Healthcare provision for medical tourism: A comparative review.

Providing quality services, using modern technologies, having effective marketing, and providing services at an international level have led to the globalization of hospital services. This study aimed to identify the components of health services in developing countries that provide services to international patients. A comparative review was conducted by searching in PubMed, Scopus, Web of Science, Google Scholar, Google, and the websites of the World Medical Tourism Organization, the World Bank, and the Ministry of Health of the selected countries from 2000 to 2022. Iran, Turkey, Jordan, Costa Rica, the UAE, and Singapore were selected. The data were collected and analyzed using a comparative table. Different strategies were used to develop the medical tourism industry among the studied countries, but the main challenges in this field included the inappropriateness of the quality of the services provided or the provision of services that did not meet the needs of patients, the lack of expert human resource, not using medical facilitation companies, communication problems with patients, insufficient government support for medical tourism, and strict laws regarding business. The development of activities in the medical tourism industry requires planning in various dimensions. It seems that developing the medical marketing and activities of facilitator companies to facilitate patient admission, monitoring the quality of services provided, improving interdepartmental coordination, and considering a single trustee for this industry will improve the medical tourism status in Iran.

Biliary atresia in Uganda: Current ethical challenges and advancement of public policy.

Biliary atresia is a progressive cholangiopathy in neonates, which often results in liver failure. In high-income countries, initial treatment requires prompt diagnosis followed by Kasai portoenterostomy. For those with a late diagnosis, or those in whom Kasai portoenterostomy fails, liver transplantation is the only lifesaving treatment. Unfortunately, in low- and middle-income countries, timely diagnosis is a challenge and liver transplantation is rarely accessible. Here, we discuss the ethical dilemmas surrounding treatment of babies with biliary atresia in Uganda. Issues that require careful consideration include: risk of catastrophic health expenditure to families, ethical dilemmas of transplant tourism, medical risks of maintaining the transplant in a low-resourced health system, and difficult decisions encountered by the surgeon caring for these patients. Four distinct models of the patient-physician relationship are applied to biliary atresia in Uganda. These models describe differences in patient and physician roles, and patient values and autonomy. Solid organ transplantation is a rapidly evolving segment of healthcare in Uganda and ongoing policy advancements may shift ethical considerations in the future.

Conservation features of the terrestrial Antarctic Peninsula.

Conserving landscapes used by multiple stakeholder groups requires understanding of what each stakeholder values. Here we employed a semi-structured, participatory approach to identify features of value in the terrestrial Antarctic Peninsula related to biodiversity, science and tourism. Stakeholders identified 115 features, ranging from Adélie penguin colonies to sites suitable for snowshoeing tourists. We split the features into seven broad categories: science, tourism, historic, biodiversity, geographic, habitat, and intrinsic features, finding that the biodiversity category contained the most features of any one category, while science stakeholders identified the most features of any stakeholder group. Stakeholders have overlapping interests in some features, particularly for seals and seabirds, indicating that thoughtful consideration of their inclusion in future management is required. Acknowledging the importance of tourism and other social features in Antarctica and ensuring their integration into conservation planning and assessment will increase the likelihood of implementing successful environmental management strategies into the future.

Modeling and analysis of a tourism supply chain considering service level and advertising in the context of regular epidemic prevention and control under COVID-19.

In the context of regular epidemic prevention and control, this paper considers a two-stage tourism supply chain consisting of a scenic spot that attracts tourists through advertising and a travel agency that invests in service improvement and epidemic prevention. By establishing theoretical game models of a tourism supply chain, we investigate how the service level and advertising level can affect the retail price, product service level, and profits of the supply chain. The results show that the service level of travel agencies could improve consumers' preferences, expand the market demand for tourism products, and improve the efficiency of the supply chain to achieve a win-win situation and increase the profits of the scenic spot and the travel agency. The retailer price, service level, promotion level, and supply chain profit all increase as the service coefficient and advertising coefficient increase, and the speed of the increase is higher for the centralized model than for other models. Some valuable information could be provided for supply chain enterprises to develop collaborative strategies and promote tourism supply chain management practices.

