ISSN 1800 6620 UDK 338.

48

TOURISM
VOLUME 2 ISSUE 3
ESTABLISHED 2007

SELECTIVE
INTERNATIONAL ACADEMIC JOURNAL

ISSN 1800-6620 UDK 338.48

SELECTIVE TOURISM
INTERNATIONAL ACADEMIC JOURNAL
ESTABLISHED 2007

ISSUE 3

SELECTIVE TOURISM
CIP , UDK: 338.48 SELECTIVE TOURISM / editor Aleksa Vueti Vol. 1, br. 1 (2007) . Igalo (Skojevska 7): Center of Tourism Development, 2007 (Podgorica: Studio Mouse). - 25 cm Godinje ISSN 1800-6620 = Selective Tourism (Igalo) COBISS.CG-ID 12008976 International academic journal Copyright2008, Center of Tourism Development. All rights reserved. This journal is founded and published by: Center of Tourism Development Skojevska 7 85347 Igalo Montenegro www.ctdmont.com ctdmont@gmail.com Editor in chief: Aleksa Vucetic, PhD aleksavucetic@gmail.com Editorial Board: Aleksa Vucetic, PhD University of Montenegro, MNE Andreas Kagermeier, PhD University of Trier, DEU Djamal Benhacine, PhD Munchen University of Applied Science, DEU Dragan Tesanovic, PhD University of Novi Sad, SRB Greg Ringer, PhD Royal Roads University, CAN Larry Yu, PhD George Washington University,USA Renata Tomljenovic, PhD Intitute of Tourism Zagreb, CRO Tatjana Stanovcic, PhD University of Montenegro, MNE Zoran Klaric, PhD Zagreb School of Management, CRO Business Secretary: Mladenka Stankovic Subscription Department: Radoslav Coso

WWW.CDTMONT.COM

Issue3

SELECTIVE TOURISM CONTENTS IMPACT OF TOURISM POLICY ON DEVELOPMENT OF SELECTIVE TOURISM ....................................................................................... 4
Aleksa Vucetic, PhD
University of Montenegro Faculty of Tourism and Hotel Management Kotor, MNE Center of Tourism Development, Igalo, MNE

SELECTIVE TYPES OF TOURISM AND SELECTIVE BUSINESS STYLE......18

Tihomir Lukovic, PhD
University of Dubrovnik Department of Economy and Business Economy, CRO

GERMAN HEALTH AND WELLNES VACATIONERS: MARKET ANALYSIS AND RECOMMENDATIONS FOR ACTION .................................. 32
Djamal Benhacine, PhD
Munich University of Applied Sciences - Faculty of Tourism, DEU

Tanja Hanslbauer, BBA

Munich University of Applied Sciences - Faculty of Tourism, DEU

Stefan Nungesser, BBA

TREUGAST International Institute of Applied Hospitality Sciences, DEU

LIMITING FACTOR OF RURAL TOURSM DVELOPMENT IN MONTENEGRO................................................................................................. 52

Ilija Moric, MSc
University of Montenegro Faculty of Tourism and Hotel Managemen Kotor, MNE

HISTORY OF SPORTS TOURISM IN MONTENEGRO ...............72

Dragan Klaric, MSc
Public Service Radio Budva , MNE

Issue3

WWW.CDTMONT.COM

SELECTIVE TOURISM
UDK: 338.48-6:615.8(430) REVIEW ARTICLE

GERMAN HEALTH AND WELLNESS VACATIONERS: MARKET ANALYSIS AND RECOMMENDATIONS

Djamal Benhacine, PhD & Tanja Hanslbauer, BBA
Munich University of Applied Sciences - Faculty of Tourism, DEU

Stefan Nungesser, BBA

TREUGAST International Institute of Applied Hospitality Sciences, DEU

Abstract The tourism health market in Germany is a strongly growing market. In 2007, health related vacations already mounted up to one point seven mil. For the year 2020, a total of three point three mil. health related vacations is expected. Due to the free rendering of services in the European Union and its interpretation by the European Court of Justice, the German source market for health tourism becomes attractive for touristic service providers in foreign countries of the European Union. This article aims to serve as a basis for decision-making for service providers with regards to positioning themselves competitively in the market for German health vacationers. Therefore, the German tourism health market is being analysed. Then a typology for German consumer expectations with regards to health and wellness vacations, which has been developed in the European Union research project ALPSHEALTHCOMP, is being presented. Based on the typology and other existing consumer studies recommendations for actions, exemplary for touristic service providers hotel and destination marketing organisation , as to product and communication policy are being developed. Key words: Health tourism, German health market, alpine wellness, typology of consumer expectations, product and communication policy.

