german health and wellness vacationers: market analysis and recommendations

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ISSN 1800 6620UDK 338.48

SELECTIVE

TOURISMVOLUME 2 ISSUE 3INTERNATIONAL ACADEMIC JOURNAL

ESTABLISHED 2007


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ISSN 1800-6620

UDK 338.48

SELECTIVE TOURISMINTERNATIONAL ACADEMIC JOURNAL

ESTABLISHED 2007

ISSUE 3


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SELECTIVE TOURISM

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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

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ISSN 1800-6620 = Selective Tourism (Igalo)

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Copyright2008, Center of Tourism Development. All rights reserved.

This journal is founded and published by:

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Editor in chief:

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Editorial Board:

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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,USARenata Tomljenovic, PhD Intitute of Tourism Zagreb, CRO

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Issue3 WWW.CDTMONT.COM 3

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


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


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UDK: 338.48-6:615.8(430)

REVIEW ARTICLE

GERMAN HEALTH AND WELLNESS VACATIONERS:

MARKET ANALYSIS AND RECOMMENDATIONS

Djamal Benhacine, PhD & Tanja Hanslbauer, BBA


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 asa basis for decision-making for service providers with regards to positioning themselves

competitively in the market for German health vacationers. Therefore, the German tour-

ism 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


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INTRODUCTION

Tourism experts all over the world agree that senior citizens are a major drivingforce in tourism. Populations in Europe are ageing quickly and simultaneously

the health sector continues to grow. The demand for products and services pro-

moting 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

reects 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% tothe 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 nancial decisions certain products and services are

being relocated from hospitals to recreation centres (tness, 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 obvi-

ous: to harmonize body, spirit and soul.

The faculty of tourism at the Munich University of Applied Sciences has been

working in this eld since 2005. It has established itself over the years as an im-

portant research centre within the academic landscape. One of the faculties Euro-

pean 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 prole was developed which is based on a representative survey for

the German market (n = 1.607). The gained results will serve for product develop-

ment 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 beingaffected least by the issue of climate change.


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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. Neodov at 1999.Neodov 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,

tness and wellness (Figure 1, the author depiction according to Neodov, 1999).

Figure 1. Kondratiev cycle

In Europe, this development is enhanced mainly by three factors: by the demo-

graphic development, resp. the gradual excess of age in populations. By shiftsof values in society with growing health awareness through all age classes. And

nally 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 rst 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 nancing of products and services. (Illing,

2009:26-27). To the rst health market all products and services are ascribed for


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which compulsory coverage with a social insurance carrier (health insurance, nurs-

ing care insurance, pension insurance and accident insurance) exists and which

are fully or partially nanced by the carrier. All products and services for which

compulsory coverage doesnt apply, which are thus optional and self-nanced,are ascribed to the second health market. A rising number of products and ser-

vices which originated in the rst health market are now partially self-nanced

(e.g. through a private additional insurance). Still they belong altogether to the

rst 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 denition 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-nanced 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, tness,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. ex-

ists 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 rst or second healthmarket? 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 pa-

tient Illing (Illing, 2009:51)) is either self-nanced (second health market) or fully

respectively partially nanced by the social insurance carrier (rst health market).

With regards to self-nanced guest patients their motives and demand are the main

factors of inuence on the supply. With regards to guest patients fully or partially

nanced 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 inuence on the supply. Suppliers abroad,


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e.g. in spa facilities in Eastern Europe, (Illing, 2009:81) often know little or noth-

ing about the legal framework, the scales of fees and the allocation regularities in

the German source market. Thus, it is difcult for them to acquire guest patients

who are nanced by the public health insurance funds. However the Germansource 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, nanced by

public health insurance funds. Insurants can then for instance receive fund-

ing 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 citizensfundamental 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 mar-

ket 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 theirphysical, 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 denition is consistent

with the integrated denition 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 accordingto Illing 2009:7). The second main aspect within the denition 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 eld

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.


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Health cure and rehabilitation tourism, which is being conducted by ill

consumer.

An ascription of health tourism and its sub forms either to the rst or to the second

health market proves to be difcult. The transition is uent 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-nanced 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 ma-

jor social insurance carrier only provide in the case of illness according to their

self-concept. Thus, secondary or tertiary prevention is traditionally their eld of

responsibility. (GKV, 2009). Health cure and rehabilitation tourism address per

denition only the ill too. They are measures within secondary or tertiary preven-

tion and are nanced by the GK as part of their catalogue of benets. Therefore

they belong to the rst health market. Historically, health cure tourism wasnt

meant only for the ill. Rather, it had been a social, self-nanced event for whichill 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 benets 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 nanced by the social insurance carrier. In the context

of health policy reforms nowadays only medical necessary Sozialkuren are

being nanced 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


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and therapeutic baths are self-paying patients. (Mller, 2009:3). This fully self-

nanced health cure vacation belongs to the second health market.

Primary prevention addresses per denition the healthy. Health prevention tour-

ism can therefore be classied 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 eld of responsibility. Primary prevention was subject to self-

paying 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 there -

fore 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 Dienstdes Spitzenverbandes Bund der Krankenkassen e.V., 2007:3) If health prevention

tourism is nanced by the GK it belongs to the rst health market. What does this

now mean for supplier in the eld of health prevention tourism? If guest patient

are partially nanced 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 Krankenkas-

sen 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 veried in a scientic

evaluation process.

In this chapter it has been demonstrated that health tourism with its market poten-

tial in the rst 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.


