nature-based activities, agriculture, rural lifestyle / culture, angling and sightseeing. Rural tourism activities take place in non-urban (rural) areas with the following characteristics:

• Low population density;
• Landscape and land-use dominated by agriculture and forestry; and
• Traditional social structure and lifestyle

Same-day visitor (or excursionist): A visitor (domestic, inbound or outbound) is classified as a tourist (or overnight visitor), if his/her trip includes an overnight stay, or as a same-day visitor (or excursionist) otherwise ( IRTS 2008, 2.13 ).

Sample : A subset of a frame where elements are selected based on a process with a known probability of selection.

Sample survey : A survey which is carried out using a sampling method.

Sampling error : That part of the difference between a population value and an estimate thereof, derived from a random sample, which is due to the fact that only a subset of the population is enumerated.

Satellite accounts : There are two types of satellite accounts, serving two different functions. The first type, sometimes called an internal satellite, takes the full set of accounting rules and conventions of the SNA but focuses on a particular aspect of interest by moving away from the standard classifications and hierarchies. Examples are tourism, coffee production and environmental protection expenditure. The second type, called an external satellite, may add non-economic data or vary some of the accounting conventions or both. It is a particularly suitable way to explore new areas in a research context. An example may be the role of volunteer labour in the economy ( SNA 2008, 29.85 ).

SDMX, Statistical Data and Metadata Exchange : Set of technical standards and content-oriented guidelines, together with an IT architecture and tools, to be used for the efficient exchange and sharing of statistical data and metadata (SDMX).

Seasonal adjustment : Seasonal adjustment is a statistical technique to remove the effects of seasonal calendar influences on a series. Seasonal effects usually reflect the influence of the seasons themselves, either directly or through production series related to them, or social conventions. Other types of calendar variation occur as a result of influences such as number of days in the calendar period, the accounting or recording practices adopted or the incidence of moving holidays.

Self-employment job : Self-employment jobs are those jobs where remuneration is directly dependent upon the profits (or the potential of profits) derived from the goods or services produced.

Self-employed with paid employees : Self-employed with paid employees are classified as employers.

Self-employed without employees : Self-employed without employees are classified as own-account workers.

Services : Services are the result of a production activity that changes the conditions of the consuming units, or facilitates the exchange of products or financial assets. They cannot be traded separately from their production. By the time their production is completed, they must have been provided to the consumers ( SNA 2008, 6.17 ).

Social transfers in kind : A special case of transfers in kind is that of social transfers in kind. These consist of goods and services provided by general government and non-profit institutions serving households (NPISHs) that are delivered to individual households. Health and education services are the prime examples. Rather than provide a specified amount of money to be used to purchase medical and educational services, the services are often provided in kind to make sure that the need for the services is met. (Sometimes the recipient purchases the service and is reimbursed by the insurance or assistance scheme. Such a transaction is still treated as being in kind because the recipient is merely acting as the agent of the insurance scheme) (SNA 2008, 3.83).

Sports tourism : Sports tourism is a type of tourism activity which refers to the travel experience of the tourist who either observes as a spectator or actively participates in a sporting event generally involving commercial and non-commercial activities of a competitive nature.

Standard classification : Classifications that follow prescribed rules and are generally recommended and accepted.

Statistical error : The unknown difference between the retained value and the true value.

Statistical indicator : A data element that represents statistical data for a specified time, place, and other characteristics, and is corrected for at least one dimension (usually size) to allow for meaningful comparisons.

Statistical metadata : Data about statistical data.

Statistical unit : Entity about which information is sought and about which statistics are compiled. Statistical units may be identifiable legal or physical entities or statistical constructs.

Survey : An investigation about the characteristics of a given population by means of collecting data from a sample of that population and estimating their characteristics through the systematic use of statistical methodology.

System of National Accounts : The System of National Accounts (SNA) is the internationally agreed standard set of recommendations on how to compile measures of economic activity in accordance with strict accounting conventions based on economic principles. The recommendations are expressed in terms of a set of concepts, definitions, classifications and accounting rules that comprise the internationally agreed standard for measuring indicators of economic performance. The accounting framework of the SNA allows economic data to be compiled and presented in a format that is designed for purposes of economic analysis, decision-taking and policymaking ( SNA 2008, 1.1 ).

Total tourism internal demand : Total tourism internal demand, is the sum of internal tourism consumption, tourism gross fixed capital formation and tourism collective consumption ( TSA:RMF 2008, 4.114 ). It does not include outbound tourism consumption.

Tourism : Tourism refers to the activity of visitors ( IRTS 2008, 2.9 ).

Tourism characteristic activities : Tourism characteristic activities are the activities that typically produce tourism characteristic products. As the industrial origin of a product (the ISIC industry that produces it) is not a criterion for the aggregation of products within a similar CPC category, there is no strict one-to-one relationship between products and the industries producing them as their principal outputs ( IRTS 2008, 5.11 ).

