By Joann Graham,2014-05-18 21:20
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    9.0 Objectives

    9.1 Introduction

    9.2 What is Health Tourism?

    9.3 Market Research and Analysis

    9.4 Designing the Health Product

    9.5 Development and Positioning the Health Tourism Product

    9.6 Future Trends and Scope of Health Tourism

    9.7 Case Studies

    9.8 Let Us Sum Up

    9.9 Clues to Answers


    After reading this Unit you will be able to:

    ? define the various forms of Health Tourism,

    ? describe the various forms of Health Tourism,

    ? design and develop a health tourism product, and ? comprehend the future scope and prospect of health tourism.


    For centuries health has been one of the main motivations for travel. Travelling for a change of weather so as to improve or to rebuild ones‟ strength/health has always existed.

    History traces it long back, though special places or destination for building health can be positively established since Roman era. The Roman Empire constructed „baths‟ popularly known as „spas‟ where various health-related services like massage, sauna, etc. were provided to visitors. Ordinarily, these spas were believed to be the resting place of divine nymph and it was believed that when a visitor used to take a dip in the holy water believed to have developed symbolic relationship with them. Later on, a city „Bath‟ in England became very famous as a destination for health tourists. This

    city boasted of baths either built by Romans or constructed on the lines of Roman baths. In modern world, health has become very precious. Feeling and looking healthy seems to be the mantra for today‟s fast moving generation. Consequently, many health related travel services have come up who looks after both the physical and spiritual well being of the tour package buyer. The customer/buyer/client/traveller has the choice of picking tours from various spas, health clubs, ayurvedic, yoga and spiritual centres. These are gaining popularity among corporate traveller who spends quite a lot of time away from home on business trips.

    In this Unit, we will first discuss about health tourism and its various forms, and will discuss about its link to tourism. Also we will discuss the various health tourism products, as you will learn how to design and develop a health tourism product.

    Finally, we will discuss the present and future scenarios and scope of health tourism.


    Maintaining, improving or rebuilding health is one of the motivators for travel. Health tourism constitutes of those travellers who travel for their health and to those destinations which cater to these travellers offering them a wide variety of services.


    Health travellers might be travelling to rejuvenate oneself at the spas, or for maintaining their looks by travelling to Swiss Cosmetic Surgery Clinics or even to Rishikesh for getting spiritual upliftment for a

    healthy and spiritualistic life. This segment consists of tourists who either go for only one specific

    health benefit or others who have desire for a complete package. For example, going to China to get

    treated of backache with acupuncture and acupressure is the example of former travelling to Kerala

    for ayurvedic treatment for entire body.

    Basically, at present three forms/types of health tourism can be identified. They are:

    1) Change of weather: A very common trend among all of us is to travel for a change of weather.

    Mostly, after some illness or mental trauma, physicians prescribe a change of weather, a change

    of scene. For a very long time this practice of travelling to a pleasant place to regain health and to

    rebuild strength has existed. A weather/climate change from hot to cold/warm and vice versa or

    wet to dry and vice versa is seen as a way of regaining health. For example, after a bout of asthma

    one advised to travel to a dry, preferable pollution and pollen free region. All of us have either

    taken such a break our self or at least know someone, who has. Maybe someone among family,

    friends or relative have taken such a trip after much consultation among family members, travel

    agent and also physician.

    2) Availing A Specialised Service: Many health destinations have come up over the years. But

    1990s have seen a real boom in health tourism, especially in India. Destination specialising in one

    service such as hot spring spas or sulphur geysers or ayurvedic centres or yoga centres have come

    up. The destinations are now popular as specialised health destination. A lot many sites can be

    found on the internet highlighting services of such centres, like the health spas around dead sea.

    Israel is promoting health tourism based on Dead Sea in a very big way.

    Dead Sea is promoted/marketed as a place/destination with unique combination of salts and

    minerals, higher oxygen content and therapeutic mud which alleviates skin conditions, muscular,

    articular and some respiratory problems. Many sites on the heating effects of Dead Sea are posted

    by travel agents, state tourist board and also hotels such as Hyatt Regency. These sites have

    information on specialised treatment sessions for dermatological problems, Arthritic and

    Rheumatic conditions, Respiratory conditions and so on. Sometimes one spa or treatment clinic

    provide only one service and sometimes all the treatment facility.

