Health Tourism and Medical Treatment two parts in Health Resorts

Health Tourism and Medical Treatment two parts in Health Resorts
20/04/2017 Health Tourism and Medical Treatment two parts in Health Resorts Ladies and Gentlemen! On behalf of the International Society of Medical Hydrology and Climatology, I am greeting most heartily the Argentinean colleagues, all guests of this international panel, and friends. Many thanks to the Organizers, for the invitation to visit your country and to speak about some basic problems in the Health Resort Medicine and Spa Treatments, in the treatment of chronic disorders and diseases, preventive strategies, and rehabilitation programs. I would like to speak to you as the president of the world organisation of Health Resort Medicine and Spa Treatments, the International Society of Medical Hydrology and Climatology, the I.S.M.H., and I would like to speak to you as a German, coming from old Europe with a long tradition in Health Resorts and Spas and traditional and natural medicine. I’ll present and describe the scope of the International Society of Medical Hydrology and Climatology as related to prevention, treatment, and rehabilitation. And, I’ll address to the future global issues of spas and health resorts to avoid the need for expensive old age care. The European Health Resorts and Spas and the new guise of American Public’s Health promote two different ways to prevent diseases and to get general health. We have the same goal but we use different natural agents and remedies: Europe with the traditional use of mineral water (somebody calls it holy water) in special centres, the health Resorts and the American’s wellness and fitness centres. The connecting link between these two ways of health is the natural reaction, the stimulation of endogenous power, training of human healthy functions and adaptation to disadvantageous environments. Let’s come together, find new and popularly acceptable systems of health care. Professor Dr. med. habil. Dr. rer. nat. Helmut G. Pratzel President of the International Society of Medical Hydrology and Climatology (I.S.M.H.) Argentinien 2001

Health Resorts ? Which kind of principles are included?
Health Tourism and Medical Treatment 20/04/2017 Health Resorts ? Which kind of principles are included? We are talking about Health Resorts. What is that? Health Resort includes all types like Spas, Balnearios, Wellnes Centres where are used the same principles ore strategies by different equipments. It is the method of stimulation and training to stabilize the organism. Centres using methods to re-activate self-healing power by Salugenetic and hygiogenetic concepts of treatment, Personally patient-oriented concepts, Use of endogenous power stimulation and stabilizing forms of treatment, Activation of the patient's own responsibility for his health, Use of a pleasant and culturally encouraging environment close to nature to stimulate the therapeutic acceptance. Balneology or Medical Hydrology and Climatology are traditional sciences of the remedies of earth, water, and climate. Balneotherapy is performed as a complex cure measure together with other comprehensive therapy methods of the physical medicine, using these remedies for bathing, drinking and inhaling by influence of climatotherapeutic factors. Health Resort Medicine and Spa Treatments are the modern balneology. Centres using methods to re-activate self-healing power by Salugenetic and hygiogenetic concepts of treatment Personally patient-oriented concepts Use of endogenous power stimulation and stabilizing forms of treatment Activation of the patient's own responsibility for his health Use of a pleasant and culturally encouraging environment close to nature to stimulate the therapeutic acceptance. Health Resorts ? Argentinien 2001

Therapeutic Principles
Health Tourism and Medical Treatment 20/04/2017 Therapeutic Principles stimulatio Naturopathic, reactivate of self healing power substitutio Substitution for metabolic malfunctions directio Pharmacotherapy excludio Surgery Therapeutic principles in medicine are different. Stimulatio: Naturopathic, reactivate of self healing power Substitutio: Substitution to correct metabolic malfunctions Directio: Pharmacotherapy Excludio: Surgery The tradition of the Health Resorts and Spas is complex; in addition to the medical field, it has also been determined by intellectual and cultural history, economy, philosophy and sociology. Balneotherapy has been in existence for many millennia. Even today, we can see how balneotherapy is practised by the population as self-medication, especially in many parts of the world where natural remedies and therapies, in particular the water of mineral springs, high rank within folk medicine. In the course of long developments, the theoretical fundamentals and the concepts of Health Resort Medicine have changed. For a long time, substance and message of balneotherapy, as a branch of practised medicine, were based on "experience" rather than on scientifically recognized clinical evaluation and basic research. First of all, it was the experience of the patient and then the scientific experience of the physician who attended to these naturopathies much later. Even Fortescue Fox, the founder of the I.S.M.H., had this experience as a patient. He was able to treat himself of a tuberculosis at the sulphur spa of Strathpeffer in the north of Scotland. hygiogenetic oriented „self healing" } pathogenetic oriented „artificial healing" Argentinien 2001