Tourism characteristic products : Tourism characteristic products are those that satisfy one or both of the following criteria: a) Tourism expenditure on the product should represent a significant share total tourism expenditure (share-of-expenditure/demand condition); b) Tourism expenditure on the product should represent a significant share of the supply of the product in the economy (share-of-supply condition). This criterion implies that the supply of a tourism characteristic product would cease to exist in meaningful quantity in the absence of visitors ( IRTS 2008, 5.10 ).

Tourism connected products : Their significance within tourism analysis for the economy of reference is recognized although their link to tourism is very limited worldwide. Consequently, lists of such products will be country-specific ( IRTS 2008, 5.12 ).

Tourism consumption : Tourism consumption has the same formal definition as tourism expenditure. Nevertheless, the concept of tourism consumption used in the Tourism Satellite Account goes beyond that of tourism expenditure. Besides the amount paid for the acquisition of consumption goods and services, as well as valuables for own use or to give away, for and during tourism trips, which corresponds to monetary transactions (the focus of tourism expenditure), it also includes services associated with vacation accommodation on own account, tourism social transfers in kind and other imputed consumption. These transactions need to be estimated using sources different from information collected directly from the visitors, such as reports on home exchanges, estimations of rents associated with vacation homes, calculations of financial intermediation services indirectly measured (FISIM), etc. ( TSA:RMF 2008, 2.25 ).

Tourism destination : A tourism destination is a physical space with or without administrative and/or analytical boundaries in which a visitor can spend an overnight. It is the cluster (co-location) of products and services, and of activities and experiences along the tourism value chain and a basic unit of analysis of tourism. A destination incorporates various stakeholders and can network to form larger destinations. It is also intangible with its image and identity which may influence its market competitiveness.

Tourism direct gross domestic product : Tourism direct gross domestic product (TDGDP) is the sum of the part of gross value added (at basic prices) generated by all industries in response to internal tourism consumption plus the amount of net taxes on products and imports included within the value of this expenditure at purchasers' prices ( TSA:RMF 2008, 4.96 ).

Tourism direct gross value added : Tourism direct gross value added (TDGVA) is the part of gross value added generated by tourism industries and other industries of the economy that directly serve visitors in response to internal tourism consumption ( TSA:RMF 2008, 4.88 ).

Tourism expenditure : Tourism expenditure refers to the amount paid for the acquisition of consumption goods and services, as well as valuables, for own use or to give away, for and during tourism trips. It includes expenditures by visitors themselves, as well as expenses that are paid for or reimbursed by others ( IRTS 2008, 4.2 ).

Tourism industries : The tourism industries comprise all establishments for which the principal activity is a tourism characteristic activity. Tourism industries (also referred to as tourism activities) are the activities that typically producetourism characteristic products. The term tourism industries is equivalent to tourism characteristic activities and the two terms are sometimes used synonymously in the IRTS 2008, 5.10, 5.11 and figure 5.1 .

Tourism product : A tourism product is a combination of tangible and intangible elements, such as natural, cultural and man-made resources, attractions, facilities, services and activities around a specific center of interest which represents the core of the destination marketing mix and creates an overall visitor experience including emotional aspects for the potential customers. A tourism product is priced and sold through distribution channels and it has a life-cycle.

Tourism ratio : For each variable of supply in the Tourism Satellite Account, the tourism ratiois the ratio between the total value of tourism share and total value of the corresponding variable in the Tourism Satellite Account expressed in percentage form ( TSA:RMF 2008, 4.56 ). (See also Tourism share).

Tourism Satellite Account : The Tourism Satellite Account is the second international standard on tourism statistics (Tourism Satellite Account: Recommended Methodological Framework 2008 –TSA:RMF 2008) that has been developed in order to present economic data relative to tourism within a framework of internal and external consistency with the rest of the statistical system through its link to the System of National Accounts. It is the basic reconciliation framework of tourism statistics. As a statistical tool for the economic accounting of tourism, the TSA can be seen as a set of 10 summary tables, each with their underlying data and representing a different aspect of the economic data relative to tourism: inbound, domestic tourism and outbound tourism expenditure, internal tourism expenditure, production accounts of tourism industries, the Gross Value Added (GVA) and Gross Domestic Product (GDP) attributable to tourism demand, employment, investment, government consumption, and non-monetary indicators.

Tourism Satellite Account aggregates : The compilation of the following aggregates, which represent a set of relevant indicators of the size of tourism in an economy is recommended ( TSA:RMF 2008, 4.81 ):

• Internal tourism expenditure;
• Internal tourism consumption;
• Gross value added of tourism industries (GVATI);
• Tourism direct gross value added (TDGVA);
• Tourism direct gross domestic product (TDGDP).

