First In-Depth Research Report on
Medical Tourism and Wellness Tourism Released at Global Spa Summit

By Susie Ellis

• Persistent Problem of Definitions/Terminology
• Overview of Existing Industry Data
• Organizational Structures & Promotional/Development Models Worldwide
• Case Studies of 12 Representative Nations

Critical Finding: At the language, marketing and organizational level
– best not to intermingle these two distinct sectors
At the 2011 Global Spa Summit held in Bali, Indonesia this May, an important new research report analyzing the rapidly growing Medical Tourism and Wellness Tourism sectors was released.

It was a collaborative effort between
Katherine Johnston, a research scientist at SRI international;
Dr. Laszlo Puczko, head of the tourism division at Xellum Ltd. in Hungary; and
Melanie Smith (PhD), a lecturer, researcher, and consultant from Corvinus University in Budapest.
I served as an advisor contributing expertise from my specialty, the global spa industry.

“Wellness Tourism and Medical Tourism: Where Do Spas Fit
?” it represents the first in-depth exploration of medical tourism and wellness tourism as potentially two different concepts. With 130-pages-plus of data and analysis, it’s
comprised of four key sections.

Part I takes on four critical issues for both Medical Tourism and Wellness Tourism: definitions, an overview of existing industry data and current organizational structures and promotional/development models used by various countries to grow these sectors.

Part II is devoted to case studies of the approaches used for developing, organizing and promoting Medical Tourism and Wellness Tourism in 12 representative countries. The nations studied: Austria, Australia, Brazil, Canada, Hungary, India, Indonesia, Jordan, Morocco, Philippines, South Africa and Thailand.

Part III delves into the results of a survey of 200+ spa industry executives (also including medical tourism, government and private sector stakeholders), measuring their understanding and perceptions of the medical and wellness tourism markets and consumer, etc.

Part IV presents recommendations (in light of this new analysis and data) for governments and businesses to move forward. With the most powerful case being made for these two heretofore ill-defined and oft-confused concepts developing separately from each other (while supporting one another), and for governments and private entities to also promote them separately.

While the report was specifically
commissioned to investigate where spas best fit into wellness tourism and medical tourism, with this magazine’s audience in mind, I’ve set out to spotlight the content that speaks most directly to the medical tourism world

And I encourage all to read the complete research paper, available at:

Persistent Definition Challenges:

In the survey of spa/wellness industry executives undertaken for the report, respondents were asked to provide their own definitions for “medical tourism,” “wellness tourism,” and “health tourism” in an open-ended format.

Strikingly, roughly 25% of survey-takers either left these questions blank, answered “don’t know,” or said these terms were not defined in their country. Furthermore, 66% left the “health tourism” definition blank or answered “don’t know.”

This data reveals that there is a high level of confusion and lack of clarity around the very concepts of “medical tourism” and “wellness tourism,” even among core industry players, and that the confusion around “health tourism” is especially acute.

The researchers ran these aggregated responses through visualization software to compile
“word clouds” for each definition, identifying which terms are most frequently associated with each tourism concept.

The most frequently deployed terms:

Medical Tourism: “procedures,” “surgery,” “health,” “care,” “country,” and “treatments,” in that order.

Wellness Tourism: “health,” “spa,” “services,”
“travel,” “destination,” “relaxation” and “treatments,”
in that order.

Health Tourism: “wellness,” and “medical”
stood out, with almost exactly the same frequency.

The survey further revealed that despite this widespread terminology confusion, respondents felt strongly that wellness tourists are an entirely different consumer
segment than medical tourists: 94% argued that the needs/interests of these two types of tourists are
different. And this position held true for respondents across Asia, Europe, and North America.