Ecotourism or ecological concerns? Tracing the impact of economic policy uncertainty and natural resources on tourism-driven ecological footprints.

The influence of tourism development and economic policy uncertainties on environmental sustainability is substantial. Promoting responsible tourism and using sustainable tourism practises, like offering eco-friendly lodging, is a key part of protecting natural habitats and lowering carbon footprints. Hence, this study tries to examine the relationship between tourism development, economic policy uncertainty, renewable energy, and natural resources on the ecological footprint of India during 1990-2022. This study applies a novel dynamic ARDL simulation approach for long-run and short-run analyses. The study also employs frequency-domain causality to check the causal relationship between the variables. The result reveals that tourism has a positive effect on the ecological footprint. Similarly, economic policy uncertainty has a positive and significant effect on the ecological footprint in India during the sample period. Additionally, natural resource rent shows a positive effect on the ecological footprint or deteriorating environmental quality in the short and long run in the sample period. However, renewable energy consumption indicates a negative effect on the ecological footprint. The results reveal that TDI and EPU have rejected the null hypothesis of no Granger cause in the long, medium, and short term. While renewable energy has a causal relationship with ecological footprints in both the long run and medium run, it is imperative for India to adopt measures that facilitate the advancement of sustainable tourism, with a particular focus on promoting environmentally friendly lodging options, enhancing public transportation systems, and implementing effective waste management strategies.

Urban professionals' restorative tourism: exploring the role of perceived environmental restorativeness, push and pull motivations and destination attributes on tourism expectations.

Introduction: Urban professionals often seek respite from their daily routines through restorative tourism, driven by a complex interplay of motivations that include both internal "push" factors and external "pull" factors. This study investigates the intricate relationship between the perceived environmental restorativeness of tourist destinations and the expectations of urban professionals engaging in restorative tourism. Furthermore, it examines how push and pull motivations mediate this relationship while also considering the moderating effect of destination attributes. Methods: The multiple regression analyses on the survey data collected from 221 urban professionals with restorative tourism experiences provided quantitative evidence regarding the hypothesized relationships among perceived environmental restorativeness, push and pull motivations, destination attributes, and tourism expectations. Results: The results showed that perceived environmental restorativeness has a positive effect on urban professionals' tourism expectations; urban professionals' pull motivation and push motivation each play a mediating role between perceived environmental restorativeness and tourist expectations; and restorative tourism destination attributes have a moderating effect between perceived environmental restorativeness and push motivation, as well as the relationship between perceived environmental restorativeness and pull motivation. Discussion: This study provides essential theoretical contributions to restorative tourism and practical implications when designing restorative tourism destinations that target urban professionals.

Exploring the Potential of a Multi-Level Approach to Advance the Development of the Medical Tourism Industry in Indonesia.

Nowadays, the global medical tourism market size has grown quite rapidly, with a projected increase of 21.1% between 2021 and 2028. This study aimed to explore barriers and potential strategies for the development of medical tourism in Indonesia. A qualitative case study design was employed, where 8 respondents were selected using an expert sampling method from various groups according to the helix framework, including academics, government, professional organizations, the private sector, and the media. Data was collected through document analysis and in-depth interviews, and was analyzed manually using an inductive thematic content analysis approach. Limitations to the development of Indonesian medical tourism are related to regulations concerning medical tourism, the number of health services, distribution, supporting resources, public trust, and competition. At the institutional level, the challenges comprise services and products, hospital facilities, supporting facilities, and marketing processes. Furthermore, at the micro level, the low competency of both health and non-health workers persist as an obstacle. The potential strategy at the macro level include the development of robust marketing and branding strategies, health infrastructure, and resources. At the institutional level, it was necessary to develop related products and services provided, improve quality, and focus on branding and marketing strategies. Additionally, improving human resource skills was needed at the micro level.

Spatial distribution and influencing factors of rural tourism: A case study of Henan Province.