Received June 2009 Revised June 2009 Accepted June 2009 32

WWW.CDTMONT.COM

Issue3

SELECTIVE TOURISM INTRODUCTION

Tourism experts all over the world agree that senior citizens are a major driving force in tourism. Populations in Europe are ageing quickly and simultaneously the health sector continues to grow. The demand for products and services promoting health and regeneration is greater than ever. Not only at home but rather during vacation modern men strive for products and services promoting health and indulgence. Spa and wellness are booming. The segment of senior citizens reflects the sociological development in the developed countries which are the major source markets in tourism. Senior citizen in the age class 60+ contribute with a travel intensity of 75% to the growth of the German travel market. They represent 29% of all tourists in Germany. (Forschungsgemeinschaft Urlaub und Reisen e.V., 2006:7) The tourism industry has realized this trend and reacts quickly. New products in tourism such as themed vacations are being developed. Besides golf, riding, hiking, biking and culinary vacations nowadays wellness vacations have become standard offers in tourism. Due to political and financial decisions certain products and services are being relocated from hospitals to recreation centres (fitness, wellness, massages, thalassic therapy). The product portfolio of suppliers in this area covers a wide range of offers: traditional medicine from Asia, kinesiatrics, feel good short trips, dietetics, spherical harp music, beauty cure e.g... The trend is thereby obvious: to harmonize body, spirit and soul. The faculty of tourism at the Munich University of Applied Sciences has been working in this field since 2005. It has established itself over the years as an important research centre within the academic landscape. One of the faculties European Union co-funded research projects dealt with issues of health and wellness in the Alpine area. In the project, altogether seven partners from Italy, Austria and Germany took part. The start of the project was constituted by the signing of the partnership agreement in spring 2005. The project ended in February 2008. The aim was, amongst others, to analyse expectations in health and wellness vacations. A consumer profile was developed which is based on a representative survey for the German market (n = 1.607). The gained results will serve for product development as well as for quality management issues. This article presents these results and is a contribution to the general trend in wellness tourism. It is the authors belief that wellness tourism is a main pillar of future tourism development mainly due to two reasons: wellness tourism is environmentally sustainable and is being affected least by the issue of climate change.
Issue3
WWW.CDTMONT.COM

33

SELECTIVE TOURISM 1. THE MARKET FOR HEALTH AND WELLNESS TOURISM IN GERMANY

Health and business with health products and services are a mega trend in the 21st century. This was already predicted by L. A. Nefiodov at 1999. Nefiodov is continuing the work of the Russian scientist Kondratiev, who originally developed the theory of the long waves of global economic condition . According to this theory the global economy goes through long cycles which are induced by one respectively several basis innovations. These basis innovations and the emerging products and services dominate for a period of 40 up till 60 years the economy worldwide. At present, the global economy is in the sixth of the Kondratiev waves. This was induced by the basis innovation health with its aspects biotechnology, psychosocial health, fitness and wellness (Figure 1, the author depiction according to Nefiodov, 1999).

Figure 1. Kondratiev cycle

In Europe, this development is enhanced mainly by three factors: by the demographic development, resp. the gradual excess of age in populations. By shifts of values in society with growing health awareness through all age classes. And finally by the technological progress resulting in better and more expensive medical treatments and therapies. Health has become a growth market with an attractive growth potential in Central Europe. (Kartte & Neumann, 2005). In Germany, a strictly regulated first health market can be distinguished from a so called second health market. The distinguishing criterion is the issue of compulsory coverage and alongside with that the financing of products and services. (Illing, 2009:26-27). To the first health market all products and services are ascribed for
34
WWW.CDTMONT.COM

Issue3

SELECTIVE TOURISM which compulsory coverage with a social insurance carrier (health insurance, nursing care insurance, pension insurance and accident insurance) exists and which are fully or partially financed by the carrier. All products and services for which compulsory coverage doesnt apply, which are thus optional and self-financed, are ascribed to the second health market. A rising number of products and services which originated in the first health market are now partially self-financed (e.g. through a private additional insurance). Still they belong altogether to the first health market since the scales of fees and allocation regularities of the social insurance carrier still apply as such. E.g. this is the case with regards to dental additional insurance (different in the definition in Illing (Illing, 2009:26-27)). Here, the scales of fees of the public health insurance funds for dentists serve as a basis for assessment of the self-financed dental additional insurance (ARAG Krankenversicherungs-AG, 2006:3). In 2003 the total volume for the health market in Germany added up to 260 bil. according to a Roland Berger survey. This represents 12.2% of the German gross domestic product. This health market is being expected to grow over 70% until 2020. (Kartte at all., 2005:7). Especially for the second health market an attractive relative growth potential is assumed. In 2003 its market volume already added up to 49 bil. ; in the year 2007 it reached 60 bil. which represents a total growth of more than 22% in four years. Thereby every German citizen spends approximately 900 additionally for products and services such as medical products, fitness, functional food and prevention. (Focus Media Line, 2007:2). It is being estimated that in this second health market already an additional demand worth 26 bil. exists for which supply is missing. (Roland Berger Strategy Consultants, 2009). With regards to the market volume in health tourism as fragment of the health market as such, the Institut fr Freizeitwirtschaft in Munich prognoses the increase of health related vacations from one point seven mil. in 2007 up to three point three mil. in 2020 (total growth rate 90%) (Institut fr Freizeitwirtschaft, 2008:405). Is health tourism in Germany by trend to be placed in the first or second health market? For supplier this matter is important with regards to market volume and market development, but also because the guest patient (cf. for the term guest patient Illing (Illing, 2009:51)) is either self-financed (second health market) or fully respectively partially financed by the social insurance carrier (first health market). With regards to self-financed guest patients their motives and demand are the main factors of influence on the supply. With regards to guest patients fully or partially financed by a social insurance carrier the situation is somehow different. Here, additionally the legal framework, the scales of fees and the allocation regularities of the social insurance carrier too have influence on the supply. Suppliers abroad,
Issue3
WWW.CDTMONT.COM