After analyzing definitions currently in use
worldwide, in conjunction with the survey results and interviews conducted for the 12-country case studies, the authors recommended the follwing definitions:

Medical tourism involves people who travel to a different place to receive treatment for a disease, ailment or condition, and who are seeking lower cost of care, higher quality of care, better access to care or different care than what they could receive at home. The category also includes cross border travel by persons seeking cosmetic enhancements. It involves conventional medical approaches, performed by licensed medical professionals at medical facilities to solve problems.
The consumer: either ill or seeking cosmetic/dental surgical procedures or enhancements.

Wellness tourism involves people who travel to a different place to proactively pursue activities that maintain or enhance their personal health and wellbeing, and who are seeking unique, authentic or location-based experiences/therapies not available at home. These experiences may, but typically do not involve, medical doctors/facilities. The consumer: seeking integrated wellness and prevention approaches to improve their health/quality of life.

The study also recommended that, for the sake of consumer and industry clarity, the term “health tourism” be used very cautiously, or preferably not at all.
The authors argued against those who have suggested this term headline one, or both, breeds of tourism - although they acknowledged it would inevitably be used in some capacity by both.

MARKET SIZE: In their landmark 2010 study,
“Spas and the Global Wellness Market: Synergies and Opportunities,” SRI International developed a model of the $2 trillion wellness industry that was comprised of nine industry sectors, and depicted each sector along what they called “the wellness continuum.”

As you can see, SRI’s continuum plots these nine industry sectors according to where they fall in relation to both conventional, medically-oriented approaches and integrated, wellness-oriented approaches – with “solving problems” as the focus of conventional medicine, while “improving quality of life” represents wellness’ focus.

One surprising, significant finding in the SRI study was that despite the fact that “wellness” is a relatively young concept/term, the Wellness Tourism market has already reached $106 billion globally, more than double the size of the better-known, better-publicized Medical Tourism market at $50 billion! The study, providing an in-depth analysis of the origin and evolution of the term “wellness,” reveals just how young the term is. First introduced in 1961 by physician Halbert L. Dunn, as the title of his book, “High-Level Wellness,” the world’s first wellness center (the Wellness Resource Center in California) was opened by Dr. John W. Travis in 1975. Workplace wellness came on the scene in the 80’s and 90’s, and around 1990 the term began being used in Europe.

Subsequently, as we all know, usage of the term became widespread, and was increasingly deployed quite imprecisely in marketing. (Because of this phenomenon, some health professionals have begun to distance themselves from the term.) But it has found a more receptive audience in the fitness, spa and integrative health arenas, where today it’s becoming an umbrella term for a host of approaches.

The new 2011 report endeavors to clarify the relationship between medical tourism and wellness tourism by deploying a very helpful visual, which maps both along a spectrum from more standard, “generic” experiences to authentic, “location-based” ones. Note the way diverse types of establishments are situated across their four-quadrant model:

This new model not only helps us clarify the very real distinctions between medical and wellness tourism (which are too often conflated), it also stresses that both types of tourisms’ products/services exist upon a continuum from generic to location-based. It also helps remind us that medical and spa/wellness cultures are significantly different: with the medical arena characterized by rules and regulations and a serious, corporate and authoritarian structure - while the spa/wellness arena is less regulated, more entrepreneurial and collaborative …and yes, often focused on subjective, intangible, even whimsical, experiences. The medical world uses the term “patients,” and prides itself on expertise - while spa/wellness businesses use the term “guests” and focus on ambiance/experiences.

So, it’s not surprising that early efforts to unite the two concepts have proved challenging. I can cite dozens of business examples that have failed in merging medicine and spa/wellness. Perhaps the most telling is the popular wellness spa, Canyon Ranch’s, partnership with the Cleveland Clinic, which ultimately unraveled after many years of attempting to forge a relationship. There have been some successes, and perhaps we can expect more in the future as both medical and spa/wellness professionals begin to understand each other better.

It is worth noting (and could make an interesting further study) that there seems to be evidence that people who travel to another country on vacation (i.e., to experience a resort spa or yoga retreat) are more likely to select that country for
medical procedures. This makes the cross-promotion of wellness tourism and medical tourism a likely win-win scenario.

