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Speech of Giorgos Patoulis, President of Central Union of Municipalities of Greece at the London School of Economics Ethical Finance Society annual event series ‘A new era Hellenic export: Medical Tourism’

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Giorgos Patoulis: “Greece has the advantages and the potential to become key player as a Health Travel Destination”

The Role of Self Government on Health and Thematic Tourism on the aim of establishing Greece on Health Travel World Index and turning the country to a unique all year- round destination

Giorgos Patoulis, President of Central Union of Municipalities of Greece, President of the Medical Tourism Council ELITOUR, and President of the Athens Medical Association, was invited as a speaker at the annual London School of Economics Ethical Finance Society event series at the LSE campus, on the focus of this year’s event on healthcare  ‘A new era Hellenic export: Medical Tourism’ for the prospects of the Medical tourism sector in Greece, as well as its potential impact on the Greek economy.


“Greece has a remarkable tourist product that is offered as a "raw material" for exploitation, it remains, though, to a large extent, one-dimensional and still plagued by intense seasonality” Giorgos Patoulis underlined in his speech , adding that “Health Tourism is contributing  positively to the expansion of the tourist season and thus to the homogeneous, as far as possible, distribution of tourist numbers  in space and time, while being a highly profitable industry with an annual turnover of more than $ 100 billion and 30 million healthcare users worldwide” .

Giorgos Patoulis’ speech referred in particular to Thermal Tourism in Greece, the only form of Health Tourism and Tourism in general, he said, that, inevitably creates forced 'repeaters'.

“Given the great dynamics of the nature of thermal tourism and the unique characteristics of Greece, on worldwide level, thanks to the country’s  bioclima and the combination of the sea and the thermal springs, the prospect of developing this form of Health Tourism in Greece are enormous. “ Giorgos Patoulis said.

The LSE Ethical Finance Society is a community of students with a common interest in the interrelated fields of finance, business and policy, always aiming to hold an ethical and fair view of European affairs.

This year’s event series is multi-themed, as it covers issues such as the rise of populism and nationalism, European integration and the importance of the healthcare sector in the European economy.

Moderator of the event that hosted Giorgos Patoulis speech, on June 4th 2018 at the LSE campus in London, was the Deputy Director of Department Health Policy P. Kanavos, while Dimitris Batakis, spokesman for the London School of Economics Ethical Finance Society prorogued Mr. Patoulis speech.

At the event, Professor of Genetics Medicine and Vice President of the International Health Tourism Center K. Pantos, also gave a speech, following President Patoulis’ speech and presentation, where he explained Greece's in vitro fertilization achievements, and the IVF therapies’ low cost compared to countries like America and Canada.

Speakers in this year’s event series of the LSE Ethical Finace Society include Mrs. Dora Bakogianni (former Minister of Foreign Affairs for Greece), Mr. Giannis Kefalogiannis (Parliamentary Spokesperson for New Democracy) and Mr. Christian Lindner (Federal Chairman of the Free Democratic Party in Germany).

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Attached you will find in full length Giorgos Patoulis speech


‘A new era Hellenic export: Medical Tourism’

 Giorgos  Patoulis, President of Athens Medical Association, President of Central Union of Municipalities of Greece     

London School of Economics Ethical Finance Society

June 4, 2018


Ladies and gentlemen,

It is my utmost pleasure and honor to address you today at one of the most important "temples of knowledge" of the world. And it is an exceptional honor, the great participation and the  high quality of of this audience .

Im  extremely delighted also , to address the prominent Greeks, among the audience, who adorn the international scientific community by their scientific expertise and professional contribution .

Based on this concept, the intervention I am attempting with my  speech , aims to highlight an opportunity for mutual reflection on one hand, and an invitation for a common step towards the economic development by the “vehicle “ of  Tourism, on the other hand.  Meaning Tourism , not by  its wide, and perhaps vague dimension, but by its thematic character, as it has developed internationally since the specialization of needs and, consequently, of demand.

The international crisis has spread rapidly to all sectors of the economy, as you very well know  The contraction in turnover, unemployment, the reduction of investment are considered the inevitable suffering of the time. Tourism has been hit on a global scale, but not to the same extent.

