Proceedings of the Faculty of Economics in East Sarajevo UDC 338.486.1.02:615.83(497.

7 Skoplje)
Year 2022, Issue 24, pр. 21-33 DOI: 10.7251/ZREFIS2224021P
Received: 10th October 2021 Preliminary Communication

Kiril Postolov Boris Postolov

Faculty of Economics, Master Candidate at Faculty of Economics,
University Ss. “Cyril and Methodius” Skopje, University Ss. “Cyril and Methodius” Skopje,
North Macedonia North Macedonia
* [email protected] * [email protected]

SPA AND WELLNESS TOURISM - THE EXAMPLE OF THE CITY OF SKOPJE

SPA I WELLNESS TURIZAM – SLUČAJ GRADA SKOPLJA

Summary: Spa and wellness tourism today is a reality that Rezime: Banjski i velnes turizam danas je realnost o kojoj
companies engaged in the hotel industry must be aware of kompanije koje se bave hotelijerstvom moraju voditi računa
when setting up their facilities. It was considered before that prilikom postavljanja svojih objekata. Nekada se smatralo da
this type of tourism is related only to the clientele that uses it je ovaj vid turizma vezan samo za klijentelu koja ga koristi iz
for health reasons. It is no longer the case. Other people are zdravstvenih razloga. Danas to više nije slučaj. Ostali
potential consumers of this type of tourism. It stems from the potrošači su potencijalni potrošači ove vrste turizma. Ovo
fact that consumers who use such services have greater and proizilazi iz činjenice da potrošači koji koriste njihove usluge
more sophisticated requirements and want to meet other imaju veće i sofisticiranije zahteve i žele da zadovolje druge
types of needs. The main thing is that in this process, the vrste potreba. Glavno je da se u ovom procesu mora dobiti
additional value must be obtained in which both parties will dodatna vrednost u kojoj će biti zadovoljne obe strane – i
be satisfied - consumers and providers of these services. potrošači i pružaoci ovih usluga. Ovaj vid turizma, pak,
This type of tourism, in turn, implies the need for more podrazumeva potrebu za većim ulaganjem u obezbeđivanju
extensive investment in providing that content, and therefore tog sadržaja, pa se u tom procesu nameće potreba za većim
in that process, there is a need for greater engagement of angažovanjem zajednice. To podrazumeva odgovarajuću
the community. It means appropriate aid by providing pomoć, pružanjem različitih vidova finansijske pomoći –
various types of financial assistance - non-repayable funds bespovratnih sredstava (grantova), kredita sa nižim
(grants), loans with lower interest rates and other types of kamatnim stopama i drugih vidova pomoći, posebno
assistance, especially of a logistical nature. Also, there is a logističke prirode. Takođe, nameće se obaveza odgovarajuće
need for the proper education of the local tourist workers edukacije domaćih turističkih radnika za pružanje ove vrste
for providing this type of services, including an appropriate usluga, kao i odgovarajuća promocija od strane šire
promotion of the broader interested community for the zainteresovane zajednice za mogućnost korišćenja banjskog i
possibility of using spa and wellness tourism in the tourist velnes turizma u turističkim objektima tokom cele
facilities throughout the calendar year. These were the main kalendarske godine. Ovo su bili glavni razlozi za pisanje
reasons for writing this paper, and we focused on assessing ovog rada, a mi smo se fokusirali na procenu realnog stanja
the real situation in terms of spa and wellness tourism u pogledu banjskog i velnes turizma u opštini Skoplje. U tu
within the municipality of Skopje. For that purpose, we svrhu konstruisali smo anketni upitnik, a zatim analizom
constructed a survey questionnaire and by analyzing the dobijenih odgovora, koristeći odgovarajuće statističke alate i
obtained answers, using appropriate statistical tools and metode, došli do odgovarajućih saznanja o razvoju ove vrste
methods, we gained appropriate knowledge regarding the turizma u cilju postizanja održljivog ekonomskog razvoja.
development of this type of tourism to achieve sustainable Ključne riječi: banjski i velnes turizam, priroda, održljivi
economic growth. ekonomski razvoj, potrebe turista
Keywords: spa and wellness tourism, nature, sustainable JEL kasifikacija: Q01, L83,
economic development, tourist’s needs
JEL Classification: Q01, L83,