Rural tourism is a powerful way to revitalize the countryside, and its spatial pattern is crucial for sustainable development. This paper analyzes the spatial distribution of rural tourism characteristic villages in Henan Province by taking 723 villages as the research object and using the nearest neighbor index, kernel density analysis, and spatial autocorrelation. It investigates the influencing factors utilizing the optimal parameters-based geographical detector (OPGD) model. The results show that, firstly, the overall spatial distribution of the rural tourism characteristic villages in Henan Province is characterized by aggregation and unbalanced distribution, and the overall spatial distribution density demonstrates the aggregation characteristics of "four cores and one belt". Secondly, the rural tourism characteristic villages can be divided into four primary categories, agricultural industry, rural culture, and featured villages and towns. The spatial distributions of the four main categories are all clustered. Thirdly, the primary factors affecting the differences in the spatial distribution of the rural tourism characteristic villages are the topographic features, economic development level, tourism market potential, traffic capacity, and relevant policies, among which the critical factor is the number of A-class scenic spots in the tourism market potential. To promote the optimisation of the spatial pattern of rural tourism, it is necessary to strengthen resource integration. Furthermore, it is important to conduct in-depth exploration of more factors in order to provide comprehensive guidance for the sustainable development of rural tourism.

Construction and evolutionary factors of spatial correlation network of China's provincial tourism resource conversion efficiency.

Research objective: To explore the spatial correlation network characteristics and formation mechanisms of tourism resource conversion efficiency, and provide reference for the collaborative improvement of tourism resource conversion efficiency at the provincial level in China. Research methods: Non parametric SBM efficiency measurement method and social network analysis method. Research hypothesis: The spatial network correlation characteristics of tourism resource conversion efficiency are obvious, and regional connections are close. Research findings: (i) during the research period, the spatial connection strength of China's tourism resource conversion efficiency continued to increase and the spatial network structure of tourism resource conversion efficiency tended to become more complex and significantly more stable. (ii) A spatially linked network with a stable tourism resource conversion efficiency structure formed in China. The number of network relations and density of the network fluctuated and increased, while the network efficiency continued to decrease; however, a strong small-world nature was observed. (iii) The economic development level difference matrix, tourism industry agglomeration difference matrix, human capital difference matrix, and marketization degree difference matrix significantly and positively affected spatial association relationship establishment, while the provincial adjacency matrix significantly and negatively affected such relationships.

Assessing the environmental impacts of three different types of accommodations in Portugal and Spain by using an LCA approach.

The tourism industry, affected by COVID-19, must reduce greenhouse gas emissions. This study evaluated the environmental impact of three hotels in coastal and mountainous regions of Spain and Portugal using Life Cycle Assessment (LCA). Data was gathered via surveys in the Greentour tool. Results indicate that the 2-star hotel (focused on cultural-urban tourism) has the highest impacts in most categories, except for CC, FRD, and POF indicators. The 3-star hotel (beach tourism) contributes the most to CC and FRD indicators, while the hostel (nature-religious tourism) has the highest value in the POF indicator. LCA findings reveal that diesel consumption in the hostel and electricity usage in both the 2-star and 3-star hotels are major contributors to environmental impacts across various categories. Overall, evidence suggests that fossil fuel and electricity usage significantly affect tourism activities environmentally. Interestingly, this study highlights that a 2-star hotel can have a higher carbon footprint (CC indicator) compared to a 3-star hotel, challenging the notion that higher star ratings imply lower environmental impact.

Twenty five years of world heritage status: Show us the benefits!

In the Solomon Islands and around the Pacific there is commonly a disconnect between government priorities for economic development through resource extraction and community aspirations for local resource management, conservation, and alternative pathways to livelihoods development, which includes tourism. Nowhere is this disconnect more stark than in communities on Rennell Island, within the region's oldest inscribed World Heritage area. These communities have so far resisted extractive industry development but have not yet benefited from inscription. Alternative livelihood opportunities compatible with a conservation economy are a priority. Our research objective was to explore community aspirations and priorities. We used Q-methodology to reveal discourses associated with conservation, livelihoods generation, and drivers of well-being and then evaluated these aspirations in scenarios in a socio-ecological system. We revealed three factors, each aligned with conservation and tourism development with clear opposition to extractive industries. Key differences focussed on immediate personal circumstances, attachment to kastom, and food and water security. Our research points to clear support for the area's continued conservation and for livelihood pathways that might secure this but low capacity to pursue this. Notwithstanding, the communities' patience is wearing thin and there is growing cynicism about the role of World Heritage protection as a route towards livelihoods development.

