Efficacious Holidays: The Therapeutic Dimensions of Pleasure and Discipline in Czech Respiratory Spas

Abstract

As evidence-based medicine has increasingly become the standard for assessing the efficacy of health care, the Czech Republic finds itself in a dilemma, with centuries of sanatorium-style spa treatments resisting easy categorization. Despite some critics' contentions that spas are "pointless holidays" and reductions in government funding of health spas, in 2014 Czech courts affirmed every Czech citizen's right to spa treatments if their health status merits it. Drawing on research in two children's respiratory spas, this article considers the experiences of patients aged 2-15 and their accompanying parents or guardians (mainly mothers) to suggest that in addition to the range of therapeutic procedures highlighted within spa cures, more amorphous aspects-such as pleasure and discipline-may be just as central to spas' successes. Indeed, as some spa physicians contend, spas may be considered a "package deal," to which EBM criteria is not easily applied.

Equality, efficiency and effectiveness: going beyond RCTs in A. L. Cochrane's vision of health care

“…Most of the (biomedically trained) healthcare staff who work in the country's system of spas evoke a shared understanding of spa cures as efficacious not only because of the provision of balneology , but due to the integrated array of therapeutics they offer (Trnka 2017b). Significantly, among the essential facets viewed as contributing to spas’ therapeutic efficacy are not only the range of medical procedures carried out, but also the fact that as patients, and in the case of young children, their accompanying parents, remain on the spa premises for several weeks at a time.…”

“…Aspects of spa stays such as the beautiful, outdoor surroundings and the availability of concerts and other artistic performances are highlighted as important facets of recuperation. The focus on such elements leads some critics to consider spa cures “holidays,” but do so is to ignore the role that relaxation and pleasure may have as part of how spa physicians’ visualise both treatment and care (Trnka 2017b).…”

“…Their curative dimensions are not thought to consist of the cumulative effects of (for example) water therapy, climate therapy, massage, etc., but to develop out of the integration of several different therapeutic facets. In addition to this, as Trnka (2017b: 54) notes, the unacknowledged elements of spa cures, such as “pleasure, discipline, and the escape from daily responsibilities” are likely to constitute important therapeutic aspects of spa care. RCTs, however, as Charlotte Brives and co‐authors document, RCTs test “standardize[d]” comparisons, “removing the background noise that makes regions and datasets incomparable” (2016: 370) and thus do not take such features into account.…”

Economic Impact of the Health Insurance System on Slovak Medical Spas and Mineral Spring Spas

“…Smith and Puczkó [24] described regional and cultural differences in understandings of European health and wellness tourism in Northern, Western, Southern, Central and Eastern Europe. It is difficult to compare medical services provided in the Slovak spas with those of other destinations [25][26][27][28][29][30][31][32][33][34][35]. This is due to the different legislative framework in each country.…”

“…The issues of the spas' orientation towards the target clientele according to the analyzed forms of reimbursement, the dependence of their financing on the health insurance system and the percentage of such financing (plus other factors mentioned in this article) are crucial in any legislative changes and discussion about them. An example of this is the crisis situation in the Czech Republic in 2013 after the adoption of a restrictive indication list, which shortened the length of spa stays for certain diagnoses, reduced re-stays, introduced regulatory fees and canceled the reimbursement of stay costs for certain diagnoses from public health insurance [32,35]. The current legislative framework for this kind of business imposes strict requirements not only on the material and technical equipment and staff of natural medical spas, but also on the use and protection of natural healing springs, their monitoring, recognition of climatic conditions suitable for treatment and their protection, the protection of the spa area and spa environment requirements.…”