 When balance is restored to the economy, priority will be to serve basic needs. However, if Tourism does not become a necessity, the period of recovery of the travel industry will be longer. In order to become a necessity, Tourism has to take its  thematic dimension, that is to say, that satisfies the desires of relaxation, due to the daily pressures that the man of modern times accepts. On the other hand, there have been needs to cover other basic health-related parameters that, as a result of globalization, have broadened the search for solutions across borders.

This is how Health Tourism has been born in modern times and became gigantic, due to its nature. An area that is rapidly growing due to its contribution against Tourism seasonality, which, despite the value of tourism, is  also its pathogenicity.

While the World Tourism Organization predicts that tourism in emerging economies will reach 57% of the world market by 2030, compared with 47% in 2010, seasonality remains at risk of over-concentration of populations in tourist destinations. Therefore, the expansion of the tourist season is based on the development of those special  thematic forms, which are increasingly gaining a significant share of travelers, and even "fans", which also contributes to the resumption of the visit, an equally fundamental quest for the success of any strategic approach to the markets . The contribution of Health Tourism to Repetitive Travel is important.

Ladies and gentlemen,

At a time of great uncertainty and intense competition, the pursuit of tourism policy has to  be fully aligned with market rules taking into account the laws of supply and demand and modern marketing methods. To achieve this, the following steps are needed :

-First, a policy has to be specified , and therefore a strategy has to be drawn

-Second, a perspective of the strategy that would be implemented deep in time is needed , so as efficiency to be achieved

-Third, the strategy has to be targeted, so as  to ensure penetration into interest groups.

The following priorities are the requested :

-The enrichment of the tourist product for the expansion of the "tanks " of raising interest

- Maintaining the relationship with repeaters to enhance rotation.

-The increase of the average stay.

- The widening of the tourist season

- The opening of new markets.

-The  “identity"

-Targeted / Strategy / Penetration

-The distribution of the visitors and tourist population in space and time

Greece has a remarkable tourist product that is offered as a "raw material" for exploitation. It is sufficient to think that tourism is the only export (after inputting resources) activity that brings the consumer to the place of production (supply) of the product (service), thus making exportive other activities also, which  by their nature are not exportable (restaurants and leisure centers, shops, etc.).

However, the pursuit of tourism policy at country and / or regional level must be fully aligned with market rules. Tourism policy has to take into account the laws of supply and demand and modern marketing methods. We can not separate one from the other  - the opposite would be a start from the wrong "starting point". When we talk about "offering" in this case, we mean nothing more than what we call the "tourist product": what is the country or region offering to its visitor.

Given that, according to established market rules, the offer must meet demand, it is necessary, in a second phase, to ascertain whether our tourist product, as it is shaped, is gaining  penetration in the tourist markets or in specific population categories of these markets. If not, or if penetration is weak relative to the target audience because of the intense competition, we need to identify or even delineate the comparative advantage, which requires clear knowledge of competition and, of course, demand.

A successful tourist product must respond to the widest possible range of demand and, most importantly, it requires the flexibility to adapt to it.

The expansion and globalization, we would say, of the phenomenon of thematic forms of tourism has gradually begun to replace mass tourism, which has forced many foreign travel agencies to specialize on Thematic Tourism . It is no coincidence that there are nowadays travel agencies aiming exclusively to Health Tourism travelers. And it is no coincidence that Wellness packages is the new trend of international Tourism market, the tourism packages developed to offer  the traveler the combination of rest with the restoration of any health problem.

This development has created the need to adjust the promotional programs as  well, since the target groups have changed, and their "channels" of approach have multiplied.

Over the last two decades, the tourist product of the Mediterranean seems to be enriched with new destinations,  enhancing competition further at all levels. Croatia, Tunisia, Turkey and Egypt are such examples. The strategic development of new destinations consists of the creation of new hotel facilities with low cost services, compared to traditional forces that currently have share losses. It also consists of the creation of units with the appropriate equipment and the scientific staff which can meet the specialized demand of Health Tourism.