    Similarly, spas and health centres worldwide talk about the “foundation of youth” springs and hot

    spring geysers, especially in New Zealand.

    3) Packaging A Treatment Destination: The latest trend in health tourism is to package a

    destination ideal for medical attention and treatment. Mostly a particular city or a region as a

    whole is promoted as a place for conventional medical treatment methods. The attraction here is

    the low price for the same or better medical facilities than at home, along with sight seeing and

    travelling during the recuperation period. Practically, the more serious patients are notable in such

    travel but the people or family members with them are also able to travel and at times act like


    Leading among such treatment travel is Cuba, especially for the American tourists/patients. India

    is also packaging itself in similar terms. Ayurvedic treatment and yoga are two upcoming

    products in this regard in the international tourism market. Thailand is trying to shake off its

    previous notorious popularity and gain ground as a tourist destination for health tourism.

    Speaking about Thailand (as a case study), it is emphasising on long stay health care, wherein the

    target patients from developed countries can stay/afford long-term treatment away from home.

    Usually these health resorts in Thailand provide medical facilities for checkups or treatment. The

    resorts also incorporate other activities such as traditional Thai massage, spas and herbal

    treatment. Speciality services, such as, dental care may be arranged on request and cultural tours

    are usually thrown in.

    Government of Thailand regulations require the participating resorts to meet stringent standards

    of service. So far about 60 resorts have applied for inspections. In addition, short-stay health care

    targets include executives who would like to take a short vacation in Thailand and have their

    periodical health check-up or some minor health problems taken care of without waiting in long

    lines. The cost of health care in Thailand is relatively cheap. A coronary bypass at a leading 104

    Bangkok hospital costs US $6500, approximately half the US price. Annual income of Thailand

    from health tourism is estimated to be around US $40 million according to the officials at the

    Ministry of Commerce (Source on Thailand: oct2000/headline/healdine_main.htm).

    4) Special Need Tourism: This is basically a very new trend. We cannot actually term it as health

    tourism since the tourists in this case do not actually come for any medical treatment or health

    related issues. But in this case the tourists are tilted towards those destinations which can cater to

    the guest‟s special medical needs. We can club this tourist segment with health tourism, since

    health related factors and reasons lead the tourist to decide on a tourist destination. Hospital

    treatment is not only costly in Europe but even for operations i small ailments like cataract, etc

    tour operators have come up with medical treatment-cum-luxury packages and these are

    becoming increasingly popular even in the domestic tourism markets.


    Market Research and its analysis is most important step when any product or service is to be designed

    to cater to a specific market segment, and to find or create a niche market. Market research also plays

    a significant role in designing and developing health tourism products since as a blend of tourism and

    medical service it is a unique tourism product. It is a very specialised service requiring collaboration

    between both the medical experts and the product designer, i.e., tourism product and destination

    service developer.

    The term „medical experts‟ in health tourism field does not limit itself to the MBBS qualified doctors

    but it is a term enclosing all the medical practitioners, i.e., medical practitioners from both traditional and alternative medicines. The alternative medicine practitioner can be an ayurvedic exponent or reiki

    expert or may be an acupuncture specialist. A complete health tourism package will consider both the

    potential of the alternative medicine and its expert along with the destination‟s other attraction. For

    example, the ayurvedic centres of Kerala have packaged their health resorts as the health care and

    rejuvenation centres nestled in nature, God‟s own country. A unique and tasteful combination of

    health care and nature has been thus designed and marketed. Thus, a niche market has been created

    and catered to which includes people willing to pay a little extra to enjoy nature with health care or

    vice a versa.

    Since health tourism product is unique in itself, the market research needs to concentrate on two

    specific aspects:

    1) What does the health tourism market and tourist need/require?

    2) Which destination or does the desired destinations have the resources needed to cater to the

    market need?

