TY - JOUR T1 - Factors Shaping Health Tourism Income in Türkiye: A Time Series Study on the Effects of Innovation, Safety and Hygiene TT - Factors Shaping Health Tourism Income in Türkiye: A Time Series Study on the Effects of Innovation, Safety and Hygiene AU - Çapar, Haşim AU - Abiş, Taner PY - 2025 DA - July Y2 - 2025 DO - 10.31201/ijhmt.1664935 JF - International Journal of Health Management and Tourism PB - Dilaver TENGİLİMOĞLU WT - DergiPark SN - 2458-9608 SP - 176 EP - 198 VL - 10 IS - 2 LA - en AB - Aim: The aim of this study is to examine the effects of global innovation index, safety and security level and health and hygiene level on health tourism income. Method: Time series analysis was applied with Türkiye's data for the years 2012-2023. After the stationarity of the series was analyzed with Philips-Perron (PP) unit root tests, short-term and long-term relationship was examined with Johanson Cointegration test. Then, shocks occurring in the short term were calculated by applying Error Correction Model and Impulse-Response Function. Results: While hygiene and health level (HH) positively affected health tourism income (EXP) (P0.05). EXP variable is affected by shocks from GII, HH and SS. Therefore, health tourism income is significantly affected by indicators such as safety and security, innovative developments in tourism, hygiene and health level in the short term. Conclusion: As a result, it is recommended that Türkiye should make continuous efforts towards innovation, hygiene and security elements in order to realize its health tourism potential. The meticulous handling of these elements by stakeholders will strengthen the country's position in the field of health tourism and increase its health tourism income by ensuring that it assumes a more competitive role in the international market. KW - Hygiene KW - Health tourism income KW - Innovation KW - Security KW - Time series analysis KW - Türkiye. N2 - . CR - Afriyie, J., Twumasi-Ankrah, S., Gyamfi, K., Arthur, D., & Pels, W. (2020). Evaluating the Performance of Unit Root Tests in Single Time Series Processes. Mathematics and Statistics, 8, 656–664. https://doi.org/10.13189/ms.2020.080605 CR - Akamavi, R. K., Ibrahim, F., & Swaray, R. (2023). Tourism and Troubles: Effects of Security Threats on the Global Travel and Tourism Industry Performance. Journal of Travel Research, 62(8), 1755–1800. https://doi.org/10.1177/00472875221138792 CR - Albayrak, Ö. K. (2021). Türkiye’nin Demiryolu Yük Taşımacılığı Talebinin Zaman Serisi Analizi ile Tahmini. Erciyes Üniversitesi İktisadi ve İdari Bilimler Fakültesi Dergisi, 58, Article 58. https://doi.org/10.18070/erciyesiibd.753557 CR - Alkier, R., Okicic, J. ve Milojica, V. (2022). Factors of Tourists’ Perceived Safety in the Post Covid Period: The Case of Opatija Riviera. https://doi.org/10.20867/thi.26.13 CR - Ateş, A., ve Sunar, H. (2024). Comparison of Türkiye’s Medical Tourism Market with Existing and Potential Competitor Countries. Toplum Ekonomi ve Yönetim Dergisi, 5(2), Article 2. https://doi.org/10.58702/teyd.1419097 CR - Barratt, A. S., Rich, K. M., Eze, J. I., Porphyre, T., Gunn, G. J. ve Stott, A. W. (2019). Framework for Estimating Indirect Costs in Animal Health Using Time Series Analysis. Frontiers in Veterinary Science, 6. https://doi.org/10.3389/fvets.2019.00190 CR - Baumöhl, E. ve Lyócsa, Š. (2009). Stationarity of time series and the problem of spurious regression. MPRA Paper, Article 