Types of Health Resorts
Health Tourism and Medical Treatment 20/04/2017 Types of Health Resorts Spas using natural spring water or natural peloids Wellness centres using equipments for pleasure and fun Climatic centres using healthy climate in the mountains Thalasso centres using the natural remedies of the sea Kneipp centres using the 5 columns of “Sebastian Kneipp” The equipments in health resorts are different. We have Spas using natural spring water or natural peloids, Wellness centres using equipments for pleasure and fun, Climatic centres using healthy climate in the mountains, Thalasso centres using the natural remedies of the sea, Kneipp centres using the 5 columns of “Sebastian Kneipp”, and may be some others too. Argentinien 2001

Water as an elixir of life
Health Tourism and Medical Treatment 20/04/2017 Water as an elixir of life cleanse refresh give pleasure enjoy take healthy compose palliative effect healing effect Dietetic baths Medical baths Water is the main part of health resorts. It could be spring water to use in balneotherapy or other water in hydrotherapy. The dietetic baths are connected with the words cleanse, refresh, give pleasure, enjoy. The medical baths take healthy, compose, have palliative and healing effects. Argentinien 2001

Water is good for treatment and for health
Health Tourism and Medical Treatment 20/04/2017 Water is good for treatment and for health It can be used in prevention (Dietetic) By drinking as food By bathing as cosmetic It can be used in medical treatment By bathing about its physical and pharmacological effects mediated by the skin By drinking about its stimulating effect to the inner organs By inhaling about its effect on the respiratory systems Water can be a medicament or is used for health. In case of healthy water we talking about the dietetic application for drinking and for bathing in hygiene. It is both a food and a cosmetic. The healing power of water is used in Balneology as mineral water and in Hydrotherapy water without minerals based on the experiences of Priesnitz and Sebastian Kneipp. Argentinien 2001

Water is the most used medicament
Health Tourism and Medical Treatment 20/04/2017 Water is the most used medicament Water is the most used medicament Everybody is using it. Everybody believes its effectiveness. The medical experience is bigger than in any other drug. The private share in costs is higher than in any other medicament. It is the cheapest medicament. No other medicament was described so many times by artists than water. Everybody is using it. Everybody believes its effectiveness. The medical experience is bigger than in any other drug. The private share in costs is higher than in any other medicament. It is the cheapest medicament. No other medicament was described so many times by artists than water. Argentinien 2001

Health Tourism and Medical Treatment
20/04/2017 Effect by immersion Air bath Half bath Full bath The main effect of water without minerals is the effect of immersion. If the body is diving into the water, blood is pressed into the thorax from the lower part of the body. It can be about 1 litre of blood. The heart becomes bigger and has to work more to avoid hypertension. Many endocrinological metabolic functions result from this primary effect. It is a strong stimulation of all systems of life. Somebody says this reaction alone give an explanation of all balneologic effects without any influence of the mineral composition. But I think we have more effects by use of mineral water. About 1000 ml of blood flows into the thorax Argentinien 2001

Effect of cold bath on Epinephrine nach Bühring
Health Tourism and Medical Treatment 20/04/2017 Effect of cold bath on Epinephrine nach Bühring An other effect can be shown by change of temperature. This picture shows the increase of Epinephrine by bathing in cold water. Body temperature 2 4 6 n g / l 1 5 3 , 7 o C 1 5 o C E r w ä m u n g b i s t e R k a l p Water temperature Epinephrine Nephrine 1 2 3 4 5 6 7 m i n . Before Argentinien 2001

20/04/2017 Effect of cold bathing Cold water can be used for thermal Stimulation and for Training of blood flow regulation. This is effective in treatment of Functional disturbance of blood flow, Phlebopathy, and Cardio vascular diseases. Cold water can be used for thermal Stimulation for Training of inurity and helps for Infect prophylaxis Cold water is mainly used in Hydrotherapy by Sebastian Kneipp. You can find a lot of different strategies in application of cold water. Thermic Stimuli for Training of regulation of blood flow Functional disturbance of blood flow Phlebopathy Cardio vascular diseases Thermic Stimuli for Training of inurity Infect prophylaxis Argentinien 2001

