DOCTORAL DISSERTATION SUMMARY: The contribution of health tourism to economic sustainability of tourist destination

Purpose The first major restriction for economic sustainability of Croatian tourism is its seasonality. If looking at the seasonality through the Gini coefficient in all aspects of accommodation, Croatia has the biggest seasonality in the Mediterranean countries. By determining the percentage of seasonality against Croatia’s major competitors in hotels and similar accommodation units, then only Montenegro has larger percentage of dependence. The seasonality in period from 2013 to 2017 is not dropping but instead from June 1 to September 30 it brings very high 86% of yearly tourist revenue. Our competitors in the same period bring 43%(Malta), 51%(Spain), 59%(Cyprus) and 62%(Italy). The second major restriction of Croatian Tourism is huge disproportion between tourism revenue of Adriatic and Continental parts of the country. Even if the size percentage ratio is 56% versus 44% in favour of Continental part, if observed by the tourist accommodation revenue, the ratio is 95% versus 5% in favour of Adriatic part of Croatia. Further on, the availability of beds over 1 square km the ratio is 41.8 versus 3.5 beds in favour of Adriatic part. The restriction is connected with the rental model of development of low added value in Croatia, when growth of accommodation capacities in 6 years (2011-2016) is rising in favour of capacities of low added value 92% private accommodation took 82%, camps took 10% of total capacities while hotels took only 6%. All the mentioned restrictions are the cause for this research, how to decrease such a high seasonality which is not supporting economical sustainability of the tourist destination. This is the reason for decision to research the contribution of health tourism to economic sustainability of tourist destination. The principal purpose of this research is to point out the meaning and contribution of health tourism development in Croatia which as such is contributing to economic sustainability of the destination. Methodology Empirical investigation has been conducted in two directions. First is based on analyzing and processing secondary information which is presenting one very important segment of economic sustainability, addressed through seasonal effect, benchmarking analysis, availability of health tourism in Croatia, and especially through analysis of five indicators of tourist intensity and their influence on economic sustainability of destination through example of 97 cities and regions of Adriatic(72) and Continental(25) Croatia. Six variables have been analysed which were divided into two groups. First group is made of health institutions and organizations in tourist destinations which are further divided into six subgroups according to the health tourism development in analysed destinations. Second group is made out of five variables of economic sustainability of tourist intensity and statistical analysis was made out of a sample of 97 tourist destantions in Croatia. Second direction of investigation has been conducted through field research where questionnaire has been presented to 92 health tourism institutions in Croatia (from wellness hotels, special hospitals and Spa’s to clinics and doctor’s offices) of Adriatic and Continental part of the country. This served as a way to obtain primary information which have been processed through scientific method while explaining statistical methods and results. Primary data has been collected by conducting exploratory, unexperimental, questionarrie style of research which was done by utilizing feedback from 92 health tourism organizations and institutions. The questions were shaped by example of Likert scale while the entire questionairre has been put toghether by BSC (balance ScoreCard) method. The methods which were used for calculating the results: number of measurments (n), arithmetic mean (x), median (M), sample testing (Man-Whitney test), distribution normality test (Komogorov-Smirnov and Sahpiro-Wilk test), nonparametric methods: rank corellation (Kendall\u27s Tau B Method; Spearman\u27s rho method); nonparametric ANOVA (Kruskal Wallis test; Post-hoc analysis by Dunn). Findings In order to accomplish the purpose and goals of scientific research in this dissertation answers are provided (research results) to several questions which came from set hypothesis: All analyzed factors which are referring to implementation of strategic regulation of tourism development of Republic of Croatia in health tourism institutions are contributing to economic sustainability of tourist destination, with detailed display of 52 factors and their influence on economic sustainability Internal key factors of development of health tourism (market orientation; processes and activities; learning and growth; and financial perspective) have effect on the implementation of strategy of tourism development of Republic of Croatia, as well as on the opinions about strategic orientation in health tourism institutions. Market orientation of health tourism institutions of Croatia is contributing the implementation of strategic development goals and economic sustainability of tourist destination. This contribution of market orientation would be even more significant if we would be to join the geographical clusters on regional and national level in order to achieve better market competitiveness. The perspective of learning and growth in health tourism institutions described in all six parts of this dissertation is contributing to implementation of strategic development goals of their establishments, thus contributing economic sustainability of tourist destination. With possibility of increasing the productivity on the level of competitiveness, high marks of all factors of financial perspective in health tourism institutions prove that financial perspective also contributes to implementation of strategic development goals of their