Decreased air quality shows minimal influence on peak summer attendance at forested Pacific West national parks.

Wildfires are increasing in duration and intensity across the United States' Pacific West region, resulting in heightened particulate matter from smoke in the atmosphere. Levels of peak particulate matter are concurrent to peak visitor attendance at National Parks, given seasonal alignment with summer vacation travel and heightened forest fire conditions. Particulate matter threatens visitor health and safety and contributes to poor visibility and a deteriorated visitor experience. To assess visitation response to diminished air quality, we utilized wildfire-generated particulate matter (PM2.5) data in conjunction with monthly attendance records for three ecoregions containing eight national parks in Washington, Oregon, and California from 2009 to 2019. We analyzed daily PM2.5 levels from data gridded at the 10 km scale for National Park Service units by Level III forest ecoregions within the National Park Service's Pacific West Unit. Data were then compared to normalized monthly visitation trends for each of the ecoregions using two statistical methods Kendall's Tau and Analysis of Variance (ANOVA) with post-hoc Tukey tests. Results demonstrate that attendance at these national parks does not decrease in response to increased PM2.5 levels. Instead, we see several statistically significant increases in attendance across these ecoregions during periods of reduced air quality. Of 115 shifts between air quality categories during the busy season of July to September, there are no significant decreases in attendance as air quality worsens. These findings suggest that visitors are willing to tolerate reduced air quality compared to other factors such as temperature or precipitation. Given that park units within each ecoregion feature diverse historical contexts, varied built environments, and unique ecological systems, our discussion specifically addresses managerial concerns associated with maintained high levels of visitation during suboptimal, and potentially dangerous, conditions. There is substantial need for specific, scalable approaches to mitigate adverse health and experiential impacts as visitors are exposed to increased risks during a range of exertional activities associated with diverse settings.

Achieving sustainable medical tourism: unpacking privacy concerns through a tripartite game theoretic lens.

Introduction: Medical tourism has grown significantly, raising critical concerns about the privacy of medical tourists. This study investigates privacy issues in medical tourism from a game theoretic perspective, focusing on how stakeholders' strategies impact privacy protection. Methods: We employed an evolutionary game model to explore the interactions between medical institutions, medical tourists, and government departments. The model identifies stable strategies that stakeholders may adopt to protect the privacy of medical tourists. Results: Two primary stable strategies were identified, with E6(1,0,1) emerging as the optimal strategy. This strategy involves active protection measures by medical institutions, the decision by tourists to forgo accountability, and strict supervision by government departments. The evolution of the system's strategy is significantly influenced by the government's penalty intensity, subsidies, incentives, and the compensatory measures of medical institutions. Discussion: The findings suggest that medical institutions are quick to make decisions favoring privacy protection, while medical tourists tend to follow learning and conformity. Government strategy remains consistent, with increased subsidies and penalties encouraging medical institutions towards proactive privacy protection strategies. We recommend policies to enhance privacy protection in medical tourism, contributing to the industry's sustainable growth.

Forecasting of Indian tourism industry using modeling approach.

Currently, India has become one of the largest economies of the world in which tourism and hospitality have significantly contributed; however, the growth rate of tourism industry has been greatly affected during the COVID-19 pandemic. In this study, we have used the modeling approach to analyze and understand the growth pattern of Indian tourism industry. To achieve this, we consider the data of international tourist arrivals before and after the lockdown. The Dickey-Fuller test, AIC and BIC methods are used to obtain the best fitted model and further, the accuracy of obtained model is also analyzed. Data and forecasting indicate that the weather and public holidays significantly affect the tourism industry.

Benefits of applying hourly resolution in the assessment of the climate aptitude to manage tourist activities in arid regions.