The enlargement of the EU with new members has raised new demographic and economic data. Tourism could not remain unaffected. New, relatively unknown and cheap destinations from Southeastern Europe made their appearance. Natural beauty, cultural attraction poles and appeal to thematic forms of tourism add value to the promise of holiday they propose. In addition, the advantageous location of the destinations in relation to Greece favors the movement from the northern European countries, which constitute the main "tanks" of tourism in Greece. The new changes contribute to the intensification of competition. On the other hand, the entry of new members could mean opening new markets.

Increasing competition from emerging destinations from the Eastern Mediterranean and the Adriatic is considered one of the major threats to Greek tourism. According to the proposed classification of the World Tourism Organization, Greece, as a whole, has a range of medium to low price products on the market.

 However, Greece's tourist product remains, to a large extent, one-dimensional and still plagued by intense seasonality. The organized approach to new markets and the enrichment of services could be a cure to the problem. However, this requires unified planning, flexibility and planning at a collective level.

In this context, Health Tourism is contributing  positively to the expansion of the tourist season and thus to the homogeneous, as far as possible, distribution of tourist numbers  in space and time, while being a highly profitable industry with an annual turnover of more than $ 100 billion and 30 million healthcare users. Assessing  that by 2020 the 65+ age bracket will be an impressive 20% of the total population in Europe, it is clear that Health Travel is turning into a dynamic tourism sub-sector. And it is important to take into consideration that the particular demographic group is becoming a prominent travel force as it seems to have the time, the necessary financial resources and the desire to travel to nearby destinations, inside and outside the country of residence.

In particular , Thermal  tourism is the only form of Health Tourism and Tourism in general,  that, inevitably,  creates forced 'repeaters'. Given the great dynamics of the nature of thermal tourism and the unique characteristics of Greece , on worldwide level, thanks to the country’s  bioclima and the combination of the sea and the thermal springs, the prospect of developing this form of Health Tourism in Greece are enormous. And we should note here that by international World Tourism assessment, Thermal Tourism in 2025, will be the world's second-largest industry after healthcare.

Greece currently has gained only the 3% of medical tourism world-wide, when Turkey, Poland and the Czech Republic hold 13% and Belgium 8%.

According to a scientific study, the worldwide market of medical tourism alone is estimated to be over $ 20 billion, showing an increase of 15% -25%, with around 14 million cross-border patients worldwide spending an average of 3,800-6,000 dollars per medical visit, including costs related to medical services, cross-border and local travel, inpatient accommodation and hotel accommodation. Countries like India, Singapore, Thailand, Costa Rica, Israel and Turkey have already claimed a bit of this lucrative market with impressive results.

Greece could become a serious competitor of the above  international "players" . Apart from an excellent climate that favors rehabilitation and recovery, it also has excellent logistic infrastructure with several international certifications, specialized medical and nursing staff, quality in the services provided, excellent hotel potential and competitive prices in medical operations, while it is still a safe country . In addition, in certain categories of medical services, Greece has a comparative advantage, both due to specialization and to favorable legislation, as is the case with in vitro fertilization. It is estimated that it could attract every year for the next five years at least 100,000 Health travelers , achieving revenues of over € 400 million per year. Numbers are interesting, especially for a country like Greece that looks forward to tourism: its contribution to GDP is expected to exceed 43 billion euros in 2021.

Given the dynamics of Health tourism and the potential of the country, the Health and Tourism Ministries have since 2013 legislated the possibility of shaping the institutional framework for the development of the sector by joint decision (Joint Ministerial Decision 27217/2013) laying down a series of special conditions and preconditions: mandatory certification of medical providers by a certification body in accordance with international standards, mandatory insurance of establishments and doctors in matters of professional liability, establishment and maintenance of a register of medical tourism providers and granting a distinctive Medical Tourism sign. In addition, a joint ministerial decision has been issued on the operating standards of the Centers for Medical Medicine and another for the Centers for Thalassotherapy.

However, while the foundations for the institutional framework have been put in place, the necessary circulars for the implementation of the Joint Ministerial Decision are pending, with the result that any initiatives in the private sector are not yet successful due to state inertia. and Greece can not claim its share in the rapidly growing market of medical tourism. This is because there is a lack of a national strategy for the development of this sector, which we, representing the Local Authorities and the scientific bodies, are trying to contribute and enforce.