establishments and institutions, thus contributing to economic sustainability of tourist destination. Analysis on perspective and stability of health tourism in Republic of Croatia shows the largest development restrictions of health tourism which can be seen in: - Marketing of health tourism on a national level - Inadequate legal regulation which does not allow the health tourism development - Inadequate measures of economic politics which are not supporting the health tourism development - Health tourism in Croatia is still not recognized as product with high development priority - Joining regional and national clusters in Republic of Croatia is still not contributing to better positioning of health tourism institutions in the market Perspective of health tourism development in Croatia shows maximum potential contribution of health tourism to economic sustainability of tourist destination. This potential contribution is primarily seen in: - Positive attitude that health tourism can secure better utilization of our hospitality capacities, year round income, elevated additional value of services and sustainable economic development of the country - Positive attitude that for health tourism development requires inter-disciplinary specialist education and level of knowledge, lifelong learning systems which can be developed in Republic of Croatia - Key perspective that health tourism can make a positive impact on reducing seasonal dependency and thus contribute to sustainability of tourist destinations in Croatia The results of research, which are based on secondary information received from tourist destinations of Adriatic and Continental areas of Croatia, are also proving the primary scientific hypothesis (H0). For this reason the indicators of health tourism development in Croatian destinations have on the economic sustainability of tourism (97 destinations in Adriatic and Continental areas of Croatia) are researched. Results of statistical analysis of five different types of health tourism destinations (VAR1 from 0 to 5) are provided, after which is made analysis of all five indicators of economic sustainability of tourist destinations: VAR2 (ZTLG) – impact of tourism on local economy, VAR3 (TIR) – Percentage of tourist intensity, VAR4 (TPR) – Percentage of tourist flow, VAR5 (TDR) – Percentage of tourist density and VAR6 (CTF) – Coefficient of tourism functionality. All these proven facts are connected with the seasonality and economic unsustainability. The variable of seasonality is the most important reference of this dissertation and as such, it has the biggest impact on the economic sustainability of tourism. Tourism seasonality in Croatia has the biggest impact in private accommodation sector, and health tourism, despite the enormous potential of reducing this issue still has very limited effect on total economic sustainability. In addition, the secondary research has shown that current health tourism capacities are not very competitive with the products and services they offer. It is very visible that reason for this is a lack of proper competition and competitiveness. From the analysis of the parameters of tourist intensity by the way of statistical method of correlation of rank it is reached the second part of conclusion pertaining the proof of set hypothesis, which together with the first part of primary field research completed each other by proving the primary and all secondary hypothesis Originality of the research This research has its contribution in development of science in theoretical and practical sense. In theoretical part, scientific facts of the relevant area have been researched as well as all the relevant and available literature on the matter. Theoretical scientific facts are contributing to development of health tourism and sustainable development of touristic destination. Following this thought, this dissertation has proven the theoretical basis of health tourism and sustainable development; this is especially pertaining to overview of previous theoretical and empirical research connected with health tourism and economic sustainability of tourist destinations. In practical part, the research has shown the results from received feedback of questionnaires. The most relevant 92 institutions and organizations of health tourism in Adriatic and Continental part of the country provided this feedback. The model of contribution of health tourism has been tested and based on 97 destinations of Adriatic(72) and Continental(25) Croatia towards the economic sustainability of tourism destination by the example of 5 indicators of economic sustainability. The originality of research is represented through the completion of its goals which are: development and explanation of model which is smart, inclusive and sustainable development of tourist destinations in Croatia which are basing their development on health tourism. Inovations which in Strategey \u27Europe 2020\u27 take central spot, and \u27smart specialization\u27 needs to make it possible for countries and regions to specialize in those activities in with they hold comparitive advantage. For Croatia and croatian tourism the oportunity lies in development of health and wellness industry. The unsustainability of seasonal tourist concept development has been proven and factors which are influencing the seasonal dependence of croatian tourism have been explained. The possibilites of connecting health tourism into geographical clusters in order to facilitate sustainable and equal development have been established. The concept of health industry and health tourism as a part of sustainable development, which furhter enables economic development has been explained. Tourism has been identified as a phenomenon with strong inovation potential which was elaborated on example of health tourism. In addition, the health tourism development model which is necessary in order to succesfully manage such tourist destination has been suggested