Paper presented at the 11th Scientific Conference with International Participation ‘’Jahorina Business Forum 2022: Economic
Lessons Learnt from the 2008 and 2020 Crises: Experiences and Recommendations for Entrepreneurial Nations”

INTRODUCTION

The new way of functioning of the companies, but also of the social community (especially as
a result of the pandemic with Covid 19), basically created great turbulence, which, among other things,
affected their physical and mental health. But there are also people who did not feel the negative
effects of those changes.
22 ô Kiril Postolov and Boris Postolov

The former feel fatigue and similar disorders in their health, and see one of the possibilities for
removing those stresses through the use of various techniques to deal with that condition. One of those
opportunities is spa and wellness tourism. Others, who do not have such consequences from stress,
want to enrich their tourist content, and again, have the opportunity to use spa and wellness tourism.
That's one side of the coin, the consumer side.
The other side of that coin is the providers of those services. They must be aware that due to
the increasing demand for this type of service, this form of tourism will be a significant tourism trend
in the future due to the fact that they are revolutionizing the approach to health. And that, spa and
wellness tourism is one of the fastest growing segments of tourism and is a great catalyst for ensuring
sustainable economic development of the community.
In today's constellation, according to available data, in Skopje, there are 39 such centers, of
which only 18 tourist facilities that provide this type of service, which means that the remaining 21
have only a health character. It is a small number of tourist facilities that provide this type of service
and usually these are hotels in which the prices of services are the highest and are less accessible to
many potential customers.
If you look at the situation with tourism in the Republic of Northern Macedonia for the years
2010, 2015 and 2020. you can see the growth rate of this sector is not satisfactory. In 2010, there were
a total of 2.020.217 overnight stays, 2015- 2.394.205, while 2020- 1.697.535 (among other things due
to the pandemic with Covid 19). In 2020, the most visitors are hotels - 675.622, while in spa tourism
only 49.1131.
Therefore, there is a need to increase this type of service in other tourist facilities, which will
make them more attractive to use, but will also increase the offer. As a result of those activities, the
increase in income in this type of activity will be affected.
Spa and wellness tourism must be seen as a new way of doing business. To do this, we must
pay special attention to the way it will work, especially in terms of funding, providing the necessary
workforce, training staff, and promoting it in order to inform the public about the benefits achieved by
using it.
The main goal of this paper is to see the possibility for implementation of this type of tourism
in business entities in the city of Skopje, as well as confirmation of the proposed hypotheses that spa
and wellness tourism are an opportunity for sustainable economic development.
The theoretical aspects, the research itself, the methodological approach applied in the
research, as well as the obtained results are original and imply appropriate impact on the wider
scientific community, academia, entrepreneurs in this sector, students, researchers, and other subjects
related to spa and wellness tourism.
Based on the empirical data given within this section, we can conclude that this form of
tourism is the least developed and is still in the initial stage of its development. The benefits for the
local community that are expected from the development of this form of tourism include a high level
of responsibility of the tourism enterprises and the employees in this sector, the active role of the small
enterprises and the exploitation of the entrepreneurial opportunities.

1. DEFINITION OF SPA AND WELLNESS TOURISM

The term spa and wellness tourism usually goes together, although there are essential
differences between the two of them.
In this paper we will introduce different definitions of their content and we are going to
present the basic difference between these two terms.
Basically, both terms are related to health, but the meanings themselves are very different. Spa
is an abbreviation for "sanus per aquam", which in Latin means "health from water". In practice, this
means that in any center that is based on water as its primary content, ideally thermal or healing
(which is not a common case), we have a justification to call it a spa center.
The term wellness has nothing to do with water. It originated as a coin of the American terms
“Well being” and “Fitness”, and signifies a healthy concept of life. If we connect it with the centers, it
is practically a healthy center, in which your activities are focused on a healthy life.