35

SELECTIVE TOURISM e.g. in spa facilities in Eastern Europe, (Illing, 2009:81) often know little or nothing about the legal framework, the scales of fees and the allocation regularities in the German source market. Thus, it is difficult for them to acquire guest patients who are financed by the public health insurance funds. However the German source market in particular contains, especially for suppliers in foreign countries of Europe, high potential. This is mainly due to two parameters (Illing, 2009:43): The planned law on prevention by which primary prevention will become an independent pillar within the German health care system, financed by public health insurance funds. Insurants can then for instance receive funding for a course on healthy nutrition etc... The free rendering of services in the European Union and its interpretation by the European Court of Justice. It guarantees European Union citizens fundamental freedom of choice with regards to medical treatment either in the home country or elsewhere in the European Union.

How can the health tourism market now be distinguished from the health market in general? Kaspar says on health tourism: Health tourism is the sum of all relationships and phenomena resulting from the journey and residence of people whose main motive is to preserve, promote and if necessary rebuilt their physical, mental and social health by use of health care for whom the residence is neither principal nor permanent place of resident or place of work. (Kaspar, 1996: cited according to Illing 2009:4). Constitutional thereby is the principal consumer motive: the preservation, promotion and rebuilding of physical, mental and social health. This definition is consistent with the integrated definition of health in the preamble of the WTO constitution from 1946: Health is a state of complete physical, mental and social wellbeing and not only the absence of illness and ailment. (WTO, 1946: cited according to Illing 2009:7). The second main aspect within the definition of Kaspar is the translocation with which the consumption of health products and services has to be accompanied with. Hence all health products and services, which are consumed neither at the place of residence nor at the place of work can be ascribed to the field of health tourism. The principal consumer motive for health tourism can then be further differentiated according to the consumers state of health. Therefore two forms of health tourism can be differentiated: Health prevention tourism, which is being conducted by healthy consumer. Wellness tourism can be seen as a sub form of health prevention tourism.
36
WWW.CDTMONT.COM

Issue3

SELECTIVE TOURISM Health cure and rehabilitation tourism, which is being conducted by ill consumer. An ascription of health tourism and its sub forms either to the first or to the second health market proves to be difficult. The transition is fluent due to changes induced by the legal health care reform (e.g. primary prevention as task of the public health insurance fund) as well as due to changes in health awareness in German society (e.g. self-financed health cure). In order to discuss possible ascriptions the term prevention will be introduced. According to Caplan (Caplan, 1964:26ff) three forms of prevention can be differentiated: Primary prevention: preservation and promotion of health, obviation of the development of illness, prevention of risk factors through adequate programs and measures. Secondary prevention: obviation of the progression of early stages of illness through diagnostics and treatment. Measures to detect illness at early stages. Tertiary prevention: obviation of aggravation of manifest illness. Obviation or mitigation of secondary damage.

Secondary and tertiary prevention address consumer who are already ill. Public health insurance funds Die gesetzlichen Krankenkassen (GK) as one of the major social insurance carrier only provide in the case of illness according to their self-concept. Thus, secondary or tertiary prevention is traditionally their field of responsibility. (GKV, 2009). Health cure and rehabilitation tourism address per definition only the ill too. They are measures within secondary or tertiary prevention and are financed by the GK as part of their catalogue of benefits. Therefore they belong to the first health market. Historically, health cure tourism wasnt meant only for the ill. Rather, it had been a social, self-financed event for which ill and healthy met in glamorous health resorts all over Europe. Only from the second half of the twentieth century in Germany, health cure tourism became part of the catalogue of benefits covered by the public health insurance funds in order to rebuild the productivity of employees. Until the nineteen-eighties, health cure tourism could be mainly characterized through the so-called Sozialkuren which were health cures financed by the social insurance carrier. In the context of health policy reforms nowadays only medical necessary Sozialkuren are being financed by these carriers. Nevertheless, it is possible to go on a health cure vacation as self-paying patient. Approximately 80% of the guest patients in cure
Issue3 37

