|Abstract (english)|| |
The doctoral dissertation titled "Public-Private Partnership - an Optimum Model of Health Tourism Development in Croatia" comprehensively and consistently researches all relevant theoretical issues related to the topic of application of public-private partnership in health tourism and includes a broad empirical analysis of the satisfaction of examinees with health tourism and opportunities for development and use of public-private partnerships in health tourism. The public private partnership as a model of tourism development has been systematically studied over the last twenty years. There is no predominant model of public private partnership in health tourism either in Croatia or internationally, because of the fact that public-private partnership in health tourism has not been sufficiently theoretically researched and applied in practice. Because of insufficiently researched and practically applied model of public-private partnership in health tourism the paper critically analyses scientific and expert literature in contribution to the scientific research of the model of public-private partnership in health tourism, and the understanding of public-private partnership through the definition of the concept and partakers of the partnership. The results of the research have shown that health tourism in the Republic of Croatia has so far been insufficiently valorised, although it has numerous comparative advantages while the management is elementary, without theoretical and scientific support, as well as without the practical application of relevant growth and development factors that have a very negative impact not only on development of health tourism and the entire Croatian tourism, but also on the development of local, regional and national economy. The paper explored and formulated the relationship between the public and private sectors in the development of health tourism products and defined the connection between the development process of health tourism and other developmental aspects of tourism as a whole, i.e. the Republic of Croatia as a tourist destination. The paper explored and highlighted the key features of existing health tourism offerings, as well as the ability to transfer experience in applying a model of partnerships for health tourism from other competitive countries. The study of the potential of public-private partnerships in Hrvatsko Zagorje health tourism was conducted through a survey of development of public-private partnership in Krapina Zagorje County as a tourist destination, identifying key factors, advantages and disadvantages as well as analysis of key factors for improving public-private partnerships. Survey of respondents collected data that was processed using SPSS (Statistical Package for the Social Sciences). The first part of the questionnaire that contains questions about the demographic characteristics of the respondents was measured on the nominal scale, and part of the data from the survey was processed using a descriptive statistic method which includes calculating the percentage and computing the arithmetic mean of the responses obtained and verifying the existence of statistical differences between the subjects by computing the Hi-square test. Also, the nonparametric test (Mann-Whitney U and Wilcoxon W) was used to compare multiple independent samples so as to determine the existence of statistically significant differences. Prior to using Mann-Whitney U and Wilcoxon W test, Kolmogorov-Smirnov and Shapiro-Wilk tests were used to determine the distribution of normality to define whether parametric or nonparametric statistics would be used. The Friedman test was used to verify the existence of statistical significance for the dependent samples, while the Kruskal Wallis test was used as a nonparametric measure for testing statistical significance among several groups. All the questionnaire statements were measured on the Likert scale with scores from 1 to 5, where rating 1 means "very dissatisfied/completely disagree" and the grade 5 means "very satisfied/completely agree”. A total of 1066 respondents participated in the research, 4% from the public sector (46 respondents), 32% from private sector (340 respondents), 38% from the general population (400 respondents) and 26% from tourists (280 respondents). The average age of respondents was 47.4 years, where the youngest respondent was 19 and the oldest was 77, of which 51% were men and 49% women. The largest number of respondents, 70% of them have a completed high school education, while the smallest number of only 1% has a Master's degree or Doctorate. Research findings suggest that the population is aware of the importance of development of health tourism, but majority thinks that the inclusion of autochthonous products in the design of tourism products is insufficient and that they are not adequately informed about activities and decision-making in tourism. Most respondents believe that the responsibility for managing tourist destinations lies with tourist boards operating in the tourist destination area. When assessing the satisfaction of hotel services and treatments, tourists are most satisfied with the expertise of staff providing medical, health and wellness treatments and are at least satisfied with the quality and quantity of food. Regarding the satisfaction of the respondents with the elements of the tourist offer, tourists are mostly satisfied with the beauties of the landscape, urban harmony and tourist signalling in the destination, whereas the public sector is most satisfied with the healing factors, while the people themselves consider themselves more kind than those who are employed in tourism. The results show that the public sector is most satisfied with the healing factors from which it can be concluded that the public sector itself is aware of the shortages of health tourism when as the most desirable factors declared were healing factors - naturally given to us and with the slightest influence on them. The research results show that all respondents are satisfied only with the elements that represent the comparative advantage of the Republic of Croatia as a destination, thus confirming the first auxiliary hypothesis. The research results show that public sector respondents to the highest degree agree with the fact that the strategy and goals of their organization include the possibility of investing according to the principle of public-private partnership, and least agree with the statement that in their organization the obligations and responsibilities of project team members for public-private partnership projects are defined and harmonized. As the main reason for the poor implementation of public-private partnership projects in health