The availability of reliable information on local climatic-tourism conditions is a growing need due to the influence it exerts on the quality of the organizational strategy of tourist destination's, and travel experience. Evaluations of the tourism potential of the climate have been carried out on a daily or monthly resolution, thus limiting the collection of detailed information that makes it possible to fine-tune tourism management and operational decision-making on an intraday scale. This research is the first case study to analyse the climatic suitability for nature tourism, using the weather types method at hourly resolution. The study applies to arid tourist destinations in Isfahan province (Iran). The detailed resolution has made it possible to identify the time slots favourable to the development of nature tourism in those periods of the year recognized as critical in the daily resolution analyses. In the same way, the hourly resolution has also identified critical bands in those periods indicated as favourable in the evaluations to daily resolution. The hourly resolution provides detailed information that can allow tourists and also tourism managers to establish intraday adaptation strategies that make it possible to develop the activity even in places with extreme climates.

Dynamic livelihoods, gender and poverty in marine protected areas: Case study from Zanzibar, Tanzania.

Livelihood initiatives are common within marine protected areas (MPAs) aiming for poverty alleviation or higher income opportunities. However, results can be mixed in reality, as well as change over time. Furthermore, who benefits is a key consideration, as results can vary based on inequalities, including gender. Here, the monetary outcomes of different livelihood strategies were investigated across three MPA regions in Zanzibar, Tanzania. Using a quantitative approach, the results show that livelihoods have shifted in a six-year period, with livelihood strategies differing in poverty incidence and income. Livelihood initiatives, namely seaweed farming and tourism, did not provide significantly higher monetary returns compared to long-standing livelihoods, such as fisheries. Seaweed farming showed income stability but a high poverty incidence predominantly within women-headed households. During the study period, men primarily remained in fisheries, whilst women shifted to small-scale businesses and fisheries, largely exiting seaweed farming. This underscores a need for adaptive, gender sensitive management within fast changing coastal contexts.

Decoding the trends and the emerging research directions of E-commerce and tourism in the light of Resource Dependence Theory: A bibliometric analysis.

E-commerce and tourism have all seen a lot of growth and development recently in both business and academia. The tourism sector has significantly changed because of the growth of e-commerce platforms, as more and more consumers buy their rooms and tickets online. The academics conducted further research to understand the impact of e-commerce platforms on the tourism industry, leading to the development of these two specific fields' body of literature. A bibliometric review was carried out to draw the trends of the research conducted to date in the field of e-commerce and tourism. Thus, it is possible to have a general overview of the literature for academics to intent to conducting future research. Employing bibliometric analysis with Biblimetrix software on 456 publications from the Web of Science database covering the years from 2000 to 2022, this study identifies predominant themes and research trends in the field. The terms "e-commerce" and "tourism" were used as keywords. During the analysis, six research questions were answered and results were combined with Resource Dependence Theory. Australia and China which are the first two countries in terms of citations. China is the outstanding country for author collaborations. Co-citation network analysis identified four clusters, namely management, model, satisfaction, and quality. Publications with keyword "communication", "enterprises", "application" and "rural" are in a decrease after 2015. Finally, future research directions were proposed.

A new, unusually large, Clavicornaltica Scherer, 1974 flea beetle from Borneo, described and sequenced in the field by citizen scientists (Coleoptera, Chrysomelidae, Galerucinae).

Background: The genus Clavicornaltica Scherer 1974 consists of very small, soil-dwelling flea beetles in South, Southeast and East Asia. Due to their diminutive size and morphological similarities, very little is known about their ecology and taxonomical diversity. It is likely that further studies will reveal this genus to be much more speciose than the 30 species currently recognised. New information: A new species of Clavicornaltica from Brunei Darussalam is described, C.mataikanensis Otani et al., sp. nov. This is the second species of this genus recorded from Ulu Temburong National Park.

How do national marine parks contribute to tourism eco-efficiency in coastal cities? The case of China.

This research investigates how establishing national marine parks in China enhances marine tourism ecology. Analyzing data from 52 coastal cities between 2006 and 2019, it uses a multi-period difference-in-differences method to evaluate the parks' impact on tourism eco-efficiency. The results show that national marine parks significantly improve coastal cities' tourism eco-efficiency, especially in the Bohai Rim and seaside cities. The study attributes this improvement to the reduction of fixed asset investments, which controls the scale of tourism development. These findings provide vital insights for countries seeking to revitalize their marine tourism sectors through similar ecological restoration strategies.