Health tourism on the rise? Evidence from the Balance of Payments Statistics

International tourism, social distribution, and environmental Kuznets curve: evidence from a panel of G-7 countries

The study examined the long-run and causal relationship between international tourism receipts (ITR), social distribution, FDI inflows, and carbon (CO2) emissions to verify the different alternative and plausible hypotheses, i.e., environmental Kuznets curve (EKC) hypothesis, "pollution haven" hypothesis (PHH), and "resource efficiency" (REF) hypothesis, in a panel of Group of Seven (G-7) countries for the period of 1995-2015. The study employed panel random effect (RE) regression and panel causality test for robust inferences. The results show that ITR and FDI inflows increase CO2 emissions to verify PHH while government education expenditures (GEE) decrease CO2 emissions to substantiate the REF hypothesis across countries. The results validate the inverted U-shaped EKC relationship between CO2 emissions and economic growth (EG) with the turning point of US$30,900. In addition, GEE increase ITR while healthcare expenditures (HEXP) decrease ITR, which partially supported the REF hypothesis in a panel of countries. The impact of income inequality (INEQ) on ITR is positive at current time period while at later stages INEQ declines ITR that supported an inverted U-shaped relationship between them. The causality estimates confirm the bidirectional relationship between ITR and EG, while there is unidirectional casualty running from (i) ITR, EG, FDI inflows, and GEE to CO2 emissions, (ii) FDI inflows to ITR, (iii) GEE to EG, (iv) EG to social expenditures, (v) income inequality to health expenditures, (vi) social expenditures (SEXP) to ITR, and (vii) INEQ to ITR. There is no causal relationship found between ITR and EG during the study time period. The findings endorse the need for efficient resource spending, sustainable tourism (STR), and rational income distribution to improve environmental sustainability agenda in a panel of G-7 countries.

Trends and structural shifts in health tourism: evidence from seasonal time-series data on health-related travel spending by Canada during 1970-2010

There has been a growing interest in better understanding the trends and determinants of health tourism activities. While much of the expanding literature on health tourism offers theoretical or qualitative discussion, empirical evidences has been lacking. This study employs Canada's outbound health tourism activities as an example to examine the trends in health tourism and its association with changing domestic health care market characteristics. A time-series model that accounts for potential structural changes in the trend is employed to analyze the quarterly health-related travel spending series reported in the Balance of Payments Statistics (BOPS) during 1970-2010 (n = 156). We identified a structural shift point which marks the start of an accelerated growth of health tourism and a flattened seasonality in such activities. We found that the health tourism activities of Canadian consumers increase when the private investment in medical facilities declines or when the private MPI increases during the years following the structural-change. We discussed the possible linkage of the structural shift to the General Agreement on Trade in Services (GATS), which went into effect in January, 1995.