tourism, public sector respondents recognize that legislation regulating public-private partnership in health tourism is not satisfactory (39%). On the other hand, those surveyed from the private sector consider that the main reason is insufficient knowledge of the opportunities offered by the model of public-private partnership (29%). In addition to identifying the main reasons for the poor implementation of public-private partnership projects in health tourism, the survey also selected other reasons for poor implementation of public-private partnership projects in health tourism. For other reasons of the poor realisation of public-private partnerships in health tourism projects of public and private sector respondents state (61% -60%) that there is no political will in the Republic of Croatia for the realization of cooperation between the public and private sector in health tourism. Also in a similar percentage (52% -56%) respondents from public and private sector point to poor public sector education on public-private partnerships. As 77% of private sector respondents believe that private sector in health tourism is not interested in co-operating with the public sector in joint projects. 59% of private sector respondents believe that bureaucracy and corruption are a barrier to public-private partnership in health tourism. It is evident from the results of the research that the public sector providing health tourism services is not qualified (financially, managerially, marketwise) to offer an internationally competitive health tourism product, however the private sector needs to link its resources (financially, managerially, marketwise) to the public sector in a wider sense, thus confirming another auxiliary hypothesis. Respondents from the public and private sector mostly agree that the public sector's interest in entering public-private partnership projects in health tourism is in increasing employment, local community development through the advancement of quality of local resources and urban regeneration, which includes reconstruction and reconstruction of previously built, and today's non-functional buildings for tourist, cultural-entertainment and recreational purposes. As far as the areas of public and private sector cooperation in health tourism is concerned, both groups of respondents, the public and private sector, point out that these areas include access to a new market, improving health and hygiene conditions, support for participation in tourism fairs, and raising quality standards. Research results suggest that respondents imply that the link between the public and the private sector affects a number of other factors that affect the development of a destination that wants to be the destination of health tourism, thus confirming the third auxiliary hypothesis. The research has shown that all respondents are familiar with the concept and law of public-private partnership, while the work of an agency overseeing the implementation of public private partnerships is more familiar to public sector respondents than private sector respondents. As far as financing sources for health tourism development are concerned, tourists prefer self-financing by the municipality, city, county, state, because they consider that they maximize the use of health tourism services financed by the Croatian Health Insurance Institute, while the other three groups of respondents prefer public-private partnership as a type of financing for the development of health tourism. Most private sector respondents believe that the involvement of a private partner in the public –private partnership project creates the foundations for faster economic development of their local community and that they have the potential to invest in a public –private partnership model in their development strategy. Most of the respondents from all four groups agree that public-private partnership can be in the function of the development of health tourism in the Republic of Croatia, thus confirming the main hypothesis. The SWOT analysis from the conducted survey shows that the accessibility of the Republic of Croatia as a destination is a strength for the development of health tourism. As a weakness of health tourism, they have identified the absence of certification for the needs of health tourism and the lack of a development vision, while an increasing number of competing destinations are considered a threat to the development of health tourism. The aging of the population and the use of public-private partnerships in the development of health tourism are seen as an opportunity for development of health tourism. The view of the strong and weak sides, as opportunities and threats from the SWOT analysis, confirms that public-private partnership is the optimum model for the development of health tourism in the Republic of Croatia. The scientific contribution of this doctoral dissertation is visible in the systematic review and critical analysis of the knowledge regarding the application of forms of public and private partnership with special emphasis on health tourism. Scientific methods have investigated the interdependence of providers of health tourism from the public and private sectors and their orientation towards the development and international positioning of this specific form of tourist offer of the Republic of Croatia. As an optimum model of public-private partnership that would enable the achievement of goals in health tourism, the DBFOOT (Design-Build-Finance-Own-Operate-Transfer) model is proposed. In addition to selecting the DBFOOT model as the optimum model of public-private partnerships in the development of health tourism, the results of the scientific research have enabled the development of an integrated tourism destination management model through public-private partnership, which includes communication and coordination of activities between stakeholders in the market with the aim of planning, development, product distribution, and tracking success, all for the purpose of sustainable development of health tourism destination by implementing the DBFOOT public-private partnership model. In addition to the scientific goals, the research has also defined the applicative research goals that provided the optimum model of public-private partnerships specific to the development of health tourism in the Republic of Croatia. The applicative research objectives are focused on giving incentives to competent development management authorities at all levels of public authority, and referring recommendations to all subjects (institutions, legal entities, owners, investors, domicile population) regarding the possibilities of applying a model of public-private partnership in the development of health tourism.