27926. https://ideas.repec.org//p/pra/mprapa/27926.html CR - Boguszewicz-Kreft, M., Kuczamer-Kłopotowska, S. ve Kozłowski, A. (2022). The role and importance of perceived risk in medical tourism. Applying the theory of planned behaviour. PLoS ONE, 17(1), e0262137. https://doi.org/10.1371/journal.pone.0262137 CR - Çapar, H. (2018). Medikal turizmde destinasyon seçimini etkileyen faktörler: Yabancı medikal turistlerin Türkiye algısını ölçmeye yönelik bir çalışma [Yüksek Lisans, İstanbul Üniversitesi]. file:///Users/hasimcapar/Downloads/554841%20(6).pdf CR - Çapar, H. (2022). Sürdürülebilir Kalkınma Hedeflerinin Medikal Turizm Üzerindeki Etkisi: Bir Panel Veri Analizi [Doktora Tezi, Sağlık Bilimleri Üniversitesi]. https://tez.yok.gov.tr/UlusalTezMerkezi/tezSorguSonucYeni.jsp CR - Çapar, H., ve Aslan, Ö. (2020). Factors Affecting Destination Choice in Medical Tourism. International Journal of Travel Medicine and Global Health, 8(2), 80–88. https://doi.org/10.34172/ijtmgh.2020.13 CR - Çapar, H., ve İnan, K. (2024). Factors Determining the Impact of Medical Tourism on Sustainable Development Goals: Evidence from Multiple Medical Tourism Stakeholders. Eskişehir Osmangazi Üniversitesi Sosyal Bilimler Dergisi, 25(3), Article 3. https://doi.org/10.17494/ogusbd.1501534 CR - Chandra, R., Supehia, S., Nath, B., Chhetri, C., Kumari, R., Joshi, K. D., Sharma, R., Chaudary, J., Joshi, K., Bhatta, R. ve Bhatt, C. R. (2022). Effects of sanitation and hygiene perceptions on international travelers’ health, travel plans and trip experiences in India. Frontiers in Public Health, 10, 1042880. https://doi.org/10.3389/fpubh.2022.1042880 CR - Chen, L. H. ve Wilson, M. E. (2013). The Globalization of Healthcare: Implications of Medical Tourism for the Infectious Disease Clinician. Clinical Infectious Diseases, 57(12), 1752–1759. https://doi.org/10.1093/cid/cit540 CR - Collins, A., Medhekar, A. ve Şanal, Z. G. (2022). A qualitative analysis of Turkish stakeholders perspective for improving medical tourism. International Journal of Tourism Research, 24(3), 487–500. https://doi.org/10.1002/jtr.2516 CR - Connell, J. (2006). Medical tourism: Sea, sun, sand and … surgery. Tourism Management, 27(6), 1093–1100. https://doi.org/10.1016/j.tourman.2005.11.005 CR - Dünya Ekonomik Forumu. (2021). Travel and Tourism Competeteivenes Report [Dernek]. https://www.weforum.org/search/ CR - Erbayraktar, A., Koc, E. M. ve Pamuk, G. (2022). Evaluation of possible telehealth scenarios in Turkey by family medicine residents in Izmir. | EBSCOhost. 11(1), 280. https://doi.org/10.5455/medscience.2021.11.374 CR - Gür Omay, E. ve Cengiz, E. (2013). Health Tourism in Turkey: Opportunities and Threats. Mediterranean Journal of Social Sciences, 4. https://doi.org/10.5901/mjss.2013.v4n10p424 CR - Godovykh, M., Fyall, A., Pizam, A., & Ridderstaat, J. (2022). Evaluating the Direct and Indirect Impacts of Tourism on the Health of Local Communities. Academica Turistica - Tourism and Innovation Journal, 15(1), 43–52. https://ideas.repec.org//a/prp/jattij/v15y2022i1p43-52.html CR - Han, J., Zuo, Y., Law, R., Chen, S. ve Zhang, M. (2021). Service Quality in Tourism Public Health: Trust, Satisfaction, and Loyalty. Frontiers in Psychology, 12. https://doi.org/10.3389/fpsyg.2021.731279 CR - Heymans, A., Van Heerden, C., Van Greunen, J. ve Van Vuuren, G. (2014). Diligence in determining the appropriate form of stationarity. https://repository.nwu.ac.za/handle/10394/16664 CR - Ivascu, L., Sarfraz, M., Mohsin, M., Naseem, S. ve