    As explained in the earlier units, the first aspect is dealt with in every market research that is

    undertaken for a new product or service. Let us take up these two aspects in detail:

    1) Market and Tourist Need Market: Research is undertaken primarily to understand the needs

    and requirements of tourists undertaking these health tourism packages or trips. The research

    helps to primarily assess as to what aspect of health tourism, i.e., the product or service will catch

    on with the travelling public. A market niche is looked for or created through promotion of the

    product. One can decide to venture into the market with an existing or totally new concept. For

    example, an already existing and a very common product in demand among health tourism

    products is the lure of youth. Although not an ailment, retaining youth has always been on the top

    priority agenda of rich and famous. We regularly come across advertisements of anti-aging

    cosmetic products on various media channels. But for the rich and famous, anti-ageing treatment

    involves treatment sessions in various anti-aging treatment clinics. Media has time and again

    linked clinics in Switzerland with the beauty and vitality and youth of most of the Hollywood

    people and many other people from the world‟s who‟s who have been attracted towards them.

    Therefore, this aspect of health tourism forms a chunk of the tourist arrivals in Switzerland. An

    existing product in a new destination can also be decided upon, such as opening ayurvedic health

    clinics in Delhi and so on. A common factor for initiating health tourism trips is rejuvenation.

    This is a very common motivator and ayurvedic sessions are very well known for these.


    Thus, market research helps you to decide upon your choice of product or services, i.e., it helps

    you ascertain which aspect of health tourism you should opt for. Also the market segment can be

    decided upon, whether to focus on domestic or international tourists or both, the regions, age

    group, income group, etc. Thus, the product developed will be tailor made for the target market.

    For example, market research might bring forth the fact that domestic tourists of middle income

    groups are looking for a health centre which will be economically viable. Furthermore, the basic

    need for health care centres is to get rejuvenated and get minor ailments taken care of. Thus, the

    developer and designer have an idea to work on and the scope of developing it as a service to

    fulfil this particular market need. For putting together an economically viable package the

    developer will have to distinguish between the core product and ancillary services. You will read

    about it in the next Section.

    2) The second aspect is to look into the availability of resources and experts for the project in

    question. Each time a developer considers bringing about a new project the resources, let it be the

    land, qualified personnel, supply of vegetables, etc. also needs to be considered. Also the

    destination has to be assessed properly in terms of accessibility, proper infrastructure and also the

    carrying capacity of destination. In addition to the above, in case of health tourism a few other

    factors also need to be considered. Unlike other tourism product, in the case of health tourism all

    the resources are not from tourism sector, they are from medical fraternity. Before the destination

    is decided on, a checklist regarding the same would be helpful. For your reference sample check

    list is illustrated here:



    1. Natural Environment 2. Climate (Warm, Low Humidity, etc.) 3. Antique Curio Shops 4. Geysers (Hot/Sulphur) 5. Health Resorts (Traditional/Alternative Medicine) 6. Lakes/River 7. Medical Experts 8. Entertainment 9. Beach/Pool 10. Resources for Treatment (Herbs/Oils, etc.) 11. Nature Walks 12. Springs (Hot/Minerals) 13. Treatment Practitioners 14. Accommodation 15. Theme Restaurant 16. Water Falls 17. Any Unique Feature To this checklist can be added many more items which will help you to ensure whether the destination

    that you have selected as your product base is appropriate or not. Coming up with a world class

    product without any long term resource backing will result in a bad experience for all involved. This

    is where Market Analysis comes in. Market analysis will study the project in question from all angles

    starting with the tourist needs, target market, the destination with its carrying capacity and

    sustainability as a destination in terms of resource availability. The analysis will consider all the

    aspects and help you, the tourism product designer and developer, to come up with a product which

    would prove to be both popular and profitable. Of course, you can utilise the services of consultants or

    specialists in this regard.



    Once you decide on the destination and the health care service that you are going to offer, getting the

    right product mix will ensure that you get maximum returns on your investments in terms of money

    and efforts. To decide on your product mix you need to consider whether you would:

    ? be providing specialised services. For example, Ayurvedic Centres for heart patient, acupuncture

    centres for back problems, etc.,

    ? be situated right in the heart of town or outside the city limits. For example, say health care

    centres in the heart of town/city for the chronic patients looking for rehabilitation and who cannot

    travel far, and

    ? have a new product and create a market for it or work out a niche for yourself in the existing

    market. For example, anti-ageing clinics are always a hit.