1
From the obtained data it is not possible to see how many of the visitors used the spa and wellness services

Proceedings of the Faculty of Economics in East Sarajevo, 2022, 24, pр. 21-33
 Spa and Wellness Tourism - The Example of the City of Skopjeô 23

This is where the term spa and wellness merge, at a point we call health, which in practice
means that both centers strive to maintain healthy living habits.
Smith and Kelly (2006) propose that wellness is a state of being whereas others contend this
by saying that wellness is synonymous with a certain lifestyle. Jonas (2005) suggests that health is a
state of being, whereas wellness is a provess of being. Myers et al. (2005) defines wellness as a way
of life oriented towards optimal health and wellbeing, they identify the body, mind and spirit as
integral to living more fully within a human and natural community. Cohen&Bodecker (2008)
expands on this further by including emotional, spiritualm sexual, occupational, financial and
environmental principle components. Porter et al. (2003) describes wellness as a psychological state,
stating wellness is what you are and what you feel. Hales (2005) includes environmental as an
additional wellness component. Spas as being used for rehabilitation and treatment of ilness (Cohen
and Bodecker 2008). Lee (2004) suggests that spa concepts are based on four elements – water, earth,
fire and air.
The term spa is defined in a variety of ways, often ifluenced by the content in which it is
meant to be used and by geographical location. In many cultures spas are closely linked with water,
health and hygiene
The Oxford English Dictionary (2011) defines spa simply as a place where there is a curative
mineral spring. The British International Spa Association (BISA 2010) refers to spa as an
establishment that provides a minimum of one approvade water-based treatment using water of known
composition. Australian Spa Association (ASPA 2012) only provides definitions of its four identified
clusters: day, destination, natural bathing and related spa without having a general definition. Asensio
(2002) defines spa as a place aiming to improve health and physical condition. De Vierville (2003)
defines spa as a place whose purpose is faciliting whole human health care, wellness and social
wellbeing.
Common definition of spa is: places devoted to overall well-being through a variety of
professional services that encourage the reneval of mind, body and spirit (ISPA 1991).

2. TYPES OF SPA AND WELLNESS TOURISM

In the literature, one can find a number of different classifications to determine the content of
this type of tourism. We believe that the most correct classification of the content of wellness and spa
tourism is given according to the International SPA Association (2010), according to which, the basic
forms are:
§ Day - A day spa offers a variety of spa services, including facial and Body treatments on a
day-use-only basis.
§ Resort/hotel - A resort/hotel spa offers a spa, fitness and wellness services, as well as spa
cuisine menu choices and overnight accommodations within a resort or hotel
§ Destination - A destination spa is not part of another resort of hotel. The destination spa’s
primary purpose is guiding individual spa-goers to healthy lifestyles. This transformation can
be accomplished by a comprehensive program that includes spa services, physical fitness
activities, wellness education, healthful cuisine and special interest programming
§ Medical - A spa in which a full-time, on site licensed health care professionals provide
comprehensive medical and wellness care in an environment that integrates spa services, as
well as traditional, Complementary and/or alternative therapies and treatments. The facility
operates within the scope of practice of its staff, which can include both aesthetic/cosmetic
and prevention/wellness procedures and services
§ Club - A facility whose primary purpose is fitness and that offers a variety of professional
administered spa services on a day-use basis. A hotel, gym, or fitness club that has a sauna,
steam or whirlpool bath is not a spa unless it explicitly offers spa products and services as an
added benefit
§ Mineral springs - A spa offering an on-site source of natural mineral, thermal or seawater
used in hydrotherapy treatments
§ Cruise ship - A spa aboard a cruise ship providing professionally administered spa services,
fitness and wellness components and spa cuisine menu choices

Proceedings of the Faculty of Economics in East Sarajevo, 2022, 24, pр. 21-33
24 ô Kiril Postolov and Boris Postolov

§ Cosmetic - A spa that primarily offers aesthetic/cosmetic and prevention/wellness procedures

and services such as facials, peels, waxing and other non-invasive procedures that are within
the scope of practice of its staff but do not require on-site medical supervision.