Effect of changing cold-hot bathing
Health Tourism and Medical Treatment 20/04/2017 Effect of changing cold-hot bathing By changing of cold and warm water other treatment effects could be found. This method can be used as thermal stimulation for training of vegetative-hormonal Functions like Convalescence Psycho-vegetative Syndrome Cardio vascular regulation disturbance Metabolic disturbance Thermic Stimuli for Training of vegetative-hormonal Functions Convalescence Psycho-vegetative Syndrome Cardio vascular regulation disturbance Metabolic disturbance Argentinien 2001

Effect of hot bath on blood circulation by Barcroft
Health Tourism and Medical Treatment 20/04/2017 Effect of hot bath on blood circulation by Barcroft 8 6 4 1 % Blood circulation in muscles By use of hot water the blood circulation in the muscles decrease. The blood flows into the peripheral vessels. Red colour of the skin is the result. But after hot bathing the effect is contrary. This is a stimulation of the vessels in training the thermoregulation. 4 5 3 2 o C Water temperature 1 2 3 4 5 6 7 8 9 m i n . Argentinien 2001

20/04/2017 Effect of hot bathing Muscle relaxation Increase of extensibility the structures of connective tissue Analgesic Anti Inflammatory by Overheating Rheumatic diseases chronic-inflammatory diseases of the urogenital system Post acute after trauma conditions and operations on locomotor system Hot bathing can be used in Muscle relaxation, Increase of extensibility the structures of connective tissue, It is analgesic, and Anti Inflammatory by Overheating for treatment of Rheumatic diseases, chronic-inflammatory diseases of the urogenital system, and Post acute after trauma conditions and operations on locomotor system. Argentinien 2001

20/04/2017 Chemical bath effects The main chemical effects by use of different minerals in water are Activation of endogenous inflammatory resistance, Decrease of increased pain sensitivity, and Normalisation of blood pressure Activation of endogenous inflammatory resistance Decrease of increased pain sensitivity Normalisation of blood pressure Argentinien 2001

20/04/2017 Rheuma baths In rheumatology Sulphur and Radon can be used to decrease pain sensitivity. Brine or Sea water is used in kinesitherapy. Peloids are used in thermo therapy. Sulphur Radon Brine Peloids Argentinien 2001

20/04/2017 Skin baths Oak bark Camomile, yarrow Shave grass Plant oils Sulphur Skin diseases are treated in case of the special situation by herbals. Sulphur is used to treat atopic dermatitis. Argentinien 2001

Permeability of skin for solutions in water
Health Tourism and Medical Treatment 20/04/2017 Permeability of skin for solutions in water µl solution/cm2/h 1000 The low absorption rate of minerals through the skin is the main problem in use of mineral water in bath therapy. The permeability of the skin is very low. Only gases like Radon, H2S and CO2 are effective. The other minerals cannot pass the skin and they have only osmotic effects. But permeation into the skin could be important, if the normal amount of such a substance in skin is low and could be increases by bathing. Especially if the skin is damaged by skin diseases or by extremely use of washing procedures the permeation of minerals into the skin could change the metabolic situation in the skin. Important may be Magnesium, Zinc and Selen. H2S Radon CO2 100 Octanol Heptanol Methylsalicylat Camphen 10 Phenylmercuryborate Estron Water Campher 1 Propanol Progesteron Ethanol Water Methanol Testosteron DMSO 0,1 Acetylsalicylic acid Sodium Ferrum II Strontium Heparin Potassium Arsenic Sulfate Corticosteron Chloride Bromide Jodide Indomethacine 0,01 Calcium Pertechnetate Caesium Cobalt Salicylic acid Cortison Cadmium Silver Hydrocortison 0,001 Ferrum III Chromium III 0,0001 Selenite Argentinien 2001