    Once you decide on the product or type of product you want, product designing comes in. Product

    designing helps you to give the desired shape to your product/service and decide on the product mix.

    As you have read in MTM-6 and preceding Units that the best approach to design tourism

    products/services is to distinguish between the core and the supporting attractions. Core attraction is

    the basic need a service provider is trying to provide for while supporting attractions are the ancillary

    services associated with the basic need.

    We will approach the designing of a tourism service on the basis of the five product levels as

    mentioned by Philip Kotler. Let us again consider the example of a health resort which is

    economically viable. The need was felt specifically for a health care centre providing treatment of

    minor ailments and rejuvenation packages. The product/service to be provided was decided upon as

    an ayurvedic package. So the five levels would be:

    LEVEL 1 CORE BENEFIT Rejuvenation Package LEVEL 2 GENERIC PRODUCT Ayurvedic Centre LEVEL 3 EXPECTED PRODUCT Ayurvedic treatment with herbs and oils, Qualified

    practitioner/expert, food, accommodation

    LEVEL 4 AUGMENTED PRODUCT Various Rejuvenation Programmer (Rasayna Chikitsa, Kayakalp

    Chikitsa, Sweda Karma and others), Qualified and Expert

    Practitioners, Accommodation in AC Rooms or cottages, Multi-

    cuisine Restaurant LEVEL 5 POTENTIAL PRODUCT Gymnasium, Herbal Steam Bath, Medicated Pool, Mineral Bath,

    Herbal Garden, Indoor and Outdoor Games, Accommodation

    with treatment rooms and kitchen, Multi-cuisine Restaurant

    providing food of your choice or diet food as advised by the

    doctors, etc.

The above model shows the step by step process to design a product. Identifying a need and then

    adding various additional attractions lead to the designing of a product or service. Providing the extra

    gives you the edge over your competitors. In the modern service industry, more value additions are

    given to attract and retain customers. For example, one of the health cares in Kerala provides a

    combination of services. The centre is accessible from Cochin or Calicut airport and according to their

    website, it is situated in the beautiful countryside of Kerala. Their product design combines all the

    attractions mentioned in level 5 along with trips to local tourist spots, elephant camps, etc. Also

    resident and visiting doctors provide consultation and supervise treatments. (Source:

    Let‟s now consider another example dealing with another aspect of health tourism, namely

    „rehabilitation‟. Rehabilitation is mainly after a person has undergone some serious illness, but this

    term is very commonly used only in context of the people who are chemically dependent. As the case

    may be, the tourist in question could be a post-operative patient or someone recovering from a bout of

    serious illness or accident. So, while designing the product, the levels can be:


    LEVEL 1 CORE BENEFIT Rehabilitation LEVEL 2 GENERIC PRODUCT Rehabilitation Centre LEVEL 3 EXPECTED PRODUCT Medical facilities, Doctors on call, Nurses, Accommodation and


    LEVEL 4 AUGMENTED PRODUCT All types of Medical Facility (Labs, OT, latest gadgets, CT Scan

    facilities, etc.), both Resident Doctors and visiting Experts, 24

    hours Observation under specially trained and experienced

    nurses, different types/categories of accommodation and food.

    LEVEL 5 POTENTIAL PRODUCT World Renowned Medical Consultants, Special Units for

    different illness, Counselling sessions with psychiatrists, natural

    beauty of the area surrounding the clinic, trips to local

    attractions, health building exercises with physiotherapists, etc.

From the above example you can see that to arrive at the right product mix, one needs to have an in

    depth knowledge about the services associated with the product you are planning to design or sell and

    only then one can decide upon the supporting attractions/ancillary services that goes with a basic or

    core service. Getting the right product mix will ensure that you get maximum returns, the prime

    motive behind running/any enterprise.