Ladies and gentlemen,

Health Tourism concerns the Prevention, Maintenance, Treatment, Recovery and  Rehabilitation of Health by modern medical or physical methods. It includes Medical Tourism, Traditional Spa tourism (Thermal Tourism) and Wellness Tourism. Medical tourism refers primarily to Tourism based on the Medical choice of the traveler. The patient chooses the Travel Destination in order to receive specific medical care, while he is being motivated by factors such as the cost of the service, the medical service quality, or, sometimes, just the opportunity to combine medical care and vacation.

Thermal tourism aims to Prevent, Maintain and Restore physical and mental health through the use of natural healing resources.

Wellness tourism combines vacations with Prevention, Maintenance, or Improvement of Health, services through rejuvenation and relaxation programs of holistic approach aiming to the improvement of the traveler’s physical, mental and emotional health.

In recent years, a series of synergies and interesting initiatives aim to establish Greece as a destination for Health Tourism. Both the private sector and the local government are making efforts for a more dynamic Greek presence in the field of Health and Medical Tourism, in the perspective of making  our country coordinate its efforts, consolidate its presence in international conferences and exhibitions, strengthen national extroversion on this sector  and attract new investments.

Allow me to mention some of the important landmarks in the evolution of the sector in Greece:

  • In 2012 the Hellenic Chamber of Commerce appoints the Institute of Social and Preventive Medicine to present  the first major study on the "Development of Medical Tourism in Greece". The study highlights the great comparative advantages of our country in the prospect of developing Health Tourism in Greece, and indicates the steps to be taken by the state and the public and private stakeholders.
  • A year later, in 2013, the  Hellenic Medical Tourism Council, ELITOUR is established. ELITOUR is a Non Governmental Organization, which I  I have the honor to chair, that brings  together companies and organizations of the health, tourism, transport, certification, business, insurance and advertising sectors, and is the first successful collective effort for the promotion  and consolidation of Greece as a top international Health Tourism destination. Last month, in May, we had the pleasure to coordinate and host as ELITOUR the 2018 IMTJ Summit and Awards in Athens, the annual conference of the International Medical Travel Journal (IMTJ), a top-level international event on Health Travel that brought together opinion leaders and top personalities of the international Health and Medical Travel community around the world, to share their knowledge and expertise on the development of the industry.
  • At the  the IMTJ  summit, the need of a national Strategy and Action Plan for the systematic promotion of Greece abroad as a Health Travel destination, has been highlighted, and this is what has already been implemented by the Athens Medical Association(ISA)  and the Central Union of Greek Municipalities (KEDE) ). The project includes the organization of conferences in large cities abroad with the presence of the Greek community of the Greek Diaspora, aiming at informing about the prospects of health tourism important business and political players in order to attract investors. In this context, we participated in conferences and scientific meetings almost all over the world with great success and great response.
  • At the same time, in order to promote medical science and the Greek medical  communities as a comparative advantage of Greece, we created the Global Institute of Greek Doctors in 2017, to facilitate the networking of Greek physicians active in the world, which we should use as the country’s ambassadors on Health Tourism . An answer to the most dramatic brain drain Greece is experiencing due to austerity crisis , because we deeply believe that the country should try to keep its best minds, the Greek scientists, within its borders, even those living outside of them .  
  • We established the International Health Tourism Center last year, which aspires to be a think tank that will help to promote each country as a credible destination for medical tourism, as well as to support healthcare providers in this direction.

And we keep augmenting our efforts by proclaiming at every opportunity the priorities that, to our opinion, should be incorporated by the National Strategy Plan on Health Travel.

First priority, Greece's competitive positioning  in the global medical tourism market, with a specific focus on products and markets. This focus may include out-of-hospital "products" and some in-hospital interventions.

The national strategy should also include the need for international certification and cooperation with international medical organizations and leading medical institutions, with a view to substantially improve the profile of Greek Health Clinics and Hospitals abroad.

Medical tourism could be promoted appropriately in target countries, through state sponsorship and participation in relevant medical tourism conferences, as well as bilateral agreements with foreign insurance funds (publicly for non-EU countries and privately for countries inside and outside the EU).