While the report presented too many findings and conclusions to detail, here are several that are directly relevant to the medical tourism industry:

• Medical tourism data is more widely available than wellness tourism data, however research data for both sectors (at both the country and global level) is spotty, unreliable and inconsistent.

• Organizational structures for developing, supporting and promoting medical tourism and wellness tourism vary widely from country-to-country, and tend to be closely linked to each nation’s overall governing structure (e.g., a centralized national government versus federal/state system, etc.).

• Governments in developing countries typically play a much more active role in guiding, supporting and promoting the tourism sector, while in developed countries, tourism sector development and promotion are typically more private-sector driven or collaborative in nature.

• Medical tourism has typically been more actively supported/promoted by governments than wellness tourism. Possibly because medical tourism is an older, more established concept; has a growing international profile in recent years; is easier to define; and is oft perceived by governments as more “lucrative” than wellness tourism. This is changing: more countries and governments are increasingly paying attention to both sectors.

• Countries with well-developed public-private collaborative bodies (i.e., medical tourism or wellness tourism “cluster networks” or associations with broad participation) typically (and not surprisingly) function more effectively in development/promotion than those with fragmented, ad hoc structures.

• In countries’ promotional materials (such as national tourism websites), wellness tourism tends to be more heavily emphasized than medical tourism.
Wellness tourism promotion also tends to be heavily dominated by spas (even if the country possesses many other wellness-related offerings). The degree of emphasis on unique/local offerings and traditions varies from country-to-country, but is broadly increasing over time.

• Medical tourism promotion tends to be more private-sector-driven. The most widespread promotional/marketing approach is for a country to attempt to reach potential tourists through medical tourism facilitators, rather than engaging in direct online promotion or traditional tourism promotional channels.

• The countries with the most well-developed medical tourism and/or wellness tourism sectors (and brand images) tend to be those where the national government has already established itself as a/the leading player in promoting these sectors.

• Many countries do not yet have a strong national brand image for either medical tourism or wellness tourism, even in countries considered to be leading market players. Too many “generic” or standardized products/services are on offer, and most countries are not effectively capitalizing on their specialties, or their immense wealth of indigenous, traditional, and natural-asset-basedwellness/healing traditions.

• As medical tourism and wellness tourism markets become more crowded and competitive, it will become increasingly important for countries to differentiate
themselves around factors other than cost and quality.

The report recommended initiatives that could help various stakeholders take
advantage of the medical and wellness tourism markets.

Those most directly related to medical tourism include:

• Establish clear and consistent definitions for medical tourism and wellness tourism and
• a emphasize the distinctions between the two. Minimize use of the term health tourism.
• Encourage a cooperative spirit between medical tourism and wellness tourism, and carefully build collaborative relationships with key players in both sectors.
• Don’t just promote a long menu of generic services and products, focus on what you’re really good at: areas where you have a well-developed and recognized specialization
aor strength.
• Market your offerings to domestic, intra-regional and international medical and wellness aatourists – all are strong opportunities, but may have very different needs and interests.
• Governments and the private sector would be wise to promote medical tourism and/or
• awellness tourism individually depending on the country’s expertise and ability to deliver.
• Improve and expand data collection efforts for the medical tourism, wellness tourism and a spa sectors.

In Sum:
This informative, interesting new report should prove very useful for any entity – whether public sector or private – who wants to forge a smart wellness tourism or medical tourism strategy.
The 12 case studies provide an especially helpful window into how various countries are organizing themselves (both effectively and ineffectively) – in the face of these explosive opportunities. It represents the first time that such a wealth of information on these young “tourisms” has been aggregated and analyzed - a real resource for both established players and those just getting into the game.

Board Member of the Global Spa Summit
(the leading annual organization and event for spa and wellness executives), and President of SpaFinder, Inc., (the largest spa media and marketing company in the world). You can contact her at: Susie.ellis@spafinder.com