    Once you have decided on your product mix, its time for you to develop it and position it in the

    market and finally create a niche. Developing the product/service involves developing the

    infrastructure to sustain the tourist flow and also the product while developing a product we need to

    consider the following (Source: The Tourism Development Handbook, by Kerry Godfrey and

    Jackie Clarke):

    1) Product Life Cycle: One needs to consider all the growth aspects of the product. Just developing

    a product is not the beginning and end of the product development rather product should be

    developed in such a manner that it sustains the tourist interest for a long way to come.

    For example: Take the example of yoga and health packages in Rishikesh. So to develop the

    product for long term, lets see the steps that will be involved:

    st1 year Yoga classes special for beginners

    nd2 year Yoga classes for curing specific ailments

    rd3 year Yoga + Reiki

    th4 year Yoga + Reiki + Ayurveda

    th5 year Yoga + Reiki + Ayurveda + Spiritual upliftment talks and so on.

    We can keep on adding features to the above to sustain tourist interest.

    2) The Product Portfolio: This stage makes you consider the various aspects of the inter-

    relationship between revenue produced and resources used.

    For example, segmenting the resources used according to the target market enables you to keep

    track of revenue and resources. Making Ayurveda packages to deal with specific ailment is an

    example of this.

    3) Relevant Gaps: One can add more to the product line and accordingly lengthen it or deepen it.


    ? Lengthen by adding more products to an existing line, like spirituality, meditation, talks on


    ? Deepen by adding more product items such as speciality treatment in ayurveda and so on

4) Analysis of Tourist Satisfaction: A check on the services provided should be maintained by

    judging the tourist reaction to them. A check on tourist reaction helps one decide on upgrading

    and providing better services. Regular feedback system through questionnaire or interface with

    tourists can always help you in improving or adding value to your services.

5) Development of Product Differentiation: The product should be distinct from competitors and

    have an identity (branding). This would ensure that your product stands out to the tourist. For

    example, opening an ayurveda centre, complete with modern health care facilities and the essence

    of ancient baths of Romans would be more than an ayurvedic centre and would be more of a

    health care centre.

It is up to you as developer to distinguish the various product levels and come up with a unique

    sustainable product so as to satisfy the identified market needs and receive quick returns on your


Once the product is developed, you need to introduce the product via proper promotional methods.

    This would ensure that the target market is made aware of the product and the product gets positioned

    accordingly. Product positioning is about reaching the target market and creating a distinct identity as a product. For example, Kerala has positioned itself as Gods own land where God blesses the curators

    or medical practitioners to rejuvenate the health of ailing suffering visitors.


    A trend that shows much scope in future is the travel taken by people to have surgeries performed in a

    foreign country. There are various reasons for this. For example, there is a long queue for operations

    like cataract in UK and the cost is also high. Such operations are easily done in India and at a much

    lower cost. Many countries including India are viewing for this tourist bracket by projecting

    themselves as countries with best medical care facilities and opportunities for hassle free recuperation.

With the increasing number of middle aged and senior citizens all the tourism products are targeted at

    these markets. An everlasting product for health tourism is the lure of youth. This tourism health

    product will always have takers. The trend going on shows a tilt towards alternative medical treatment

    and for some time to come the tilt will be towards alternative treatment.

    An important factor to consider here is that although health tourism attracts tourists from world over, for a country like India it‟s the domestic tourists who can play a major part in revenue generation.

    And, therefore, products developed should always consider them.


Health Tourism in India immediately conjures up the image of Kerala. Kerala has come up as one of

    the major tourist destinations and is one of the „50 must see‟ destination as prepared by National

    Geographic Traveller magazine.

Both domestic and foreign tourists have patronised Kerala for health tourism. Natural beauty and

    ayurvedic treatment have lured tourists to Kerala. Ayurvedic treatment is best remedy if taken during

    monsoon months. The tourist data provided shows an increase in tourist arrival during the monsoon