Another priority is the introduction of modern practices in quality assurance, licensing, and the framework of controls, in particular in out-patient care, including  patient register and procedures.

Applying a credible quality assurance system is a prerequisite for complying with EU directives, improving the perceived quality of Greek clinics, and possibly speeding up / facilitating compensation for cross-border therapies in Greece.

Accordingly, the current restrictive licensing regime for surgical procedures (eg surgical interventions that are allowed only in hospitals with more than 60 beds) could be revised for more flexibility (eg island infrastructures, day surgery centers) and lower costs for procedures that require up to one day of hospitalization.

The third priority should be the specialization of the product offered and the cost reduction through economies of scale in the main treatments and interventions.

The fourth priority in consequence, but not in importance, is to highlight the use of international networks to attract patients.

International examples from leading medical centers suggest that patients can be attracted to specialized treatments by strengthening  partnerships with medical providers and insurance funds in target countries, as well as non-medical partners (eg, specialized tour operators) .

Within the framework of the new national strategy, the aim is to combine the medical product with the required services for health travelers, including, for example, multilingual support, transportation support, accommodation, online testing, joint access in the patient's electronic file by associate doctors, and closer links with the tourism industry (eg, wellness tourism).

The product offered could also include the development of health resorts, in which multiple treatments could be offered to patients individually or in groups, covering the full range of health and wellness services.

Other key factors that can make a decisive contribution and act as multipliers of this national effort to strengthen Greece’s Health Tourism, are:

  • Our natural and cultural heritage
  • Our climate
  • The intense diversification of the natural environment, which satisfies even the most demanding visitor
  • The high popularity of the country as a travel destination
  • The longevity lifestyle and diet  of the Greek countryside
  • The smile and courtesy that characterizes the Greek people philoxenia
  • The modernization of the infrastructure of both the tourist and the private medical sector
  • High-end hotel infrastructures, competitive to those  of other developed tourist countries.

Ladies and gentlemen,

Our commitment to all these initiatives and those that will follow is due to our deep belief that the potential for the development of Health Tourism in Greece is unlimited. Pioneering practices, specialized medical personnel, state-of-the-art facilities and competitive prices,  make Greece as a Health Travel destination competitive in many disciplines, including ophthalmology, IVF, robotic surgery, rehabilitation, dentistry, hemodialysis, aesthetic dermatology the Plastic Surgery.

At the same time, the development of health tourism has created the conditions for the development of a new - and extremely emerging - professional sector, this of a Health Travel co-ordinator. The international Health Traveler  plans his therapy in certified Greek hospitals, while also all the details of his trip to Greece have been supported with care by Health Travel coordinators, people who practice this specialty. Optionally, interpreting and translation services are available, hotel air tickets, transport services, help with all bureaucratic and procedural issues, as well as tourist activities for the patient and / or his / her family members.

All that I just mentioned shows the range of possibilities that Greece has in a period of protracted economic recession. Suffice it to say that on average a medical tourist will spend about EUR 5,000 with his companion while a classic tourist for the same days will spend about EUR 1,500. Athens is the prime destination for Health Tourists, with small exceptions for people wishing to stay on an island in the Cyclades.

Greece, however, has one more advantage in addition to special health care centers and its specialized medical staff. And that has to do with the cost of providing these services.

Typically, when 46% of the world's medical tourism turnover is spent exclusively on dental treatment, in Greece, the cost of these dental work is 20% -30% of the equivalent at the destination of international patients. Estimates also show 60% -90% lower healthcare spending and shorter waiting lists compared to UK, Canada, or the United States. Take into consideration that IVF in Greece costs roughly 3,000-5,000 euros, while in America and Canada it costs about 20,000 euros and in England 8,000 euros. In the field of aesthetic interventions, respectively, a facelift in the US can cost 13,000 euros, while in Greece 3,500 euros.