Diseases of the locomotoric system
Health Tourism and Medical Treatment 20/04/2017 Diseases of the locomotoric system The following treatments are effective: Sulphur baths, this is the smelling form of suphur (only in bath tubs or showers), Radon baths, this is the emanation of Radium (only in bath tubs or in gas containers), Brine baths, this is high concentrated salty water, Carbon dioxide baths, without inhaling (only bath tubs or in gas containers), Hot water baths, with artificial heat or natural heat of Thermal water. The following treatments are effective: Sulphur baths (only in bath tubs or showers) Radon baths (only in bath tubs or in gas containers) Brine baths Carbon dioxide baths (only bath tubs or in gas containers) Hot water baths Argentinien 2001

Therapeutic use of Sulphur Baths in rheumatology
Health Tourism and Medical Treatment 20/04/2017 Therapeutic use of Sulphur Baths in rheumatology Sulphur can be used in treatment of Degenerative diseases of joints Extra articular rheumatism Rheumatoid arthritis Post traumatic lesions Postoperative therapies Degenerative diseases of joints Extra articular rheumatism Rheumatoid arthritis Post traumatic lesions Postoperative therapies Argentinien 2001

Therapeutic use of Radon baths
Health Tourism and Medical Treatment 20/04/2017 Therapeutic use of Radon baths Radon can be used in treatment of Rheumatoid Arthritis (not acute stadium) Ankylosing spondylitis Treatment of pain by Radiculitis, Neuritis, Neuralgia Hypertension Stadium I und II WHO Sklerodermie Osteoporosis Rheumatoid Arthritis (not acute stadium) Ankylosing spondylitis Treatment of pain by Radiculitis, Neuritis, Neuralgia Hypertension Stadium I und II WHO Sklerodermie Osteoporosis Argentinien 2001

Therapeutic use of Carbon Dioxide baths
Health Tourism and Medical Treatment 20/04/2017 Therapeutic use of Carbon Dioxide baths Disturbance of micro circulation in the skin Trophic Ulcera of the skin, venues Ulcera Decubitus Peripheral arterial occlusive disease in any stadium Functional arterial disturbance of vascularity Carbon dioxide can be used in treatment of Disturbance of micro circulation in the skin Trophic Ulcera of the skin, venues Ulcera Decubitus Peripheral arterial occlusive disease in any stadium Functional arterial disturbance of vascularity Argentinien 2001

General rules for effective bathing
Health Tourism and Medical Treatment 20/04/2017 General rules for effective bathing Chemical effects of water can be used only in bath tubs No disinfection Concentration in bath tub H2S > 10 mg/l Radon > 1 kBq/l CO2 > 1 g/l Brine g/l (in case of indication) Physical effects of water can be uses in pools With disinfections (chemical substances are destroyed Temperature >30 °C (in case of application) The minimal concentration is important for effectiveness. In pools the gases are lost or destroys by disinfections. It is a difference in the effectiveness in bath tubs and pools. Chemical effects of water can be used only in bath tubs No disinfection is needed Concentration in bath tub has to be H2S > 10 mg/l Radon > 1 kBq/l CO2 > 1 g/l Brine g/l (in case of indication) . Physical effects of water can be used in pools With disinfections (chemical substances are destroyed) Temperature >30 °C (in case of application). Argentinien 2001

Basic Infrastructures of Health Resorts (I)
Health Tourism and Medical Treatment 20/04/2017 Basic Infrastructures of Health Resorts (I) Natural resources and remedies certificated for treatment High quality standard of air and healthy climate Resort with special equipment depending on indications for bathing, drinking, inhaling, gymnastics and physical therapy Favourable therapeutic environment with parks and walking areas Areas for fitness, sports, and relaxing Specialized physicians and medical teams Today, Health Resort Medicine and Spa Treatments in Europe are being of high quality standards, the application of natural remedies as "soft" medicine without side effects having considerably increased the health resort patient's own responsibility for their health. Health Resorts and Spas are certificated and their quality are continuously supervised by the government. Basic infrastructures of Health Resorts are Natural resources and remedies certificated for treatment High quality standard of air and healthy climate Resort with special equipment depending on indications for bathing, drinking, inhaling, gymnastics and physical therapy Favourable therapeutic environment with parks and walking areas Areas for fitness, sports, and relaxing Specialized physicians and medical teams Argentinien 2001