    Table 1: Monthwise Arrival of Domestic Tourists to Kerala

    Sl. No. Month 2001 2002 2003

    1. January 472377 471608 511396

    2. February 399215 387550 427116

    3. March 396320 382452 400503

    4. April 498856 499217 514213

    5. May 479515 537429 566603

    6. June 383196 406500 450537

    7. July 396805 406622 421346

    8. August 428608 488050 469920

    9. September 432608 466928 496977

    10. October 427181 472056 513082

    11. November 442386 494481 526578

    12. December 482942 555363 572957

     Total 5240009 5568256 5871228

    Table 2: Monthwise Arrival of Foreign Tourists to Kerala

    Sl. No. Month 2001 2002 2003

    1. January 31625 29440 41845

    2. February 30862 29105 36163

    3. March 21957 19246 25261

    4. April 17868 18028 20106

    5. May 10653 10794 12675

    6. June 6571 6610 10820

    7. July 7747 8581 14824

    8. August 13373 14226 19240

    9. September 12629 17808 20253

    10. October 11913 20744 24702

    9. November 19310 26190 32165

    12. December 24322 31792 36567

     Total 208830 232564 294621

    Earnings From Tourism in Kerala

    Earnings from Tourism are very difficult to estimate due to various reasons. However, on the basis of

    surveys and studies conducted from time to time for the estimation of expenditure pattern, average

    number of stay of tourists, earnings from foreign tourists are estimated. The following table depicts

    earnings from foreigners since 1988.


    Table 3: Earnings From Tourism

    Year Earnings

    (Rs. in Crs.)

    1988 17.50

    1989 21.15

    1990 26.99

    1991 28.28

    1992 59.75

    1993 105.72

    1994 116.11

    1995 158.76

    1996 196.38

    1997 273.20

    Figures available with Ministry of Tourism

    are available upto 1997

    It is noted that earnings from Tourism shows an increasing trend over the years.

    Share of Kerala in Indian Tourism Market

    It is estimated that total foreign tourist flow to Kerala in 1997 was 182427 which constitutes 7.68% of

    the total foreign tourists visited India. Table 8 indicates the number of foreign tourist arrival to Kerala

    from 1993 to 1997 in relation to the total number of foreign tourist arrival to India.

    Table 4: Number of Foreign Tourists Visited India and Kerala and

    Share of Foreign Tourists Arrival to Kerala

    Sl. Year No. of Foreigners Share of Foreign

    Tourists Arrival to No. India Kerala Kerala %

    1. 1993 1442643 95209 6.60

    2. 1994 1886433 104568 5.54

    3. 1995 2123683 142972 6.73

    4. 1996 2287860 176855 7.73

    5. 1997 2374094 182427 7.68

    Figures available with Ministry of Tourism are available upto 1997 It is clear from the Table that foreign tourist inflow to Kerala is steadily increasing.

    The trends of foreign tourist arrival of the selected centres of tourist attraction from 1993 are given in

    Table 9.

    Table 9: Foreign Tourist Arrivals in Important Tourist Centres of the State

    Sl. No. Centres 1993 1994 1995 1996 1997 1. Thiruvananthapuram 50359 26019 27743 41636 42035 2. Kovalam 44850 28184 35122 37274 39384 3. Kochi 60761 78125 56590 61588 62371 4. Thekkady 16640 7881 6429 11023 12054 5. Kollam 9941 4871 4562 4697 4769 6. Alappuzha 12470 5022 6375 12811 12920 7. Kottayam 3706 1966 2137 2621 2756 8. Thrissur 2437 1135 1009 1995 1413 9. Guruvayoor 73 98 110 240 473 10. Palakkad 329 202 372 503 1265 11. Kozhikkode 3849 2566 2523 2467 2987

    Figures available with Ministry of Tourism are available upto 1997


     Check Your Progress

1) What do you mean by health tourism? What are its components?





2) How would you design and position health tourism products in Indian market?






    In this Unit, we have discussed aspects related to health tourism and how these existing potentialities

    can be converted into tourism products. This conversion will not only help the state economies to

    strengthen their regional development and finances required for them but it will also add value to our

    existing product line. In other words, so far we have been focussing upon cultural aspects of our

    tourism resources but now with the development of health tourism product we can attract more of

    need based tourist who can even spend more.

    In this context, we have also discussed the examples of Kerala and Rishikesh who have initiated the

    health tourism but more states of India will need to participate. For example, Rajasthan, Leh and more

    particularly north-eastern states.


     Check Your Progress

1) Sec. 9.2.

2) Secs. 9.4 and 9.5.


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