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Wellness tourism and medical tourism...different concepts?

Women relaxing in a wellness spa

Susie Ellis, board member of the Global Spa Summit, and president of SpaFinder, Inc., outlines the key findings of a new report on the Medical Tourism and Wellness Tourism Industries and explains how medical tourism and wellness tourism may be viewed as two different concepts.

The new report is a collaborative effort between Katherine Johnston, a research scientist at US-based 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.  Susie Ellis served as an advisor with a long background in the global spa industry.

Entitled “Wellness Tourism and Medical Tourism: Where Do Spas Fit?” the report represents an 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 covering critical issues for medical tourism and wellness tourism: case studies of the approaches used for developing, organizing and promoting medical tourism and wellness tourism in 12 countries, the results of a survey of 200-plus industry executives and recommendations for governments and businesses to move forward.

Defining medical and wellness tourism

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 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 following 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.” 

[ Zoom ]
Global Spa Summit diagram
The Wellness Continuum

As you see, SRI plots these nine industry sectors comprising the wellness market 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” representing wellness’ core focus. 

One surprising, significant finding from this SRI study was 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 medical tourism market at $50 billion. The study further provides an in-depth analysis of the origin and evolution of the term “wellness,” which reveals just how young the term/concept is. The term “wellness” was first introduced in 1961 by physician Halbert L. Dunn (in the title of his book, High-Level Wellness), and 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 ’80s and ’90s, and around 1990 the term began to be used in Europe.  Subsequently, as we all know, the term’s usage 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.   

A model for understanding wellness tourism and medical tourism

The new 2011 report endeavors to clarify the relationship between medical tourism and wellness tourism by deploying a helpful organizing principle, mapping both “tourisms” according to where they fall on a spectrum from standard, “generic” experiences, to authentic, “location-based” ones.

[ Zoom ]
Global Spa Summit diagram
The Wellness Tourism and Medical Tourism Market Spectrum

This new model clarifies some very real distinctions between the too-often-conflated medical and wellness tourisms, stressing that while both of these industries’ products/services exist upon a continuum from generic to location-based, wellness tourism models tend to fall squarely within the “authentic, location-based” quadrant.  The graphic 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, collaborative…and yes, often focused on subjective, intangible, even whimsical, experiences. The medical world obviously uses the term “patients” and prides itself on expertise ─ while spa/wellness businesses use the term “guests” and focus on ambience/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 Canyon Ranch Destination Resort Spa’s partnership with the Cleveland Clinic, which ultimately unravelled after many years of attempting to forge the right relationship.  (Perhaps we can expect more success in the future as both medical and spa/wellness professionals begin to understand each other better.)      

It’s 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.

Key findings and conclusions

While the report presented too many findings and conclusions to detail, here are several speaking directly 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 all tourism sectors, 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.

  • 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 for medical tourism campaigns ─ or their immense wealth of indigenous, traditional and natural asset-based wellness/healing traditions for wellness tourism.

  • 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.

Recommendations of the report

The report recommended initiatives that could help various industry players take advantage of the medical and wellness tourism markets.  Those most directly related to medical tourism stakeholders include:

  • Establish clear and consistent definitions for medical tourism and wellness tourism and 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 or strength.

  • Market your offerings to domestic, intra-regional and international medical and wellness tourists – 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 wellness 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 spa sectors.

In conclusion...

This interesting new report should prove useful for any entity – whether public sector or private – who wants to forge an informed wellness tourism or medical tourism strategy. The 12 case studies provide an especially helpful window into how various countries (at different states of promotional development) are organizing themselves (both effectively and ineffectively) in the face of these potentially 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.  The entire report can be accessed for free: read the report.

Comment

Profile of the author

Susie Ellis, Global Spa Summit

Susie Ellis is a board member of the Global Spa Summit (an organization and event for top spa and wellness industry executives), and president of SpaFinder, Inc., (a global spa media and marketing company). She can be contacted at: Susie.ellis@spafinder.com.

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Thank you for this article. Also in Europe there are lot of discussions about what is Medical, Spa, Wellness etc Tourism. I would like to mention one more source what helps to understand this topic -WHO Constitution and definition of Health.

Armands Muiznieks (05/12/2011 08:40:32)

Great article. It's so helpful to have this research to properly define each sector!

My concern is the public awareness of the word "wellness." In my experience working with social media marketing as well as wellness coaching for spas, spa-goers do not seem to understand what wellness truly means. There is still the perception that wellness is simply diet, weight and exercise, rather than understanding it from the true holistic perspective of wellness as a lifestyle moving toward a healthy integration of mind, body and spirit.

To me, it seems like education and communication is crucial to the success of both medical and wellness tourism. If patients/guests truly understand what each is and the differences between them as you describe, they may be more inclined to participate. Awareness is key!

Glad I found this report and thank you again.

Stacy Conlon (22/10/2011 23:10:28)

In 2006, healthCare cybernetics (hCc) - a think and do tank with an internationally recognized thought leader with competence in Health Tourism Development, disambiguated and provided the definition and scope of Health Tourism.
“Health Tourism” is the collective term for services related to health and involving some travel.
These services are classified under 8 Segments:
Medical Tourism
Dental Tourism
Spa Tourism
Wellness Tourism
Sports Tourism
Culinary Tourism
Accessible Tourism
Assisted Residential Tourism

hCc has also provided the definition and scope of each of the Segments.
Of course, all this has been done after much thought – and after taking into consideration the interests of the Health Tourism Sector Stakeholders – including the Consumers / Market.

Convincing supporting arguments have been provided on why the definition and scope of Health Tourism, and the 8 Segments, makes sense.
From the perspective of the Industry – the clear advantage is that this creates an expanded industry to address a much broader market – meaning more business for all. Furthermore, it encourages cross referrals, which again means more business for all.

This 8 Segment concept also literally makes every tourist a potential Health Tourist. Thanks to information dissemination and awareness promotion, people are also beginning to consider Health Tourism as a lifestyle choice (from “have to” to “want to”).

Industry insiders are accepting and adopting this – because it makes clear sense – and does not conflict with legitimate interests of stakeholder groups.

Constantine Constantinides (22/10/2011 04:31:25)