Basic Infrastructures of Health Resorts (II)
Health Tourism and Medical Treatment 20/04/2017 Basic Infrastructures of Health Resorts (II) Special hotels or pensions with dietetic measures and maintenance for patients Cultural events Health education centre Health promoting urbanisation Equipment of medical care and first aid High quality standard of hygienic equipment Special hotels or pensions with dietetic measures and maintenance for patients Cultural evemts Health education centre Health promoting urbanisation Equipment of medical care and first aid High quality standard of hygienic equipment Balneotherapy, dietetics, order therapy, motivation for a healthy way of life and many other naturopathies under the guidance of experienced and well qualified medical experts in a pleasant environment which is accepted by the patient, close to nature and culturally encouraging are the main contents of modern Health Resort Medicine and Spa Treatments. We call this type of treatment in Germany "Kur". It is an important part of the health policy sector of prevention, rehabilitation medicine and public health. Argentinien 2001

"Kur" and Rehabilitation (Definitions)
Health Tourism and Medical Treatment 20/04/2017 "Kur" and Rehabilitation (Definitions) "Kur" (cure of treatment, course) is a special type of medical treatment in Health Resorts with natural remedies during a period of 3-6 weeks. It mainly use the reactivation of self-healing powers by stimulation and training by minimize the use of drugs. Prevention or Rehabilitation are the goal of treatment. "Kur" (cure of treatment, course) is a special type of medical treatment in Health Resorts with natural remedies during a period of 3-6 weeks. It mainly use the reactivation of self-healing powers by stimulation and training by minimize the use of drugs. Prevention or Rehabilitation are the goal of treatment. . Argentinien 2001

Two Functions of Health Resorts and Spas
Health Tourism and Medical Treatment 20/04/2017 Two Functions of Health Resorts and Spas Health Resorts are centres in treatment of chronicle diseases and to realize preventive and rehabilitative goals. Health Resorts are centres to get health in healthful vacations. Besides health education encouragement and motivation for schools, businesses, and communities, Health Resorts offer ideal locations and conditions for teaching patients how to learn to live with their own long standing disorders and individual needs. Numerous Health Resort personnel have successfully worked with specific patient groups by using group dynamics and by teach to impart diseases and to avoid risks. Future health care policy will need to address expenditure containment measures and issues of prevention and rehabilitation as they relate to the health care needs of our ageing populations. The combination of individual and institutional financed health care insurance programs will allow more Health Resort and Spa patients and visitors to conduct useful and healthful vacations. This is a right goal for future development within the field of Health Resort Medicine. Argentinien 2001

Importance of Health Resorts and Spas
Health Tourism and Medical Treatment 20/04/2017 Importance of Health Resorts and Spas Therapeutic use of classical forms of prevention and rehabilitation. They provide economic incentives for regional health care industries and tourist markets. They serve as healthy ecological location for environmental protection and appreciation. In terms of the Public Health, the importance of Health Resorts is characterized by three factors: (1) Therapeutic use of classical forms of prevention and rehabilitation. (2) They provide economic incentives for regional health care industries and tourist markets (3) They serve as healthy ecological locations for environmental protection and appreciation. Argentinien 2001

Integration of Spas and Health Resorts in the Health Care System
Health Tourism and Medical Treatment 20/04/2017 Integration of Spas and Health Resorts in the Health Care System Out-patient treatment by the Family Physicians In-patient treatment of special acute diseases in Hospitals In-patient or out-patient rehabilitation mainly in Spas and Health Resorts of chronic diseases of acute diseases, stroke, street accidents a. o. after treatment in special hospitals In-patient or out-patient prevention in Spas and Health Resorts Spas and Health Resorts are integrated in the Health Care System by out-patient and in-patient treatments mainly in prevention and rehabilitation programs. Argentinien 2001

Situación y competencia térapéutica
Health Tourism and Medical Treatment 20/04/2017 Situación y competencia térapéutica Vacaciones de salud en spa Sano Agotado Enfermedades crónicas Enfermedades agudas Caso de emergencia en spa Tra-tamiento Médico de familia Hospital Argentinien 2001