Tourism sector : The tourism sector, as contemplated in the TSA, is the cluster of production units in different industries that provide consumption goods and services demanded by visitors. Such industries are called tourism industries because visitor acquisition represents such a significant share of their supply that, in the absence of visitors, their production of these would cease to exist in meaningful quantity.

Tourism share : Tourism share is the share of the corresponding fraction of internal tourism consumption in each component of supply ( TSA:RMF 2008, 4.51 ). For each industry, the tourism share of output (in value), is the sum of the tourism share corresponding to each product component of its output ( TSA:RMF 2008, 4.55 ). (See also Tourism ratio ).

Tourism single-purpose consumer durable goods : Tourism single-purpose consumer durables is a specific category of consumer durable goods that include durable goods that are used exclusively, or almost exclusively, by individuals while on tourism trips ( TSA:RMF 2008 , 2.41 and Annex 5 ).

Tourism trip : Trips taken by visitors are tourism trips ( IRTS 2008, 2.29 ).

Tourist (or overnight visitor): A visitor (domestic, inbound or outbound) is classified as a tourist (or overnight visitor), if his/her trip includes an overnight stay, or as a same-day visitor (or excursionist) otherwise ( IRTS 2008, 2.13 ).

Tourism value chain : The tourism value chain is the sequence of primary and support activities which are strategically fundamental for the performance of the tourism sector. Linked processes such as policy making and integrated planning, product development and packaging, promotion and marketing, distribution and sales and destination operations and services are the key primary activities of the tourism value chain. Support activities involve transport and infrastructure, human resource development, technology and systems development and other complementary goods and services which may not be related to core tourism businesses but have a high impact on the value of tourism.

Travel / traveller : Travel refers to the activity of travellers. A traveller is someone who moves between different geographic locations, for any purpose and any duration ( IRTS 2008, 2.4 ). The visitor is a particular type of traveller and consequently tourism is a subset of travel.

Travel group : A travel group is made up of individuals or travel parties travelling together: examples are people travelling on the same package tour or youngsters attending a summer camp ( IRTS 2008, 3.5 ).

Travel item (in balance of payments): Travel is an item of the goods and services account of the balance of payments: travel credits cover goods and services for own use or to give away acquired from an economy by non-residents during visits to that economy. Travel debits cover goods and services for own use or to give away acquired from other economies by residents during visits to other economies ( BPM6, 10.86 ).

Travel party : A travel party is defined as visitors travelling together on a trip and whose expenditures are pooled ( IRTS 2008, 3.2 ).

Trip : A trip refers to the travel by a person from the time of departure from his/her usual residence until he/she returns: it thus refers to a round trip. Trips taken by visitors are tourism trips.

Urban/city tourism : Urban/city tourism is a type of tourism activity which takes place in an urban space with its inherent attributes characterized by non-agricultural based economy such as administration, manufacturing, trade and services and by being nodal points of transport. Urban/city destinations offer a broad and heterogeneous range of cultural, architectural, technological, social and natural experiences and products for leisure and business.

Usual environment: The usual environment of an individual, a key concept in tourism, is defined as the geographical area (though not necessarily a contiguous one) within which an individual conducts his/her regular life routines ( IRTS 2008, 2.21 ).

Usual residence : The place of usual residence is the geographical place where the enumerated person usually resides (Principles and recommendations for population and housing censuses of the United Nations, 2.16 to 2.18).

Vacation home : A vacation home (sometimes also designated as a holiday home) is a secondary dwelling that is visited by the members of the household mostly for purposes of recreation, vacation or any other form of leisure ( IRTS 2008, 2.27 ).

Valuables : Valuables are produced goods of considerable value that are not used primarily for purposes of production or consumption but are held as stores of value over time ( SNA 2008, 10.13 ).

Visit : A trip is made up of visits to different places.The term "tourism visit" refers to a stay in a place visited during a tourism trip ( IRTS 2008, 2.7 and 2.33 ).

Visitor : A visitor is a traveller taking a trip to a main destination outside his/her usual environment, for less than a year, for any main purpose (business, leisure or other personal purpose) other than to be employed by a resident entity in the country or place visited ( IRTS 2008, 2.9 ). A visitor (domestic, inbound or outbound) is classified as a tourist (or overnight visitor), if his/her trip includes an overnight stay, or as a same-day visitor (or excursionist) otherwise ( IRTS 2008, 2.13 ).

Wellness tourism : Wellness tourism is a type of tourism activity which aims to improve and balance all of the main domains of human life including physical, mental, emotional, occupational, intellectual and spiritual. The primary motivation for the wellness tourist is to engage in preventive, proactive, lifestyle-enhancing activities such as fitness, healthy eating, relaxation, pampering and healing treatments.