WWW.CDTMONT.COM

SELECTIVE TOURISM and therapeutic baths are self-paying patients. (Mller, 2009:3). This fully selffinanced health cure vacation belongs to the second health market. Primary prevention addresses per definition the healthy. Health prevention tourism can therefore be classified as a measure in the context of primary prevention. For public health insurance funds (GK) primary prevention had been for a long time not their field of responsibility. Primary prevention was subject to selfpaying patients and belonged to the 2nd health market. As a result of the health care reform in 2000 and the GK and Wettbewerbstrkungsgesetz (GKV-WSG) in 2007 primary prevention became part of the SGB V in 20 and 20a and therefore part of the responsibility of the GK. (Bundeszentrale fr politische Bildung, 2009) In 2007 public health insurance funds spent on prevention and workplace health promotion 300 mil. with the tendency still rising. (Medizinischer Dienst des Spitzenverbandes Bund der Krankenkassen e.V., 2007:3) If health prevention tourism is financed by the GK it belongs to the first health market. What does this now mean for supplier in the field of health prevention tourism? If guest patient are partially financed by the GK the criteria in the Leitfaden Prvention from the Medizinischen Dienst des Spitzenverbands Bund der Krankenkassen e.V. have to be applied (Medizinischer Dienst des Spitzenverbandes Bund der Krankenkassen e.V., 2007:17ff): Offers have to be of a neutral philosophy; In a trainer manual layout, aims, content and methods of units have to be lined out in written form; The target group aim has to be traceable; and The effectiveness of the concept in use has to be verified in a scientific evaluation process.

In this chapter it has been demonstrated that health tourism with its market potential in the first as well as in the second health market is attractive especially for suppliers coming from the foreign countries of Europe In the following chapter the German health and wellness vacationers will be characterised.

38

WWW.CDTMONT.COM

Issue3

SELECTIVE TOURISM 2. GERMAN HEALTH AND WELLNESS VACATIONERS

German health and wellness vacationers can be defined as consumers of health products and services in the context of health tourism. But they are also complex creatures which are not only acting as heavily cited homo oeconomicus, e.g. rational utility maximiser. Rather they are also acting as homo psychologicus, e.g. individuals striving for signification (Cohen, 1970) and homo sociologicus, e.g. carrier of social predefined roles at the intersection of individual and society (Dahrendorf, 1968:20). Consumer behaviour is furthermore being influenced by various other determinants (Kroeber-Riel und Weinberg, 2003:49ff). These are mainly: The broader social environment or culture of the guest patient vs. the closer social environment or family and reference groups; Personal determinants such as lifestyle or social demographics (age, education, sex, occupation, income etc.), and Psychological determinants such as values, attitudes, motives etc.

Beyond that, one factor especially influences consumer behaviour in health tourism. Here, consumption is not exclusively self-determined, but partially third-partydirected, e.g. when health products and services are being financed by a social service carrier. (Illing, 2009:52). Due to this, the impact of other determinants of consumer behaviour is limited. If for example a health cure is being financed or subsidized by a social insurance carrier, then a doctor determines or influences what, when, who and how. Personal determinants like income as major determinant in a self-financed health cure or the closer social environment like the family which would co-determine e.g. the date for a self-financed health cure or even psychological determinants like attitudes with regards to certain therapy forms play only minor roles. Within the last few years changes in the broader and closer social environment and their consequences have had a major influence on health tourism in Germany (Laesser, 2007:6): Willingness to perform is socially approved and in the meantime rather expected or assumed. The engagement with ones own body in order to
Issue3
WWW.CDTMONT.COM

39

SELECTIVE TOURISM preserve and enhance the willingness to perform promises happiness, success and social contacts; Many senior citizens are nowadays fit enough to travel. New products emerge, such as special vacations for grandmothers and grandchildren; Within an integrated health definition body, spirit and soul are being viewed conjointly. On vacation the desire e.g. the demand exists to do something for a healthy condition; Vacations gain more and more hedonistic significance. Health issues on vacation have to be fun: a combination of relaxation and health program; Tendency to individualisation processes in which everybody is responsible for oneself. Health cure and therapeutic baths in Germany nowadays have a large portion of self-paying guest patients who have a high aspiration level; and The government is more and more receding from subsidies and social security contributions. This leads to a higher private engagement with regards to health issues.

Personal determinants have changed too within the last few years. Especially apparent becomes this in the emerging of new lifestyle concepts such as Lifestyle of Health and Sustainability (LOHAS). A Lifestyle of Health and Sustainability is pursued by 17% of American citizens according to a survey by The Nielsen Company and Nielsen Company und Natural Marketing Institute. If adding the percentage of the naturalities , who show a similar profile compared to LOHAS (the focus is here more on personal health and less on planetary health) than the total sums up to 34%. (The Nielsen Company und Natural Marketing Institute, 2009:3) The segment of LOHAS is expanding in Germany too. (LOHAS, 2009) LOHAS consume economically, ecologically and sanitary sensible products. The purchasing decision is increasingly influenced by attributes such as bio , fair trade and sustainable consumption . (Schommer, Harms and Gottschlich, 2007:4). For these attributes consumers are willing to pay a higher price even in their vacation. With regards to socio-demographic factors it is mostly one development which will influence health tourism within the next 10 or 20 years significantly: The obsolescence of society and interlinked with that the formation of a silver economy
40
WWW.CDTMONT.COM

