The objective of the present research was to identify the role of health tourism in the competitiveness of three Hungarian counties (Baranya, Somogy and Zala) of the Croatian-Hungarian border area. The key factors of success and criteria for sustainability were to be found in order to help the local decision-makers in their attempts to create a strategy for the development of health tourism. As a part of a large research project the current paper describes the results of a qualitative survey of 21 interviews with mayors, spa managers, and hotel managers, to represent general tourism supply to identify the impacts of health tourism developments on the settlement, the economic and social effects on the local population.
The selection of interviewees was done to ensure, that successful, average, and not really successful spa towns were represented among the locations. Among the possible locations in counties Zala, Somogy and Baranya the interviews were finally conducted in Hévíz, Zalaszentgrót, Nagyatád, Marcali, Harkány and Szigetvár, and, to include a location where planned spa development was not implemented, in the village Somogysámson. Besides, the president of the Hungarian Baths' Association was interviewed, who used to be the director of the Szent András Rheumatic Hospital in Hévíz for a long time. Due to some of the interviewees' non-availability two additional locations, Letenye and Kehidakustány, were also included to complete the list of interviews. An interview was conducted with the mayor of Somogysámson about an unimplemented spa development plan.
The main findings of the research underlined that the number of domestic tourists, and within this wellness tourists, is very low compared to the opportunities. For this reason the further development of domestic tourism is of crucial importance. The reasons for that are partly the prevailing habits, the lack of tourism culture, the lack of recreation culture, and financial difficulties.
The successful, progressive spas are those that have continued their development activities relying on their natural endowments, and responding with their innovations to the current expectations of the market and the environment. They have improved their medical treatments, introduced new machinery and technology, built new sight and fun components in the spa. Financial efficiency was achieved by those who were able to attract a sustainable number of visitors. According to the international literature an attraction with a visitor-centre like establishment (a museum, a fun park, a spa, etc.) will be very profitable after it reached 1 million visitors a year in terms of services sold.
A small spa may be financially viable, if the capacities are well designed and the construction responds to the services demanded, as the example of Nagyatád shows.
An adequate spa town image would definitely be needed for the further development of spas. Balatonfüred and Héviz are the only spas that have started to establish a real spa image in Hungary.
The other important component should be the complete documentation for the patients and the treatments in spas and spa hotels, and the same is valid for wellness and fitness. The client should be informed about the impacts of the treatment on the patient's condition.
The spas that are situated in small settlements do not possess resources for financing more serious marketing actions.They also lack creative groups of staff to develop a long-run strategy for the settlement, and to implement planned development projects. The microregions may be the suitable units to take over this role, but because of too many tasks it is highly questionable whether they are able to carry out such strategic developments.
There is need for setting up a national resource inventory, and certain components of developing this system could be done at research and development teams of the universities. This resource inventory could reflect the endowments of the currently existing spas, their visitor numbers, and their qualities.
One of the most problematic areas of the operation of medicinal spas in Hungary is the issue of support from the National Health Insurance Fund, as the amounts have been the same in the last four years. Without this support the spas would not be able to sustain themselves, but the prices of the treatments should be redefined, this is a crucial aspect of sustainability.