Ozturk, I. (2021). The Causes of Occupational Accidents and Injuries in Romanian Firms: An Application of the Johansen Cointegration and Granger Causality Test. International Journal of Environmental Research and Public Health, 18(14), Article 14. https://doi.org/10.3390/ijerph18147634 CR - Jovanović, S., Janković–Milić, V. ve Ilić, I. (2015). Health and Hygiene Importance for the Improvement of Tourism Sector Competitiveness in Serbia and the South-eastern Europe Countries. Procedia Economics and Finance, 19, 373–382. https://doi.org/10.1016/S2212-5671(15)00038-6 CR - Karanfil, M. ve Kılıç, C. (2015). Türkiye Ekonomisinde Üçüz Açık Hipotezinin Geçerliliği: Zaman Serisi Analizi. Uluslararası Yönetim İktisat ve İşletme Dergisi, 11(24), Article 24. https://doi.org/10.17130/ijmeb.2015.11.24.823 CR - Khan, N., Gilliar, W., Bamrah, J. S. ve Dave, S. (2023). Post-COVID-19: Can digital solutions lead to a more equitable global healthcare workforce? BJPsych International, 20(1), 18–23. https://doi.org/10.1192/bji.2022.12 CR - Konak, S. (2022). The impact of tourist’s hygiene-safety perception on their intention to travel during the Covid-19 pandemic in Turkey. Journal of Tourism Theory and Research, 8(1), Article 1. https://doi.org/10.24288/jttr.1021221 CR - Kumar, J., Hussian, K. ve Taylor’s University. (2016). Factors affecting medical tourism destination selection: A Malaysian perspective. Journal of Global Business Insights, 1(1), 1–10. https://doi.org/10.5038/2640-6489.1.1.1000 CR - Lee, T. J., Han, J.-S. ve Ko, T.-G. (2020). Health-Oriented Tourists and Sustainable Domestic Tourism. Sustainability, 12(12), Article 12. https://doi.org/10.3390/su12124988 CR - Mataković, H., & Mataković, I. C. (2019). The impact of crime on security in tourism. 27(5). https://doi.org/10.35467/sdq/115539 CR - Onafowora, O. A. ve Owoye, O. (2015). Structural Vector Auto Regression Analysis of the Dynamic Effects of Shocks in Renewable Electricity Generation on Economic Output and Carbon Dioxide Emissions: China, India and Japan. International Journal of Energy Economics and Policy, 5(4), Article 4. CR - Özer, Ö. ve Sonğur, C. (2013). Türkiye’nin Dünya Sağlık Turizmindeki Yeri ve Ekonomik Boyutu. Mehmet Akif Ersoy University Journal of Social Sciences Institute, 4(7), Article 7. CR - Panasiuk, A. (2018). Theoretical aspects of innovation in health Tourism. European Journal of Service Management, 25(1), 213–220. CR - Perron, P. (1989). The Great Crash, the Oil Price Shock, and the Unit Root Hypothesis. Econometrica, 57(6), 1361–1401. https://doi.org/10.2307/1913712 CR - Pirnar, I. A. (2024). Systematic Literature Review of Health Tourism Innovation. https://doi.org/10.25145/j.pasos.2024.22.026 CR - Rasethuntsa, B. (2022). Health and hygiene strategies for tourism promotion: Guidelines for Africa. Journal of Tourism Leisure and Hospitality, 4(2), Article 2. https://doi.org/10.48119/toleho.1088463 CR - Ruiz, S., Viñals, M., Teruel, L. ve Segarra-Oña, M. (2021). Security and Safety as a Key Factor for Smart Tourism Destinations: New Management Challenges in Relation to Health Risks (pp. 511–522). https://doi.org/10.1007/978-3-030-72469-6_34 CR - Ryndach, M., Sergeeva, E., Churilina, I., Chernenok, M., Khismatullina, E. ve Shostak, M. (2024). Innovations in medical tourism. BIO Web of Conferences, 113, 06012. https://doi.org/10.1051/bioconf/202411306012 CR - Santana Gallego, M., Fourie, J. ve Rosselló, J. (2019). The effect of safety and security