Issue3

SELECTIVE TOURISM - the so-called jungen Alten . (menschen machen wirtschaft e.V., 2009) For these active senior citizens with relatively much time and money to spend, health preservation is an important prerequisite. What do they expect from a health and wellness vacation? (Petermann, Revermann and Scherz, 2006:59ff) In general current senior citizens (senior citizen: older than 60 years, junior seniors: 50 64 years (Petermann and co-authors, 2006:59) are supposed to be a generation which is quite optimistic, which shows a sense of responsibility and appreciates traditions and values. They have high expectations with regards to quality and service. They have an extensive desire for information and compare prices elaborately. Communication is a main issue. They have a distinctive desire for protection. With regards to the form of organisation, senior travellers prefer well organised package holiday. Important motives for senior travellers are recreation and no stress or gathering new strength . During vacation, seniors are quite active. The most common activities are excursions, hiking and the indulgence in culinary specialities typical for the country. Being on vacation, they seek an intact environment and a healthy climate. They prefer to visit cultural or historical sites and nature attractions instead of relaxation, shopping or bathing. Senior travellers, although they are critical consumers with a long travelling experience and high expectations with regards to quality, also tend to spend above average. 29% of all travel expenditures of German citizen altogether are being spent by senior travellers. Conjointly with the LOHAS they are the most influential factors for consumption in general. (menschen machen wirtschaft e.V., 2009). The Reiseanalyse of Forschungsgemeinschaft Urlaub und Reisen e.V. (F.U.R.) in Kiel is an annually conducted, representative consumer survey in tourism for the German source market. Thereby, single motives as well as motive complexes are being evaluated. (F.U.R. 2008, S. 88). The motive complex health/environment/nature proves to be quite stable over the years. The singular motive to do something for health is in this context with 26% declining (from 30% in 2005). (Winkler und Grimm, 2006:8). But a wide variety of other motives or rather motive complexes show additionally strong health related context like the motive complexes physical recreation and psychological relaxation and sport . Especially the first one gains in comparison to 2005. Therefore it can be altogether still assumed that health issues on vacation have a high significance for consumers. In 2005, expectations with regards to health vacations were analysed in the Reiseanalyse. (Winkler and co-authors, 2006:35). Thereby, it was differentiated between health cure in vacation, wellness vacation and health vacation. With regards to health cure and health vacation it is mostly the health preserving aspect or rather health rebuilding which is of a high significance. Attributes such as healthy nutrition, healthy climate, health check and medical treatments e.g. classical health cure
Issue3
WWW.CDTMONT.COM

41

SELECTIVE TOURISM treatments can be found at the top of priorities. With regards to wellness vacations it is mostly the relaxation and feel good aspect which is important. Beauty and pampering as well as baths and sauna, followed by offers for relaxation and swimming are important product attributes in this context. In a representative consumer survey in the European Union project ALPSHALTHCOMP, 1,607 participants were interviewed in Germany during January 2007 with regards to their expectations on health and wellness vacations. The definition for health and wellness vacation in this survey unified the three vacation types from the Reiseanalyse in the previous paragraph. Health and wellness vacation has been defined thereby as a vacation with the main motive to do something for ones health . From the results gained in the survey a typology of consumer expectations was deducted by the measures of cluster analysis. Within this typology the following six clearly differentiated consumer groups could be identified (Bausch, Hanslbauer and Nungesser, 2007:5): a) The athletic and active vacationer (massages, sports and fitness (13.7%)) These consumers expect to be offered all massages and body treatments as well as fitness and sports facilities. One third of them wish to have a sauna as well. They tend to be younger (42.2% younger than 40), with incomes above average (36% more than 2,500) and they have had fewer experiences in the wellness and health vacation sector than the average (14 %). b) The ambitious health vacationer (massages and wellness (26.5%)) All members of this group expect massages and body treatments, a third of them additionally expect a swimming pool or a water park. Well over one fourth of them are also interested in special wellness, health and fitness offers, some of them also take advantage of additional products (e.g. oils, cosmetics). The majority of them is aged between 40 and 69 (53.5%) and has already had a lot more experiences in the health and wellness vacation sector than the average (27.4%). c) The problem-oriented novice (bathing, health cure and special wellness (4.6%)) All of them expect a swimming pool or a water park whereas almost one third wishes to have health cure treatments. Many of them also expect special offers in the field of health and nutrition. These consumers are aged above average (49.4% are 60 and older) and have almost no experiences in the health and wellness sector (4.6%).

42

WWW.CDTMONT.COM

Issue3

SELECTIVE TOURISM d) The recreation seeking vacationer (sauna and massage (24.9%)) This relatively large group first of all expects sauna, sauna landscapes and solariums and 60.7% of them wish to have massages and body treatments. Many of them also expect to have a swimming pool or water park in addition (29.5%). Sport and fitness only play a minor role, additional health and wellness products and services are mentioned less frequently and thus below average. More than half of the group members are between 20 and 49 years old (51.8%) and have an average or low income. Almost one fourth (24.5%) has already had experiences with health and wellness vacations. e) The dignified bon vivant (well-being and enjoyment (19.0%)) Concerning the ten main expectation dimensions, this group stands out because of its above-average interest in beauty treatments and basic additional products (e.g. cosmetics). There are strikingly high results in this group for expectation dimensions which play a minor role elsewhere: atmosphere and ambience, nice hotel, good service, good food, leisure and cultural activities. The motives relaxation and well-being are extremely important for them. Despite its high age (56.1% of them are 50 and older), this group has partly had experiences with health and wellness vacations (20.3%) and has medium incomes. f) The sceptic (scepticism and rejection (11.3%)) All members of this group have a sceptical or even negative attitude to health and wellness vacations. Here, personal restrictions (unable to travel) are often the reason for this attitude. People of this group are spread evenly across all age and income groups.