20/04/2017 Course of Treatment depending on impairment, malfunctions, disability or handicap Out-patient treatment course (Patients stay in Pensions or "Kur"-Hotels) In-patient treatment course (Patients stay in Sanatoriums or Rehabilitation Clinics) Depending on the degree of the malfunction out-patient and in-patient treatments are used by different types of hospitalization. Out-patient treatment is cheaper. Argentinien 2001

European Spas and Health Resorts
Health Tourism and Medical Treatment 20/04/2017 European Spas and Health Resorts In 1994 a European inquiry in 18 states was done about the question, if Health Resort and Spa Treatments are absolutely necessary in treatment of rheumatic diseases. The result was that 17 rheumatological societies said „yes“ and one society gave no answer. This table shows nearly all 1700 Spas and Health Resorts in Europe. Argentinien 2001

German Spa and Health Resort Industry
Health Tourism and Medical Treatment 20/04/2017 German Spa and Health Resort Industry 329 Health Resorts and Spas annual increment value million $ Work force persons (=$ per person) 118 million overnights 1993 in beds (=44,5%) 9.8 million visitors 1993 (=12 days per visitor) 8.2 million patients privately financed (=83,6%) 1.6 million patients social financed (=16,4%) For the 80 million Germans there are 329 Health Resorts and Spas with a work force of persons. The annual increment value (growth rate) for the German Health Resort and Spa Industry is about 13.3 thousand million Dollars. This is more than the annual increment value (growth rate) of the German auto industry. In 1993 visitors to German Health Resorts and Spas accounted for over 118 million overnights. This is about 40 % of the total overnights for all of German tourism. Argentinien 2001

20/04/2017 German Spa Statistics 1993 This is the detailed statistic separately for East- and West Germany. Argentinien 2001

Costs of Treatment in Spas and Health Resorts
Health Tourism and Medical Treatment 20/04/2017 Costs of Treatment in Spas and Health Resorts Out-patient treatment $2000 during 3 weeks insurance pays $10 per night and 90% of treatment costs In-patient treatment $2500 during 3 weeks patients pay about $10 per day Health Resort Medicine is accepted by the patient more than treatments by drugs. Therefore, the visitors at a health resort pay a large portion of the health costs themselves thus relieves the community. 83,6 % (8.2 million) visitors in 1993 privately financed their own treatments. German health insurances pay 10$ per night and 90 % of the costs of out-patient spa treatments. So everybody has to pay about 2000$ by him selves during 3 weeks treatment. The in-patient rehabilitation costs at German Health Resorts and Spas are similar to those of German hospitals; the patients pay a portion (about 10$ per day). The Patients will pay for his health if he can hope that nobody makes an unfair profit by his misfortune. This is the reason, why patients visit physicians in spas, especially in the eastern part of Europe. There the physicians spend enough time to give a personal oriented speaking medicine meaning talking to the patient and the treatment in these countries is cheaper. Argentinien 2001

Public Health the goal of present-day Health Resort Medicine
Health Tourism and Medical Treatment 20/04/2017 Public Health the goal of present-day Health Resort Medicine Prevention is better than Therapy Learning to Live Healthfully After the 2nd global war a change can be seen in the frequency of diseases from infective diseases to those of civilisation. These are especially metabolic diseases, rheumatic diseases, diseases of the circulatory system, malignant tumours, and allergic diseases. False human behaviour is often the reason of death like stroke, street accident, cancer of lungs, bronchitis, and cirrhosis of the liver. These diseases have a long pre-period without any pain. If the patient feels any symptoms and consults the doctor it is often too late. In these cases the school medicine in the present form is overcharged, because mainly of the curative and not preventive orientation. Final progress comes from the orientation of the social medicine contrary to the risks and tradition of the school medicine’s treatment of established malfunctions. But in some cases it is wrong to avoid the risks factors. I believe, if we try to fight risks by withholding everybody from every possible situation, we will realize the contrary, we will cultivate malfunctions. The only positive way is to activate and to maintain in training the human organism and the human soul to be always in the situation to win the fight with the life threatening environment. Dr. Hans Selye of the University of Montreal says: " Stress can also be the spice of life". This is the main concept of a natural way of life in Public Health and this is the real way of natural treatment and therapy. In 1977 the WHO concept „Health 2000“ was passed and the European States developed regional objections of health and social care in The crucial point of new programs was the promotion of a more healthy way of life and a health related environment protection to decrease the reasons for these diseases. The rules of Public Health published by the Ottawa Charter of the WHO in 1986 will become more and more significant in the European regulations. The clear reorientation of health policy according to the principle: "Prevention is better than therapy" or the program "Learning to Live Healthfully" has an increasing importance for future developments of Health Resorts and Spas. Argentinien 2001

