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Development of Bulgaria as a sustainable health tourism destination and application of good practices in the field of medical spa, spa and wellness tourism in the times of the СOVID-19 pandemic

Siyka Katsarova


Introduction: Health tourism is an emerging, global, complex, and rapidly changing segment that needs to be managed with modern management tools in the present era. Health tourism comprises around 5% of general tourism in the EU28 and contributes approximately 0.3% to the EU economy. Health tourism has a much higher domestic share than general tourism. Increasing the share of health tourism may reduce tourism seasonality, improve sustainability and labor quality, and may help to reduce health costs through prevention measures and decreased pharmaceutical consumption (research for TRAN Committee—Health Tourism in the EU. General Investigation, June 2017). Health tourism is increasing its role as a significant contributor to the development not only of regional but also of national economies. Despite certain tendencies of preferring individual tourism, it is expected that health tourism and health tourism destinations will continue to increase their influence and take bigger part in the tourism mix in the future. In the National Strategy for Sustainable Development of the Tourism on the Territory of Bulgaria, 2014–2030, the Ministry of Tourism has determined that tourism is a leading structuring national industry. Tourism is a stable factor contributing to the constant optimization of the Bulgarian economy through significant share in the GDP—12–18%. The strategic aim of Bulgaria is: increasing the competitiveness of Bulgaria as a destination on the world market by increasing the quality of the tourism product, strong brand of the destination and product specialization and diversification. One of the main priority of the Ministry of the Tourism is increasing the share of the specialized types of tourism, leading to a year-round and more intensive workload: balneotherapy (medical spa), spa and wellness.

Aim: The authors believe that Europe needs to consider the important role of tourism for health prevention and inform as great number as possible of its citizens and visitors about self-responsibility and health prevention combined with using natural remedies based on mineral water, landscape and climate, and counteract bad health habits. To promote spa medicine as a curative and preventive approach using natural remedies, rehabilitation techniques and education in healthy lifestyle (ESPA) are needed.
This article aims to present: 1) the important role of the health tourism (medical spa, spa and wellness tourism), and the fact it that can limit both the negative effects of pollution by engaging in tourism in natural areas and at the same time meet the demanding needs of the aging society to maintain good health for as long as possible; 2) to show the position of balneotherapy in the healthcare system in the leading European countries and the place of Bulgaria in it; 3) the role of balneology and its benefit for people in the times of COVID-19.

Materials and Methods: Written documentation, researches, and reports from leading public sources are used, as well as personal experience from being deeply involved in the field of the European health tourism.
Results: Bulgaria has developed a sustainable year-round health tourism focused on the medical spa, spa and wellness product. The global COVID-19 pandemic has dramatically changed not only the tourism sector, but also people’s attitude to travel—a historic time for revival and recognition of balneology and climatic health resorts.

Conclusion: Health tourism could be linked to and described as green tourism: from the environmental point of view, sustainability means minimizing any damage to the environment (flora, fauna, water, soils, energy use contamination, etc.), while trying to value the environment in a positive way through protection and conservation.
The current coronavirus pandemic has established more clearly than ever the indisputable role of balneology as a long-term guardian of the human immune system, with fundamental consequences for saving lives and preventing economic collapse in future pandemics.


health tourism, medical spa, spa& wellness tourism, balneotherapy, COVID-19, TRAN Committee EU, European Spa Association (ESPA), World Tourism Organization (UNWTO), European Travel Commission (ETC), Bulgarian Union of Balneology and Spa Tourism (BUBSPA),

Full Text


Ангелова Т., Кацарова С. Балнеолечението в основата на управлението на превенцията и профилактиката на хроничните заболявания, Списание по физикална медицина, рехабилитация, здраве, година ХIX, бр. 3 - 4, 2020 г., ISSN – 1312-0417

European Spa Association;,

European Spa Association, Epidemiological Survey, medical research,ESPA, 2018.

Kostadinov, D., L.Tsvetkova, L.Karakolev, Bulgarian Resorts, Sofia, 1976

Kostadinova Т., Katsarova S. The importance of the European health tourism for the development of economy of wellbeing, 4th International Thematic Monograph: Modern Management Tools and Economy of Tourism Sector in Present Era, 2019 pp.527-539 DOI:

Ministry of Tourism – Bulgaria,

National strategy for sustainable development of the tourism on the territory of Bulgaria (2014-2030)”, Ministry of Tourism –Bulgaria.

Research for TRAN Committee –Health Tourism in the EU – General Investigation. Study 2017” , Policy Department for Structural and Cohesion Policies, European Parliament/ authors: NHTV Breda University of Applied Sciences: Tomas Mainil, Eke Eijgelaar, Jeroen Klijs, Jeroen, Nawijn, Paul Peeters, Acknowledgements: We would like to thank Prof. Dr. Olaf Timmermans, University of Antwerp, Belgium, and Dr. Sabina Stan, Dublin City University, Ireland

World Tourism Organization (UNWTO) and European Travel Commission, “Exploring the Health Tourism”


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