Allow me, however, to focus on the theme of our Thermal spas. According to data from the Institute of Geological and Mineral Exploration (IGME), there are approximately 750 metallic sources in Greece, ie natural springs (hot, hypothermic or cold) with therapeutic properties, which are mainly due to the trace elements that drag along their rise the depth of the earth. While geologically speaking, Greece could become one of Europe's largest heater centers, its sources are largely untapped, and Thermal tourism remains just a promising dream.

The Association of the Hellenic Thermal Sources (SIPR) has been performing important work over the past two and a half years, helping municipalities and operators of thermal springs with the recognition and licensing process, the economic and technical studies required by the law after the GGD recognition, the financing of the facilities. Additionally, recognizing that Greece is lacking in know-how that will enable entrepreneurs to make the best use of natural healing resources, ICPC has joined the EHTTA to transfer know-how from the European site to the Greek one.

The Hellenic Academy of Medical Medicine aims to promote the therapeutic medicine as a complementary and preventative therapeutic scheme and to promote and develop therapeutic tourism with scientifically documented methods.

In the recent, 3rd Panhellenic Congress of Medical Medicine organized by the Academy in Kamena Vourla, specialized doctors of different specialties presented the complementary therapeutic actions of thermal natural resources in a wide range of diseases - which even reveals the turning of a large part of the medical community towards a more holistic approach to medicine to include alternative forms of treatment. This is certainly a positive sign for the promotion of thermal  medicine in general, which, however, is in itself not sufficient if the advantages of thermal  medicine are not communicated to a wider public (both as a means of treatment and as a means of prevention); in a systematic way. This is the only way to cultivate the culture of Therrmal  healing already existing in other countries. If the domestic tourist is not convinced to use the existing facilities first, neither the private sector will be mobilized to upgrade or create new ones, nor will we finally be able to claim incoming Thermal healing tourism, which is the big deal.

Ladies and gentlemen,

In addition to legislative entanglements and dysfunctions that do not create a favorable regime for the development of initiatives not only from the self-government but also from the business sector, the self-government organizations,  recognizing the importance of Health Tourism, have also borne the burden:

- Improving the infrastructure and services offered in the health sector in general and the Thermal Centers in particular.

-The enrichment of the tourist product of their regions to provide a complete package of services.

-To promote these specific forms of Tourism in markets and interest groups.

At the same time, as Self-Government we call for :

-Financial funding for infrastructure improvement and the emergence of thermal springs and their development in modern spa centers.

-The conclusion of agreements with health systems and insurance funds of mainly European countries. Already, the Hellenic Association of Municipalities’ Thermal Springs has undertaken initiatives through the support of the Embassies of Austria and Germany as well as with the Swedish Insurance Fund.

-Transnational agreements that may be concluded with countries outside the European Union, such as Russia and the Arab countries.

-The synergies and collaborations with international research and specialized medical centers for the exchange of know-how.

Personally, consistent to  my statement and my belief in the usefulness of Health Tourism, as a form of Economy rapidly growing world-wide, I have devoted an important share of my thinking and work along with my counselors and colleagues for the development of this field in Greece.  I believe it, I claim it, I proclaim it. And in every corner of the world , along with all those who support or share this vision,  we are looking for allies and co-operatives.

Ladies and gentlemen,

Creating a strong brand and reputation for Greece as an attractive Health Travel destination is critical to the success of the new strategy. In this direction, we are systematically working both with interventions in the central administration of Greece inside the borders , and with presentations of the capabilities of our country abroad. This is the meaning of standing here today and addressing you Medical Tourism as  ‘A new era Hellenic export’.

Health and Medical tourism has given the opportunity to countries with a completely different profile to become important Health and Medical Destinations. So how can Greece be deprived of its market share that so obviously  deserves?

It takes willingness. Initiatives are needed both in Greece and internationally. And we all want you next to us. To join forces. To achieve our goal. To open channels of communication. To establish partnerships.

Yes, Greece can make it . We deeply believe in that . And I'm sure, you share that belief with us .

Thank you

Giorgos Patoulis

President of Central Union of Greek Municipalities  (KEDE)

President of Athens Medical Association (ISA)

President of  Hellenic Medical Tourism Council (ELITOUR)

President of Global Institute of Greek Doctors

President of  International Health Tourism Center

Mayor of Amarousion (Major Healthcare Services Hub)