3. RECOMMENDED ACTIONS FOR SERVICE PROVIDERS IN TOURISM

As being described in the previous chapters, social, economic, structural or political changes are influencing the market for health tourism in Germany in a sustainable way. Self-financed health benefits are becoming more and more important, from the demand- as well as from the supply-side. Consequently, the health market, as compared to other markets, is being transformed into a demand-oriented market
Issue3
WWW.CDTMONT.COM

43

SELECTIVE TOURISM (Figure 2., the author representation according to the Kompetenzzentrum Gesundheitstourismus Schleswig-Holstein).

Figure 2. Health as a Social and Economic Growth Factor

Service Providers in tourism are forced to react on these developments and to reassess their competitive positioning. Thus, the authors focus in the following on subject-related implications for marketing and especially on recommended actions as to product and communication policy. The product policy of a company often is being described as the heart of marketing: The performance and product policy is one of the central pillars of the marketing policy of a company. Comprised are all the decisive factors that lead to a market-driven creation of a companys performance (products and/or services). (Gardini, 2004:282). Thereby, the offer has to be designed in a way to satisfy the demands, wishes and needs of the customers or guests and to clearly set the company apart from its competitors. Important hints for the creation of a product and performance policy can be found from the definite typologies of the German health and wellness guest in the project ALPSHEALTHCOMP. Complemented by the description of further, amended framework requirements, recommended actions for the touristic service provider hotel are being derived exemplarily: 1. It becomes clear from the typologies that the German guest has definite ideas regarding the hardware of a health-oriented hotel when it comes to health and wellness. The ambitious health vacationer as well as the recreation seeking vacationer expect a spa or a spa area with, e.g., a swimming pool,
44 Issue3

WWW.CDTMONT.COM

SELECTIVE TOURISM a whirlpool, experience shower and sauna facilities with different kinds of saunas, steam and aroma baths. Furthermore, a part of the guests (especially athletic and active vacationer ) is also looking for a gym. These facilities require space and very often significant investments. According to the consulting firm TREUGAST, the required investment for a spa area in Germany with a surface of 600 square meters amounts up to 1.5 mil. (Table 1., TREUGAST Trendgutachten Hospitality, 2009/2010).
Table 1. Exemplary investment costs for a spa area

2. Next to the hardware, the software plays an important role from a German health tourists perspective. The need for treatments can be discovered in almost all identified consumer groups. Investigations prove that demand is concentrated to a large degree on rather classical treatments like full body massages, reflexologies, face and skin care, fango treatments and gymnastic offerings. This represents a unique opportunity for hotels to distinguish themselves through their own, special offerings connected to the region. Combined with welltrained personnel from a professional as well as from a personal perspective, a distinctive service offering, a USP (USP = Unique Selling Proposition (authors note)), can be created. Thus, the authors suggest that the major focus has to lie on the creation of the service offering, closely connected to human resource policy. Another aspect that has to be pointed out in this context would be the guests attention regarding sufficiently trained therapists and requirements when it comes to health insurance billing. (compulsory or private insurance). 3. Another need that should be taken into account when planning the service policy for a health oriented hotel is the need for recreation and relaxation. Even if not every hotel is situated close to nature, sufficient quiet rooms and
Issue3
WWW.CDTMONT.COM

45

SELECTIVE TOURISM public spaces are of vital importance. This holds also true for the atmospheric environment (air condition, temperature, humidity etc.), the acoustics (rooms with sound absorption, treatment areas and chill-out music, etc.), optics (daylight in rooms, treatment areas, etc.) as well as olfactory perception (pleasing scents). Furthermore, natural and environmentally sustainable materials should be used for the interior of the rooms. The overall goal should be to create an authentic or harmonious atmosphere that contributes to the guests wellbeing. 4. Nutrition represents another important factor during health vacations. Not only the LOHAS are paying attention as to the origin of food and beverages, but also other target groups (e.g. the problem-oriented novice ) are expecting offerings for a conscious and balanced diet. In the authors opinion, a balanced diet should belong to the self-concept of a health-oriented hotel. Part of this concept would be calorie-reduced meals, health-related information as to the used ingredients and their preparation, if applicable whole food or vegetarian dishes as well as the use of regional products. Besides, attention has to be paid to special diet- and nutritional conditions (e.g. diabetes). In order to do so, it is suggested to train chefs accordingly and, in the case of a large number of guests, to employ a diet assistant who can also give advice on health-conscious diets. 5. A general requirement for board and lodging facilities is the fulfilment of minimum criteria. These criteria are often part of a classification system and comprise requirements for furnishing and equipment, but also for the service. Guests have high demands for health- and wellness hotels, minimum criteria should be covered sufficiently by the companys product policy.