Social Taxable Rate in Germany
Health Tourism and Medical Treatment 20/04/2017 Social Taxable Rate in Germany 19,2 % of income for the Retirement Insurance (income more than $350 per month) 13.2 % of income for the State Health Insurance (income $ per month) The general increase in costs in the public health sector, mainly due the demographic development of the population, the frequent use of apparatus and high-tech methods producing great expense, due to the great number of drugs offered excessively and in part inefficiently, due to the waste of drugs not used, etc., has promoted new thinking about the future development of the public health sector. Everyone has to raise a considerable portion of his income (in Germany if his income is more than 350$ per month) for health and retirement insurance even now. In Germany the taxable rate was 19,2 % of income to the retirement insurance and 13,2 % to the state health insurance (if the income is between 350 and 3600$ per month). In future this will increase. Now, the citizen cannot be expected to accept a further increase in costs. Therefore, a structural reform in Germany provides with good reason that all those rendering services in the public health sector shall take a corrective line and be given a share in the costs of the community, thus also bearing some of the economic responsibilities. Argentinien 2001

Health Costs in Germany
Health Tourism and Medical Treatment 20/04/2017 Health Costs in Germany million$ million$ payment of the State Health Insurance million$ in-patient treatment in hospitals 37,1 % out-patient treatments 29,0 % administration 6,0 % health resort and spa treatment 2,3 % payment of the Retirement Insurance million$ In 1969 German health costs where 46 thousand million Dollars and in 1992 it increased to 286 thousand million Dollars. The state health insurance paid 138,4 thousand million Dollars (48,4 %) and the retirement insurance 19,3 thousand million Dollars (6,8 %). The budget of all the health and retirement insurances is about three quarter of the budget of the social ministry. For state health insurance, the part costs for in-patient treatments in hospitals is 37,1 %, for out-patients treatments 29 %, for administration 6 %, and for Health Resort and Spa Treatments the costs amount now to only 2,3 % of overall costs. Argentinien 2001

Costs of Chronic Back Pain in Germany 1994
Health Tourism and Medical Treatment 20/04/2017 Costs of Chronic Back Pain in Germany 1994 ,3 million cases of back pain resulted 43 million non-working days million$ treatment costs for disorders of spine and back pain and million$ non-working salary total million$ If a 45 years old worker in Germany has to retire due to illness, the community loses more than 300 thousand Dollars from loss of fees to the insurance, from paying more pension, and from loss of productivity. The average time of illness or impairments and non-working of a German worker is about 64,8 days per year. German industries lose through illness about thousand million Dollars per year. One missing day brings an industrial deficit of nearly 650 million Dollars. Chronic diseases and disorders are an increasing challenge to modern medicine. More than 50 % of all patients suffer from some forms of chronic illness, many of them include chronic back pain. In 1989 Germany registered 2,3 million cases of back pain that resulted in 43 million non-working days. In 1994 Germans paid 30 thousand million Dollars to treat disorders of spine and back pain and 18 thousand million Dollars were to pay for non-working salary. This is totally 48 thousand million Dollars only for these impairments. In many of these back pain cases the disorder resulted or was exacerbated from improper medical treatments. In 60 to 70 % of all back pain cases no clinical reasons were clearly identified or stated. Further investigation revealed that psycho-social factors played a more affective and significant role in back pain patients than did biomechanical risks. Unfortunately, prevention, treatment, and rehabilitation of these back pain disorders are underdeveloped and inadequately supported by most private and/or national health care systems. Argentinien 2001

