CAPÍTULO 3. InTrOdUcción
3.4. Abordaje terapéutico del ictus: código ictus y tratamientos
3.5.2. Nuevas fronteras en tratamiento endovascular
Most of the IRM motivations found in the literature concentrate more on the pull factors (as illustrated in Figure 2.6), which are the destination attributes in attracting retirees to retire in an overseas destination. Similar to internal migration in the United States, one of the major pull factors is low cost of living in an overseas destination (Balkir & Kirkulak, 2007; Breuer, 2005; Casado-Dıaz et al., 2004; Gibler et al., 2009;
King et al., 1998; Ono, 2008; Rodriguez et al., 2004). In the IRM scenario, the Germans are drawn to retire in the Canary Islands (Breuer, 2005). Mediterranean destinations such as Spain, Italy, and Portugal (Hoggart & Buller, 1995; O’Reilly, 2000; Williams et al., 1997) have been the favourite retirement destinations for the Central and Northern European retirees (Friedrich & Warnes, 2000; Myklebost, 1989; Williams et al., 1997) due to lower living costs and warmer weather. Ono (2008) supports the notion by indicating Japanese retirees chose Malaysia to retire due to low living cost.
56 However, surprisingly, in Gibler et al. (2009)’s study low living cost ranked only the third most important pull factor among international retirees. Instead of the general low living cost motivator, Gibler et al. (2009) found housing prices as the second most important pull factor. Housing prices normally relate to the affordable rental price of accommodation and housing maintenance costs overseas (Gibler et al., 2009; Rodriguez et al., 2004).
Retirement destinations that provide attractive natural and cultural amenities (Balkir & Kirkulak, 2007; Gibler et al., 2009; Rodriguez et al., 2004) will pull international retirees towards their destination. In fact, natural amenities were rated as the most important pull factor in Gibler et al. (2009)’s study. Rodriguez et al. (2004) reported that Europeans are pulled to Spain for retirement due to the Latin and Mediterranean cultures that satisfy the curiosity and the retirees’ interest. Both natural and cultural amenities may be good and effective factors for international retirees to spend their retirement time in a foreign land.
Favourable climate in overseas retirement destinations is widely cited as an important pull motivator to IRM (Breuer, 2005; Casado-Dıaz et al., 2004; King et al., 1998; Ono, 2008; Rodriguez et al., 2004; Sunil & Rojas, 2005). Rodriguez et al. (2004) reported that 92% respondents indicated that the favourable climate in Costa del Sol, Spain pulled them to retire in this Mediterranean coast. Rodriguez et al. (2004) explained the favourable climate in Southern Spain provides mild weather with an annual average temperature of about 18ºC and about 2,852 hours of sunshine annually.
Light and warmth climate are often the effective pull factors that drive German retirees to retire in the Canary Islands (Breuer, 2005).
Good infrastructures (Gibler et al., 2009) also act as a pull force to motivate international retirees to choose a specific retirement destination. Breuer (2005) reported that German retirees in the Canary Islands made telephone calls to their family in their
57 home country at least once a week. Thus, communication infrastructure may be seen as a paramount factor to ensure the retirees’ smooth daily life activities and maintaining social contacts with their family and friends.
Recreation and entertainment opportunities at the retirement destination (Ono, 2008; Gibler et al., 2009) are commonly evaluated by international retirees when deciding where to retire. Recreational activities such as sports and cultural activities are what the Japanese retirees are seeking when retiring in Malaysia (Ono, 2008). Similarly, in the European continent, Rodriguez et al. (2004) reported that European retirees have ample time to enjoy the leisure resources available in Costa del Sol. This motivator indicates that retirement destinations that provided active lifestyle attracts active-seeking retirees, particularly the younger cohorts. American retirees migrated to Mexico due to the possibility to remain active (Sunil & Rojas, 2005). This indicates that the possibility of being active acts as a destination attribute, pulling the American retirees to retire in Mexico and satisfying the needs for being active during retirement age.
Efficiency and simplicity of visa systems is another pull factor in IRM. In the study of Japanese retirees in Malaysia, Ono (2008) found that Penang is favoured over the Gold Coast due to the difficulty of visa re-issuance and a larger amount of bank deposits required in Australia as compared to Malaysia. Therefore, a Japanese couple who initially thought of retiring in Australia and had bought a condominium in the Gold Coast finally decided to sell off the property and move to Penang to retire.
Gibler et al. (2009) indicated lower local tax rate as a pull factor. Though in their study, there is no specific definition of the local tax rate, it could be assumed the general taxes are service tax, value-added tax and income tax. Generally, retirees are not expected to have income, and perhaps relying on pension funds to support their daily life while retiring overseas. Nevertheless, there is a possibility among retirees to work
58 part-time or have their own business at the retirement destination. Thus, income tax is relevant as a pull motivator in this context.
Retirees seek a casual and leisurely lifestyle (Casado-Dıaz et al., 2004; King et al., 1998; Rodriguez et al., 1998; Rodriguez et al., 2004) during retirement where coastal areas (e.g. the Mediterranean, the Carribean, Antalya, Penang, Phuket, Bali, and others.) are perfect choices. Rodriguez et al. (2004) reported that almost 49% of the respondents indicate the informal Spanish lifestyle draws them to retire in Costa del Sol.
During retirement retirees emphasise on rest and relaxation.
The availability of healthcare and medical facilities (Gibler et al., 2009;
Rodriguez et al., 2004) can be an important pull motivator to international retirees, particularly for those who have health problems. Most retirees will evaluate a retirement destination, in this regard, to ensure the healthcare and medical facilities suit their requirements and needs. Consequently, international retirees will evaluate the pull motivator of ‘availability of care for the elderly’ in the retirement destination. Ono (2008), in her study of Japanese retirees in Kota Kinabalu, Malaysia discovered that Japanese retirees need to ensure that the retirement destination has good and reliable care service for their parents who also join them retiring in Malaysia. This shows that the evaluation for a particular motivator may not be necessarily for the retirees themselves, but also for their partner or family member(s) who follow them along.
Sunil and Rojas (2005) reported that American retirees migrate to Mexico due to the Mexican people. This shows that friendly locals play an essential role as pull factor.
Besides that, Gibler et al. (2009) and Rodriguez et al. (2004) in their articles also pointed out that the retirees are able to connect better with the host country when there is in existence of other expatriate communities.
Geographical closeness to home country (Gibler et al., 2009; Rodriguez et al., 2004) reduces travel hassle among retirees between the host and home country.
59 Closeness between the retirees and their family members at home country can be ensured as more frequent trips can be made by both parties to each destination. This motivator is observed among the European retirees who retire within the European continent (e.g. Breuer, 2005; Casado-Dıaz et al., 2004; Gibler et al., 2009; King et al., 1998; Rodriguez et al., 1998; Rodriguez et al., 2004) and the American retirees who retire in Central and South America (e.g. Dixon et al., 2006; Sunil & Rojas, 2005).
Pull motivators such as children and family (Breuer, 2005) and family networks and kinship (McHugh, 1990; Mullins et al., 1989) drive the retirees to retire in the destination where they can be united with their immediate family members. Marshall and Longino (1988) studied the Canadian retirees retiring in Florida and found that the distance between the retirees and their relatives also acts as a motivator. The close distance enables the retirees to seek social support from their relatives. The easy access to the retirement destination by air further reduces the distance and escalates the reach of retirees to their children and family (Breuer, 2005).