Health tourism trends in the United Kingdom: Are they net exporters of health services?

The study investigates the inbound and outbound health tourism in the United Kingdom (UK) to determine if the UK can be considered as a net exporter of health services. Although there is an increasing number of studies analysing the phenomenon of health tourism, little empirical data are available. This paper contributes to reducing this gap by providing reliable data on health tourism flows for the British case. Using microdata drawn from the International Passenger Survey (IPS) for the period 2000-2014, we estimate the flows, number of nights and expenditure of tourists looking for medical treatment who complete international visits of less than 12 months’ duration to and from the UK. In addition, we analyse the main destinations of UK residents (outbound health tourists), and country of origin of overseas residents (inbound health tourists). The results show the upward trend of inbound and outbound patients (163 and 364% during the period 2000-2014, respectively), the strong seasonality in outbound patients (lower during the summer), and the significant increase in the levels of expenditure of overseas residents since 2005. Poland, France, India and Hungry are the chosen countries by UK residents to be treated, whereas Irish Republic, Spain, United Arab Emirates and Greece are the main countries providing inbound health patients. Public policy considerations are given.

Explaining tourists´ support for environmental protection

Any movement towards sustainable tourism is dependent not only upon the industry and other key stakeholders but also the demand side, namely the tourists. Yet, there is a limited literature from the demand point of view. In this area, contributions to an understanding of tourists’ support to sustainable development are necessary. This paper analyzes the main determinants in tourist behavior regarding the environmental considerations when they are making decisions about their holiday plans. General literature on this issue highlights the need to consider socio-economic variables of the individual as well as the attributes related of their style of living. If the econometric model takes into account all these variables simultaneously, then the linkage between contextual changes and tourists´ behaviour is enriched and it may be estimated more accurately. In this sense, a multilevel approach using a random-intercept logistic models is proposed, since tourists belong to a country are affected by the same contextual variables. The analysis comprises a joint dataset composed by microdata belong to the survey Attitudes of Europeans Towards Tourism, which corresponds to Flash Eurobarometer 281, macrodata from Eurostat (GDP in pps and GDP growth) and additional variables profiles from the 2005 Environmental Sustainability Index. Country-specific effects are calculated across the EU-27 countries, which corroborated that attitudes to the sustainable tourism are heterogeneous geo-graphically. The higher the level of GDP, the lower the level of tourists´ support. These results could be explained because tourists of richer countries already have to pay more tax for envi-ronmental protection. Age, gender and educational attainment are relevant. Motivations for travelling, size of the community, type of the destination, and environmental sustainability indi-cators of the place of residence are also important factors.