3. ECONOMICAL SIGNIFICANCE OF SPA AND WELLNESS TOURISM

Conceptually, spa and wellness tourism businesses and their products are expected to
contribute to all dimensions of sustainability in the places visited, for example, promoting local spa
and wellnessnomy. Generally, spa and wellness tourism is argued to be a foundation for sustainable
tourism as it contributes benefits to the economic, social and environmental development of the local
areas. Social benefits may also be enhanced through the intercultural appreciation and understanding
between the host community and visitors (Hunt at al. 2014). For instance, when tourists visit a spa,
they may have a chance to meet and interact with locals. Learning a local language may be an example
of social learning. During their visits, foreign tourists might get a chance to speak the local language
through simple communication, such as greetings and saying goodbye. Tourists may also learn
something from the locals (for example, culture, ways of life, local food), and even buy souvenirs. The
economic impact assessment generates an estimate of the spa and economic consequences of a
particular project on the local economy. However, this provides only one piece of the puzzle in a
broader evaluation process. In some cases a more general cost benefit analysis will attempt to place a
monetary value on environmental and social impacts (Stynes 1997). Spa and wellness tourism
generates direct and indirect employment opportunities at the community level and enables equitable
distribution of economic, social and cultural benefits to the local population. The economic impacts of
spa and wellness tourism also causes social changes, which are manifested in the improvement of
living conditions in terms of municipal equipment, the development of physical and social
infrastructure, and the enrichment of cultural life. The economic importance of spa and wellness
tourism is also manifested in the growth and diversification of the overall economy and the
opportunity to create new jobs and generate additional income. Furthermore, it has an impact on
increasing the well-being, the economic development of the local economic community and the
region; impact on the living standard of the local population; impact on social change in the daily lives
of locals.
On the other hand, there are adverse effects, such as:
§ increasing costs, especially infrastructure costs.
§ high rate of return on investment;
§ the growth of excessive dependence on tourism, changes in the spa and wellness structure of
the local economy;

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 Spa and Wellness Tourism - The Example of the City of Skopjeô 25

4. EMPIRICAL RESEARCH

In the framework of this paper, an appropriate empirical research was conducted on the
readiness for implementation of spa and wellness tourism within the municipality of Skopje. For this
purpose, 80 respondents living on the territory of the municipality were randomly selected by
telephone. The demographic characteristics of the sample are:

Table 1. Structure of respondents

Frequency Structure
Gender
Male 42 52,50%
Female 38 47,50%
Age
<30 33 41,25%
31-45 age 17 21,25%
46-60 age 28 35,00%
>60 2 2,50%
Education
High 15 18,75%
Faculty 62 77,50%
M.A. and Ph.D. 3 3,75%
Source: Own research

In the follow-up study, we used the Likert scale with responses ranging from 1 disinterested,
to 4 highly interested. Respondents were asked a total of 17 questions in order for us to receive a
strong conclusion.
In the previous part of the paper, we wrote that "implementing spa and wellness tourism
creates economic and other benefits in the area concerned", and based on that, we have defined the
four basic hypotheses with whom we want to prove the attitude of the respondents in the Municipality
of Skopje area.
According to the literature used and consulted, we have tested this claim through the following
auxiliary claims:
1. Institutional support and country`s support influenced for the implementation of the spa and
wellness tourism concept
2. Opportunity and capability provide for the implementation of the spa and wellness tourism
concept
3. Additional resources provide for the implementation of the spa and wellness tourism concept
4. Entrepreneurship concept provides for the implementation of the spa and wellness tourism
concept

The following sets out the null hypothesis (H0) and the alternative hypothesis (H1), for each
claim to be tested.
1. Institutional support and country`s support influenced for the implementation of the spa and
wellness tourism concept.
H0: Institutional support and country`s support not influenced for the implementation of the spa
and wellness tourism concept
H1: Institutional support and country`s support influenced for the implementation of the spa and
wellness tourism concept
The first hypothesis will be analyzed first.

Proceedings of the Faculty of Economics in East Sarajevo, 2022, 24, pр. 21-33
26 ô Kiril Postolov and Boris Postolov

Table 2. Correlation between respondets and hypothesis variables 1

Question 5 Question 8 Question 10
Spearman`s rs Question 5 Correlacion
1.000 -0,317 0,322
Coefficient
N 80 80 80
Question 8 Correlacion
-0,317 1.000 0,147
Coefficient
N 80 80 80
Question 10 Correlacion
0,322 0,147 1.000
Coefficient
N 80 80 80
Source: Own research

According to the results, question 5 is in negative correlation with question 8 (institutional

assistance) and in positive correlation with question 10 (state aid). This means, if the desire to
implement spa and wellness tourism is reduced, institutional assistance is reduced. The correlation
between question 5 and question 10 (state aid) shows that if the implementation of spa and wellness
tourism is increased, state aid will also increase. It can also be noted that question no. 8 is in positive
correlation with question no. If those same variables are put into a standard regression model where
question 5 is a dependent variable and questions 8 and 10 are independent variables, the following
results will be obtained:

