1. QUALITY ASPECTS IN EUROPEAN SPAS
SPA IS MORE…
QUALITY ASPECTS IN EUROPEAN SPAS
Janka Zálešáková
MUSZYNA, June 5th, 2009

2. European Spas Association (ESPA) Europäischer Heilbäderverband (EHV) Association Européenne du Thermalisme et du Climatisme (AETC) Asociasión Europea de Estaciones Termales (AEDET)
4/30/20194/30/2019

3. EUROPEAN SPAS – members of ESPA

4. European spas Thermal spas Mineral spas Peloid spas Climatic spas
Spas and spa facilities are in the most European countries the part of a health system
Inseparable part of a health system and the health tourism
Conditions necessary for creation
and existence of a Spa in Europe
Local natural healing source (healing water, healing peloids, healing gases, natural healing sources of sea, climatic conditions suitable for healing, acknowledged natural system of cure – Kneipp, Priesnitz.
High quality environment
Specific and protected spa place
Medical background for rehabilitation and cure, primary and secondary prevention
Thermal spas
Mineral spas
Peloid spas
Climatic spas
Kniepp spas
Radon spas
Priesnitz spas
Tallasso spas ...

5. Main products of European Spas
Relax
Wellness
Weekend Breaks
> Relaxation Stays
Prevention - primary
Regeneration, Detoxification
> Regeneration Spa Stays
Part of health system, in many countries paid by insurence companies
Postacute rehabilitation
Chronic diseases, prevention - secondary
> Medical Spa Stays

6. Medical resorts and wellness - conditions
● License of state authority
● Natural curative sources and traditional treatments recognised by authority
● Strong medical background (high qualified staff, e.g. physicians,
physioterapists, masseurs etc.)
● Implementation of new modern treatments and specialized
services (e.g. diagnostics, laboratory tests, nutrition consulting)
● Medical and preventive packages
● Length of stay (more than two weeks)
Wellness in spa (medical wellness) EUROPE /day spa in some countries (America, Azia)
● Philosophy of wellness is the harmony of body & soul, and good physical condition
● Implementation of new services in direction of beauty, relax and fitness (cosmetic
saloons, aqua parks...)
● Relaxation and short-term packages
● Length of stay (no more than one week)
no licence of state authority for therapies
(e.g. chockolate massage),
no control of staff education
number of hotels

7. Main groups of diseases treated in European spas
diseases of cardiovascular system
disorders of nourishment and metabolism
diseases of the respiratory tract
neurological diseases
psychological problems
diseases of the locomotor apparatus
gynecological diseases
urogenital diseases
skin diseases
recovery after oncologic treatment
indications according natural healing source

8. Common european market in health services
Outboard services (telemedicine, laboratory services, distance diagnosis)
Services abroad (pacient in movement „mobility of pacients“) – SPA TREATMENT
Permanently presence in another member state (holiday destinations)
Mobility of personel (physicians, physioterapeutists, nurses, health workers)
Huge world market of medical services,
NO rehabilitation after high-tech medicine intervention
NEED: HARMONIZED QUALITY CRITERIA

9. Quality in medical spas...
QUALITY - different things for different people
fitness for us – J.M. Juran (1988)
conformance to specifications, meets and fulfill customer standards, customer expectations, customer needs , customer expectations in future needs – Ozeki, Asaka (1990)
I will know (feel) quality, when I see, or compare it.
best of the group bad products - also a reality - quality product ???

10. Definitions of quality
Feed back, customer qustionary
Customer based – fitness for us, meeting customer expectations
Manufactoring based – conforming to design, specification, or requirements → „having no defects“
Product based – the product has something that other similar products do not → adds value
Value based – product is the best combination of price and features
Transcendent – it is not clear what is it, but it is something good
Norms, quality label, law
Marketing, oft products without quality !!!!!!!!
Marketing
Subjective personal tools

11. Health Related Quality of Life –HRQOL index
Physical activity
Physical disability
Psychical disability
Physical and psycical disability of social functions
Pain
Psychical health
Vitality
Perception of own health
Used in Czech Republic for evaluation of spa stay in cooperation of 4 spas and University in Ceske Budejovice