Statistics of Health Resort and Spa Treatment 1992
Health Tourism and Medical Treatment 20/04/2017 Statistics of Health Resort and Spa Treatment 1992 53 % Diseases of the locomotoric system 14 % Diseases of the circulatory system 13 % Psycho-social diseases 5 % Metabolic diseases 5 % Tumours 5 % Respiratory tract diseases 5 % others The German statistics of 1991 about the distribution of diseases in Health Resort or Spa Treatment can be seen in the following figure: 53 % Diseases of the locomotoric system 14 % Diseases of the circulatory system 13 % Psycho-social diseases 5 % Metabolic diseases 5 % Tumours 5 % Respiratory tract diseases 5 % others Argentinien 2001

20/04/2017 Education Learning to treat chronic illness needs the patients with these disorders, efficient therapy centres, teachers with enough practise. University education is not sufficient to treat chronically illnesses, because there are not enough patients with these disorders or diseases in the university hospitals. Young physicians learn more and more the use of drugs and surgery. A big lobby of the pharmaceutic industry controls the university research and prefers a special knowledge in use of drugs but not in use of natural agents and remedies by financial promotions. Sickness is their business and not health. To develop quality standards of treatment in Health Resorts and Spas, we need more clinical schools in Health Resorts and Spas. Physicians without this knowledge get to authority positions with important influence in political decisions and insurances. They are well prepared in high-tech medicine and the use of drugs, but not in preventive and rehabilitative strategies by use of patient’s physiological functions and self healing power. We know many decisions which cause damage to the health care systems in Europe. Argentinien 2001

The fight against the chronic illnesses
Health Tourism and Medical Treatment 20/04/2017 The fight against the chronic illnesses cannot be won only by control of the free market can only be won by political decisions We need competent authorities to regulate the health care system. Schools of Public Health and the graduation in the „Master of Public Health“ are suitable to give more profession in social regulations of the health care system and in understanding of Health Resort Science to avoid the social diseases in the future. Argentinien 2001

20/04/2017 Research Three levels of research goals are important: medical treatment effect during the course of treatment long-term medical and social-medical effectiveness difference between expense and success: the efficacy. The following methods are suitable: clinical comparison comparison of costs before and after treatment comparison of non-working time Health Resorts and Spas are important practising centres in prevention and rehabilitation. Therefore we need basic experimental research to understand preventive physiological reactions and to develop an increasing standard of rehabilitative methods. The basis of preventive strategies is the Public Health Research. In this field we have to develop the physiologic science of health, the principles of salugenesis. The question is, why does one of the two similar persons in an similar environment becomes sick. Research must be done more in biochemistry of stress proteins and immunological adaptation processes. A cure success as a complex phenomenon can be achieved practically in all cases. Open questions are: how great is the cure success, how long does it hold and what is the relevance of the individual cure measures to the cure success? Argentinien 2001

20/04/2017 Conclusion Chronically ill patients are dependent on the possibilities offered at the Health Resorts and Spas. But healthy tourists learn in Health Resorts too. The goal of both groups in treatment and prevention is the same: “To die young, but as late as possible”. The basis of Health Resort Medicine and Spa Treatments is the complex and serial application of various balneological and physical methods as well as dietetic measures and order therapy in a favourable therapeutic environment. Chronically ill patients are dependent on the possibilities offered at the Health Resorts and Spas. We do not know in Europe any better therapeutic method for these patients. The scientific basis of Health Resort Medicine as a medical subject has therefore to be adapted to this concept in research and teaching. The evaluation of the findings available in various nations and the translation of these findings into relevant measures in the field of prevention and rehabilitation as well as the organization of Health Resort Medicine research on a international basis to create optimum health conditions for men is the primary goal of the ISMH. Health Tourism is an other part of Health Resorts. In Health Tourism we have no patients, we have healthy visitors with a little bit illness. Most of them are retired and have more time. They use more time in vacation and use the holidays to stabilize their physical, physiological and mental functions. Most experience in Health Resort medicine can be adapted to help this group. Also clients with lesser time for vacation are welcome for weekend courses of training in health resorts. But Health Tourism is a Tourism of a special group of persons. We get problems if tourists make noise in the evening. Health Resorts should never imitate Las Vegas with discos and noise from cars. Health Resorts are primary oriented for patients who like to sleep in the evening without the noise of young tourists. The goal of both groups in treatment and prevention is the same: “To die young, but as late as possible”. Argentinien 2001

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Health Tourism and Medical Treatment two parts in Health Resorts

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Health Tourism and Medical Treatment two parts in Health Resorts

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