Table 3. Standard regression model about 1 hypothesis

Chi-Square Sig.
Final 10.388 0,033
Source: Own research

In this case the p-value of the individual parameters is below the set threshold p <0.05 and is
0.033, so there are statistically significant differences between spa and wellness tourism, institutional
and state aid.
According to the analysis, the null hypothesis Hо is rejected and the alternative hypothesis is
accepted, H1: Institutional and state aid contribute to the increase of spa and wellness tourism.
2. Opportunity and capability provide for the implementation of the spa and wellness tourism
concept
H0: Opportunity and capability do not provide for the implementation of the spa and wellness
tourism concept.
H1: Opportunity and capability provide for the implementation of the spa and wellness tourism
concept
We proceed to the analysis of the spa and wellness hypothesis:

Table 4. Correlation between respondets and hypothesis variables 2.

Question 5 Question 11 Question 14
Spearman`s rs Question 5 Correlacion
1,0000 -0,062 -0,123
Coefficient
N 80 80 80
Question 11 Correlacion
-0,062 1.000 0,305
Coefficient
N 80 80 80
Question 14 Correlacion
-0.123 0,305 1.000
Coefficient
N 80 80 80
Source: Own research

According to the results, question 5 is in negative correlation with questions 11 (ability) and
14 (ability), which means that if the respondents' ability and ability is lower, we will have spa and
wellness tourism development and vice versa.

Proceedings of the Faculty of Economics in East Sarajevo, 2022, 24, pр. 21-33
 Spa and Wellness Tourism - The Example of the City of Skopjeô 27

Questions No 11 and 14 are in a positive correlation which means that if the opportunities
improve, the ability will increase and vice versa. These two variables do not enhance the development
of spa and wellness tourism, as evidenced by the results of the regression model.

Table 5. Standard regression model about 2 hypothesis

Chi-Square Sig.
Final 0,433 0,690
Source: Own search

In this case the p-value of the individual parameters is above the set threshold p <0.05 and is
0.690, so there are no statistically significant differences between spa and wellness tourism
implementation and capability and opportunities.
According to the analysis, the null hypothesis Ho: Opportunity and capability is not provided
for the implementation of the spa and wellness tourism concept.
3. Additional resources provide for the implementation of the spa and wellness tourism concept
H0: Additional resources do not provide for the implementation of the spa and wellness tourism
concept.
H1: Additional resources provide for the implementation of the spa and wellness tourism concept.
Analysis of the third hypothesis:

Table 6. Correlation between respondets and hypothesis variables 3

Question 5 Question 16 Question 17
Spearman`s rs Question 5 Correlacion
1,000 0,066 -0,518*
Coefficient
N 80 80 80
Question 11 Correlacion
0,066 1.000 -0,062
Coefficient
N 52 52 52
Question 14 Correlacion
-0,518* -0,062 1.000
Coefficient
N 80 80 80
*Correlation is significant at the 0.05 level (2-tailed)
Source: Own research

According to the results, question 5 is in positive correlation with question 16 (friends' funds)
and in negative correlation with question 17 (bank loans). This means that if received from friends, the
desire for spa and wellness tourism will increase. If you look for bank loans as a source, the desire for
spa and wellness tourism is reduced.
The Ordinary Regression Model of Claim no.3 shows the following:

Table 7. Standard regression model about 3 hypothesis

Chi-Square Sig.
Final 6.123 0,259
Source: Own research

In this case, the p-value of the individual parameters is above the set threshold p <0.05 and is
0.259, so there are no statistically significant differences between Spa and wellness tourism
implementation and additional resources of financing.
According to the analysis, the null hypothesis Ho: Additional resources not provided for the
implementation of the spa and wellness tourism concept is accepted.
4. Entrepreneurship concept provides for the implementation of the spa and wellness tourism
concept
H0: Entrepreneurship concept does not provide for the implementation of the spa and wellness
tourism concept.
H1: Entrepreneurship concept provides for the implementation of the spa and wellness tourism
concept

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28 ô Kiril Postolov and Boris Postolov