12. EUROPESPA® med
EUROPESPA® med – fulfill of standards for spa therapie, hygiene and safety conditions for clients – 400 test points
EUROPESPA®
→ improvement of services
→ comparison the quality of structure,
products with others
→ more transparency in the market
→ motivation for improvement of
services

13. Potential of medical orientated Spa in future
Common factors influencing spa business:
demographic evolution
trend of health condition (overweight,
hypertension, cancer, cardiovascular
diseases, chronic locomotor system
diseases, depression, drugs...)
health system of the country (financial
condition) financing prevention
health education of inhabitants (healthy
holidays, healthy nourishment, physical activity)
QUALITY OF ALL SPA SERVICES – spa medicine,
gastronomy, structure of spa place, spa
environment, no pollution ...
Evidence based medicine – need also for spa medicine
Lack of grants for this field of medicine in Europe

14. Demographic trends in Europe
Europe is the continent with the lowest fertility
patterns (e.g. France 1,89. Spain 1. 22)
Increase of Life expectancy → significant aging
old age ratio (number of eldery as percentage
of young peopl)
∟decline of labour force
∟rising expenses of health services
∟ rehabilitation will be more important
component of health care
Very important is disability free life expectansy
Reha in Spa

15. Changes in Lifestyle PREVENTION IN SPA Smoking
∟ Cardiovascular diseases
∟ Cancer
∟ Respiratory diseases
Nutrition (lack of fruits and vegetables, excess of
fat and sugar in fast food)
∟ Overweight and obesity (risk for cancer, DM, CDV)
Lack of physical activity
∟ OA, OP, CVD
∟ Obesity
Stress, psyco-social determinants
Alcohol harmful abusus, and other drugs
PREVENTION IN SPA

16. Leading causes of mortality and morbidity in EU
Morbidity (chronic) non communicable
Ischemic heart and cerebrovascular diseases
Cancer
Osteoartrosis and osteoporosis
Asthma and other allergic diseases
Chronic obstructive pulmonary diseases
Diabetes mellitus
Obesity
Hepatic cirrhosis and other chronic liver diseases
Mental diseases and disorders
Mortality
cardiovascular diseases 41 % (max. Estonia,
Lithuania, min. France, Portugal)
cancer 25 %
suicide 12 %

17. Target of prevention in Spas
Healthy nutrition → prevention of cancer, cardiovascular diseases, DM, obesity
Physical activity → prevention of cancer, cardiovascular diseases, osteoporosis, OA, obesity
No smoking →prevention of certain types of cancer, cardiovascular diseases
No drugs → prevention mental and physical
disorders
Lack of stress → prevention of depression
Positive thinking → stimulation of all body systems
NEW QUALITY OF LIFE STYLE
SPA STAY

18. Future of European Spas linked with health needs
„Europa needs not only consumers but healthy inhabitans too. Population of Europe die because of diseases connected with unhealthy nutrition, lack of excercises, tabacism and other drugs“ - (former EU commisioner M. Kyprianou)
Preventive programmes directed at changing of life style and as a prevention of common diseases – aim for Europe and Spas
Old age of European women(increased number of seniors) – programmes directed at keeping the quality of life in old age
Classic spa treatment mainly for diseases of locomotory apparatus, psychiatric diseases - depresive stage, cardiovascular diseases
Wellness programmes with medical background for healthy women

19. Research and investigation of spa services/evidence based spa medicine
Balneological Research Institute
Universities and High schools with
pregradual and postgradual education in field
balneology
Insurance companies – studies on economical
benefits of spa treatment
Spa facilities – objectification of own health
products and own natural healing sources
Professional associations (Kneippverband,
ESPA ?)
Tourist research institutions (ETI in Trier)
In comparison with other medical fields less money (no interest of pharmaceutical companies)
In future existence of spa health resorts with medical background without research and investigation is endanger
NEED OF EUROPEAN REASERCH BALNEOLOGICAL INSTITUTE

20. THANK YOU FOR YOUR ATTENTION