Alongside with the product-related recommendations, also communication-related measures can be drawn from the data generated by market research. The increasing competitive pressure caused by the growing number of offerings and the freedom of services inside Europe turn the target group of the German health tourist into an attractive one, especially abroad. Often, destination management organisations (DMOs) are responsible for targeted communication measures. Included are measures aimed at communicating information about the company and its service offering and to influence the addressees in terms of a systematic behaviour control. (Gardini, 2004:364) Hereby, the classic instruments of communication are applied such as advertising, promotions or public relations. The following recommended actions are being proposed:

46

WWW.CDTMONT.COM

Issue3

SELECTIVE TOURISM I. There are a steadily growing number of services that are covered by compulsory and public insurances in the course of preventive measures, but with very different programs and requirements. The points mentioned above give a broad overview over the possibilities. Therefore, a thorough analysis of individual programs of health insurances is recommended in order to go for targeted cooperation. The cooperation could be designed in a way that the health insurance is advertising a destinations offerings and in return receives better prices. A more moderate measure would be to raise the insurance customers attention regarding the use of these programs by employing classic promotional tools such as catalogue- or print advertising. A further possibility to communicate with the help of cooperation is related to (expert) media or publications. A number of magazines, journals and newspapers in Germany treats health-oriented subjects and represents an ideal platform for the announcement of the health offerings of a particular region. The best and most cost-effective possibility would be the connection of reporting and lottery or drawings. When creating advertising material or online appearances related to health or wellness offerings of a destination, one has to consider that a major part of German guests already has experience with these kind of offerings (27.4% of the ambitious health vacationers , 24.5% of the recreation seeking vacationers und 20.3% of the dignified bon vivant ). For these target groups, the effective communication of the USP of a region or individual offerings is most important. Connected with an emphasis on health-related competencies and the quality of the personnel, these factors compose the framework as well for the print material as for the online appearance. When profiling a tourist destination with health-related offerings, an emphasis has to be placed on individual, natural factors and regional distinctiveness. This could happen via an image campaign in order to complete the communication measures with the specific components of the offering. Natural factors would be remedies like earth, wind and water or climatic conditions and regional distinctiveness could be generated from specific products as used in gastronomy or for treatments. Especially the target groups of the ambitious health vacationer , the recreation seeking vacationer and the LOHAS are interested in these (natural) products and services. Therefore, the cooperation with regional marketing organisations that can contribute to the image campaign would be obvious.

II.

III.

IV.

Issue3

WWW.CDTMONT.COM

47

SELECTIVE TOURISM CONCLUSION This article aims to offer suggestions for product development and ways to attract German guests, based on current market data and structural developments on the German market for health and wellness, especially health tourism. The health tourism market in Germany is a highly attractive market with a large market potential for domestic suppliers as well as for suppliers from other EU countries. Due to the free rendering of services in the European Union, German guests have a freedom of choice whether they take medical treatment in Germany or elsewhere in the EU. In the course of the health care reform and further structural changes in the German health system, primary prevention became part of the responsibility of public health insurance funds. For suppliers of health prevention tourism, e.g. wellness tourism in order to address these consumer segments, it is therefore important to know the legal framework, the scales of fees and the allocation regularities in the German source market. This article aims to raise awareness regarding this issue and additionally describes some basic requirements. Besides the political and structural changes, consumer behavior has changed too. Especially the propensity to take self-financed preventive measures has grown. Evidence for this can be found particularly by looking at newly emerged lifestyle concepts such as LOHAS, the Lifestyle of Health and Sustainability . The purchasing decision of the LOHAS is increasingly influenced by attributes such as bio , fair trade and sustainable consumption , for which they show less price sensitivity by being willing to pay a higher price even while being on vacation. This recent development is presumably going to be a major influence on tourism demand in Germany. Additionally, due to demographic change, tourism demand in Germany will increasingly be influenced by the so called silver economy within the next decades. These seniors citizen have high expectations regarding quality and service. They also appreciate traditions and values and have an extensive desire for information and communication. Therefore, for suppliers in the market for German guests it is important to react to these developments and assess their competitive positioning. The consumer typology which originated in the EU project ALPSHEALTHCOMP provides concrete starting points for product and communication policy regarding health and wellness vacationers. Based on the typology, recommendations have been formulated exemplarily for the supplier hotel with regards to product policy and for the supplier destination management organisations with regards to communication policy. German guests have pre-established ideas about the
48
WWW.CDTMONT.COM

Issue3

SELECTIVE TOURISM hardware of a health-oriented hotel (spa or a spa area with, e.g., a swimming pool, a whirlpool, experience shower and sauna facilities with different kinds of saunas, steam and aroma baths). Suppliers have to be prepared for the significant investments which these infrastructures require in many cases. Another main issue is the software , resp. the treatments. Here exists a unique opportunity for hotels to distinguish themselves by offering special tourism products which are connected to the region and its traditional characteristics. In combination with well-trained personnel (professional and personal) by creating distinctive service offerings, a Unique Selling Proposition can be generated. With regards to communication policy, it is highly recommended to go for a targeted cooperation with a health insurance company. A steadily growing number of services are covered by compulsory and public insurances in the course of preventive measures, but with very different programs and requirements. A targeted cooperation, where the health insurance is advertising a destinations offerings, would be an advantage in this extensive context. (Expert) media or publications can also be used in order to advertise the health offerings of a particular region. There are a large number of magazines, journals and newspapers in Germany dealing with health-oriented topics that represent an ideal platform. Still it is important to keep in mind that a major part of German guests already has experience with these kind of offerings. It is therefore very important to have an effective communication of the Unique Selling Proposition of a region or individual offerings in the print material as well as in the online appearance. These and other definite starting points for touristic service providers have evolved and have been described in this article. Thereby, touristic service providers will gain important knowledge for positioning themselves competitively on the German health tourism market.