Analysis of the fourth hypothesis

Table 8. Correlation between respondents and hypothesis variables 4

Question 5 Question 18 Question 19
Spearman`s rs Question 5 Correlacion 1.000 -0,373 -0,027
Coefficient
N 80 80 80
Question 11 Correlacion -0,373 1.000 0,382
Coefficient
N 80 80 80
Question 14 Correlacion -0,027 0,382 1.000
Coefficient
N 80 80 80
Source: Own research

According to the results, question no. 5 is in negative correlation with question no. 18
(entrepreneurial spirit) and question no.19 (family support), which means that the implementation of
spa and wellness tourism is in negative correlation with the entrepreneurial spirit and support from the
family.
Table 9. Standard regression model about 4 hypothesis
Chi-Square Sig.
Final 6.218 0,278
Source: Own research

In this case the p-value of the individual parameters is above the set threshold p <0.05 and is
0.278, so there are no statistically significant differences between work motivation and teamwork and
team rewards.
According to the analysis, the null hypothesis - Ho: Entrepreneurship concept is not adopted
for the implementation of the spa and wellness tourism concept.

CONCLUSION

In preparing the paper that is in front of you at the moment, we must emphasize that we have
encountered a number of limitations. These limitations are reflected in the fact that although the
survey questionnaire was distributed to a much larger number of employees engaged in this activity,
valid answers that were then processed were 80 respondents. Also, the next limitation can be noted in
terms of age and level of education of the respondents, where the answers received reflect those
demographic characteristics. However, we believe that the answers received largely reflect the real
situation regarding this issue.
Spa and wellness tourism is a specific form of tourism and should be viewed from a
multidisciplinary perspective, including spa and wellness, environmental and socio-cultural analysis.
The introduction of spa and wellness tourism must be an ongoing process. Today, people want to pay
more attention to their health, but also to the enjoyment of using services of this type. At the same
time, it must be noted that the satisfaction of their specific needs imposes the need for spa and
wellness in the way of organizing activities in this segment of tourism.
Based on the answers received, a number of conclusions can be drawn, in relation to the real
situation and what needs to be done in order to promote and develop this form of obtaining tourism
services.
Through empirical research it has been proven that institutional support is needed by the state
and state bodies in order to develop spa and wellness tourism. The research has shown that in our
country the state and state bodies are interested in the development of this type of tourism.
Rregarding the possibility and ability to implement the concept of spa and wellness tourism, it
was found that they have a negative sign. This means that they do not affect the development and
implementation of spa and wellness tourism

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 Spa and Wellness Tourism - The Example of the City of Skopjeô 29

It is obvious that there is no interest in using funds, both own and from other sources for the
purpose of financing in this form of tourism. And that's not good, given that there needs to be an
entrepreneurial spirit in order to develop this type of tourism. However, it is a fact that the research
shows that there is no entrepreneurial spirit among people employed in the tourism sector in order to
develop and implement the concept of spa and wellness tourism.
To be a sound development policy, the process must involve entrepreneurs, the state and state
bodies through public administration and local self-government, as well as financial institutions as
providers of additional capital.
It is very important in that process to define an appropriate strategy, the implementation of
which will bring benefits to all stakeholders. On the one hand, satisfied customers, on the other hand,
effective and efficient providers of this type of services.
The appropriate strategy for the development of this type of tourism must incorporate the
potential opportunity of our companies to obtain adequate quality of this type of services. It is not an
easy process due to the fact that consumers have their own specific and more sophisticated
requirements arising from the use of this type of service in more developed destinations around the
world.
We must emphasize institutional support, as a catalyst in the development and implementation
of the concept of spa and wellness tourism. Special attention must be paid to the development of
appropriate legislation that will institutionalize this type of tourism. Thus, we emphasize the role that
the legislation has, in order to define the issues for performing this type of activities.
Then, although it is a matter of private facilities, the state must, through appropriate
mechanisms, enable adequate development and investment in equipment, infrastructure and human
resources of this type of tourism. Here as an idea for institutional support we can mention the
possibility of concluding agreements through the Chamber of Commerce with similar institutions in
other countries that would benefit the development of spa and wellness tourism in our country.
Finally, but also in its importance, appropriate participation in the development of strategies, programs
and action plans for the development of spa and wellness tourism, in cooperation with international
and other institutions that have the appropriate knowledge and expertise in this area.

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30 ô Kiril Postolov and Boris Postolov

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