issues on international tourism. Annals of Tourism Research, 80. https://doi.org/10.1016/j.annals.2019.02.004 CR - Serra, P. V. ve Seabra, C. (2023). Hygiene and Health in Tourism, in a Post-Pandemic Context: From Expected Requirement to Mandatory Criterion. In C. Seabra & M. E. Korstanje (Eds.), Safety and Tourism (pp. 195–215). Emerald Publishing Limited. https://doi.org/10.1108/978-1-80382-811-420231011 CR - Solanki, S., Inumula, K. M. ve Chitnis, A. (2020). Sectoral Contribution to Economic Development in India: A Time-Series Co-Integration Analysis. The Journal of Asian Finance, Economics and Business, 7(9), 191–200. CR - Sosysal, A. (2017). Sağlık Turizmi: Tehdit ve Fırsatlar Bağlamında Türkiye Açısından Bir Durum Değerlendirmesi. Çatalhöyük Uluslararası Turizm ve Sosyal Araştırmalar Dergisi, 2, Article 2. CR - Stoumpos, A. I., Kitsios, F. ve Talias, M. A. (2023). Digital Transformation in Healthcare: Technology Acceptance and Its Applications. International Journal of Environmental Research and Public Health, 20(4), 3407. https://doi.org/10.3390/ijerph20043407 CR - Sultana, S., Haque, A., Momen, A. ve Yasmin, F. (2014). Factors Affecting the Attractiveness of Medical Tourism Destination: An Empirical Study on India- Review Article. Iranian Journal of Public Health, 43(7), 867. CR - Sun, X. (2018). Research on the Model of Cross-Border Medical Tourism Decision-Making under the Background of Globalization. Open Journal of Social Sciences, 6(9), Article 9. https://doi.org/10.4236/jss.2018.69016 CR - Szymańska, E. ve Panfiluk, E. (2020). Determinants of Technological Innovations in Health Tourism Enterprises. Verslas: Teorija Ir Praktika, 21(1), 348–359. CR - The World Intellectual Property Organization (WIPO). (2024). Global Innovation Index [Dernek]. https://www.wipo.int/en/web/global-innovation-index CR - Toker, A., & Emir, O. (2023). Safety and security research in tourism: A bibliometric mapping. European Journal of Tourism Research, 34, 3402–3402. https://doi.org/10.54055/ejtr.v34i.2871 CR - Tontus, H. Ö. ve Nebioglu, S. (2018). Turkey as a Health Tourism Destination: Reviewing of 2015-2016 Data. Journal of Tourism & Hospitality, 7(1), 1–7. https://doi.org/10.4172/2167-0269.1000336 CR - Türkiye İstatistik Kurumu (TÜİK). (2024). Turizm İstatistikleri, III. Çeyrek: Temmuz-Eylül, 2024 [Kamu]. https://data.tuik.gov.tr/Kategori/GetKategori?p=Egitim,-Kultur,-Spor-ve-Turizm-105 CR - Uslu, Y. D., Kedikli, E., Yılmaz, E., Çiçek, A., Karataş, M. ve Aydın, S. (2021). Developing Strategies for Increasing Market Share of Turkey on Health Tourism by Using Fuzzy AHP Method. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi, 10(2), Article 2. https://doi.org/10.37989/gumussagbil.869887 CR - Vellas, P. F. (2011). The Indirect Impact Of Tourism: An Economic Analysis [Kamu]. Tourism Ministers. https://webunwto.s3.amazonaws.com/imported_images/28700/111020-rapport_vellas_en.pdf CR - Vudathaneni, V. K. P., Lanke, R. B., Mudaliyar, M. C., Movva, K. V., Kalluri, L. M. ve Boyapati, R. (2024). The Impact of Telemedicine and Remote Patient Monitoring on Healthcare Delivery: A Comprehensive Evaluation. Cureus, 16(3), e55534. https://doi.org/10.7759/cureus.55534 CR - Yavuz, E. ve Zhalelkanova, N. (2018). İkiz Açık Hipotezinin Ampirik Olarak Test Edilmesi: Johansen Eş-Bütünleşme Analizi. Gümrük ve Ticaret Dergisi, 11, Article 11. UR - https://doi.org/10.31201/ijhmt.1664935 L1 - https://dergipark.org.tr/en/download/article-file/4722656 ER -