Issue3

WWW.CDTMONT.COM

49

SELECTIVE TOURISM REFERENCES

(2006). Tarifbersicht mit Tarifbeschreibungen (Teil III der Allgemeinen Versicherungsbedingungen). Mnchen, DEU. (2007). HM ALPSHEALTHCOMP Report 1. Mnchen, DEU: Wahrnehmung des Alpenraums als Gesundheits- und Wellnessdestination.
(2008). Gesundheitstourismus und Wellnesstourismus. Mnchen, DEU: Oldenbourg Wissenschaftsverlag. Bundeszentrale fr politische Bildung (bpb). (2009). Retreived June 22, 2009, from Web site: www.bpb.de. Bausch, T. & Hanslbauer, T. & Nungesser, S.

ARAG Krankenversicherungs-AG.

Berg, W.

(1964). Principles of Preventive Psychiatry. New York, USA: Basic Books. Cohen, J. (1970). Homo Psychologicus. London, GBR: Allen & Unwin. Dahrendorf, R. (1968). Homo Sociologicus. 7. edition. Kln, DEU: Westdeutscher Verlag. Die gesetzlichen Krankenkassen (GKV). (2009). Retreived June 22, 2009, from Web site: www.gkv.info.

Caplan, G.

(2007). Der Markt der Gesundheit. Daten, Fakten, Trends.

Focus Media Line.

F.U.R. Forschungsgemeinschaft Urlaub und Reisen e.V.

(2006). Die 36. Reiseanalyse RA 2006. Kurzfassung. Kiel, DEU. F.U.R Forschungsgemeinschaft Urlaub und Reisen e.V. (2008). Die 38. Reiseanalyse RA 2008. Kurzfassung. Kiel, DEU.

50

WWW.CDTMONT.COM

Issue3

SELECTIVE TOURISM
Gardini, A. (2004). Marketing-Management in der Hotellerie. 1. edition. Mnchen, DEU: Oldenbourg Wissenschaftsverlag. Illing, T. (2009). Gesundheitstourismus und Spa-Management. Mnchen, DEU: Oldenbourg Wissenschaftsverlag.

(2008). Der Gesundheitstourismus der Deutschen bis 2020. Marktchancen fr HealthCare-, Anti-Aging-, (Medical-) Wellness- und Beauty-Urlaub. Mnchen, DEU.

Institut fr Freizeitwirtschaft.

Kartte, J. & Neumann, K. (2005). Innovation und Wachstum im Gesundheitswesen. Roland Berger Strategy Consultants. DEU. Kompetenzzentrum Gesundheitstourismus i.G. (2009). Qualittshandbuch Prventionsorientierter Gesundheitstourismus Schleswig-Holstein. (2003), Konsumentenverhalten. 8. edition. Mnchen, DEU: Vahlen Verlag. Laesser, C. (2007). Der Wellness Tourist. Conference contribution ICRET Neue Produkte und Leistungen im Alpinen Tourismus. Innsbruck, AUS.
LOHAS. (2009). Retreived June 22, 2009, from Web site: www.lohas.de. Medizinischer Dienst des Spitzenverbandes Bund der Krankenkassen e.V. (2008). Prventionsbericht 2008. Essen, DEU: MDS. Kroeber-Riel, W. & Weinberg, P.

(2009). Retreived June 22, 2009, from Web site: www.menschen-machen-wirtschaft.de.

Menschen machen wirtschaft e. V.

(2009). Die neue Kur als Wachstumsmotor in Deutschland. Position paper of Deutscher Heilbderverband.
Issue3
WWW.CDTMONT.COM

Mller, G.

51

SELECTIVE TOURISM
Nefiodov, A.

(1999). Der sechste Kondratieff. Wege zur Produktivitt und Vollbeschftigung im Zeitalter der Information. 3. edition. Sankt Augustin. (2006). Zukunftstrends im Tourismus. TAB-Arbeitsbericht Nr. 101. Berlin. (2007). LOHAS. Lifestyle of Health and Sustainability. Ernst & Young AG. (2009). Winning at Green. Nielsen White Paper. New York. USA.
TREUGAST International Institute of Applied Hospitality Sciences. The Nielsen Company and Natural Marketing Institute. Schommer, P. & Harms, T. & Gottschlich, H. Petermann, T. & Revermann, C. & Scherz, C.

(2009). TREUGAST Trendgutachten Hospitality 2009 / 2010.

Winkler, K. & Grimm, B.

(2006). Modulbericht Gesundheit, Wellness & Kur im Urlaub. Reiseanalyse RA 2006. Forschungsgemeinschaft Urlaub und Reisen e. V.

52

WWW.CDTMONT.COM

Issue3