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2. GERMAN HEALTH AND WELLNESS VACATIONERS

German health and wellness vacationers can be dened as consumers of healthproducts 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 signication (Cohen, 1970) and homo sociologicus,

e.g. carrier of social predened roles at the intersection of individual and society

(Dahrendorf, 1968:20).

Consumer behaviour is furthermore being inuenced 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, edu-

cation, sex, occupation, income etc.), and

Psychological determinants such as values, attitudes, motives etc.

Beyond that, one factor especially inuences consumer behaviour in health tourism.

Here, consumption is not exclusively self-determined, but partially third-party-

directed, e.g. when health products and services are being nanced 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 nanced or

subsidized by a social insurance carrier, then a doctor determines or inuences

what, when, who and how. Personal determinants like income as major determi-

nant in a self-nanced health cure or the closer social environment like the familywhich would co-determine e.g. the date for a self-nanced 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 inuence on health tourism in Germany

(Laesser, 2007:6):

Willingness to perform is socially approved and in the meantime ratherexpected or assumed. The engagement with ones own body in order to


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preserve and enhance the willingness to perform promises happiness, suc-

cess and social contacts;

Many senior citizens are nowadays t enough to travel. New products

emerge, such as special vacations for grandmothers and grandchildren;

Within an integrated health denition 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 signicance. Health issues on

vacation have to be fun: a combination of relaxation and health program;

Tendency to individualisation processes in which everybody is responsiblefor 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 ap-

parent 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 prole 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 inuenced 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 inuence health tourism within the next 10 or 20 years signicantly: The ob-

solescence of society and interlinked with that the formation of a silver economy


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- 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 generalcurrent 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 tradi-

tions 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 mostcommon activities are excursions, hiking and the indulgence in culinary speciali-

ties 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 expecta-

tions 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 inuential 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/environ-

ment/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

rst one gains in comparison to 2005. Therefore it can be altogether still assumed

that health issues on vacation have a high signicance 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 signicance. Attributes such as healthy nutrition,healthy climate, health check and medical treatments e.g. classical health cure


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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 ALPSHALTH-

COMP, 1,607 participants were interviewed in Germany during January 2007 with

regards to their expectations on health and wellness vacations. The denition for

health and wellness vacation in this survey unied the three vacation types from

the Reiseanalyse in the previous paragraph. Health and wellness vacation has been

dened 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 expecta-

tions was deducted by the measures of cluster analysis. Within this typology thefollowing six clearly differentiated consumer groups could be identied (Bausch,

Hanslbauer and Nungesser, 2007:5):

a) The athletic and active vacationer (massages, sports and ftness (13.7%))

These consumers expect to be offered all massages and body treatments as

well as tness 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 experi-

ences 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 tness

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 spe-

cial offers in the eld 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%).


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d) The recreation seeking vacationer (sauna and massage (24.9%))

This relatively large group rst of all expects sauna, sauna landscapes

and solariums and 60.7% of them wish to have massages and body treat-

ments. Many of them also expect to have a swimming pool or water parkin addition (29.5%). Sport and tness 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 dignifed bon vivant (well-being and enjoyment (19.0%))

Concerning the ten main expectation dimensions, this group standsout 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 inuencing the market for health tourism in Germany in a sustainable

way. Self-nanced health benets are becoming more and more important, from

the demand- as well as from the supply-side. Consequently, the health market, ascompared to other markets, is being transformed into a demand-oriented market


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(Figure 2., the author representation according to the Kompetenzzentrum Gesund-

heitstourismus 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 mar-

keting: 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 productand performance policy can be found from the denite 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 denite 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,


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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 signicant investments. According to the consult-

ing rm 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

identied consumer groups. Investigations prove that demand is concentrated

to a large degree on rather classical treatments like full body massages, reex-

ologies, 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 well-

trained 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 sufciently 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 forrecreation and relaxation.

Even if not every hotel is situated close to nature, sufcient quiet rooms and


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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 (day-

light in rooms, treatment areas, etc.) as well as olfactory perception (pleasingscents). 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 wellbe-

ing.

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 shouldbelong 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 fullment ofminimum criteria. These criteria are often part of a classication 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 sufciently 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 organisa-

tions (DMOs) are responsible for targeted communication measures. Included

are measures aimed at communicating information about the company and its

service offering and to inuence 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:


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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 thoroughanalysis 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.

II. A further possibility to communicate with the help of cooperation is related

to (expert) media or publications. A number of magazines, journals andnewspapers 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 connec-

tion of reporting and lottery or drawings.

III. 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 seekingvacationers und 20.3% of the dignied 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.

IV. When proling 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 tocomplete the communication measures with the specic components of the

offering. Natural factors would be remedies like earth, wind and water or

climatic conditions and regional distinctiveness could be generated from

specic 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.


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CONCLUSION

This article aims to offer suggestions for product development and ways to attractGerman guests, based on current market data and structural developments on the

German market for health and wellness, especially health tourism. The health tour-

ism 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-nanced preven-

tive measures has grown. Evidence for this can be found particularly by looking

at newly emerged lifestyle concepts such as LOHAS, the Lifestyle of Health andSustainability . The purchasing decision of the LOHAS is increasingly inuenced

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 inuence on tourism demand in Germany. Additionally, due to demographic

change, tourism demand in Germany will increasingly be inuenced 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. There-

fore, 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


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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 signicant

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 combina-

tion 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 cov-

ered 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 deal-

ing 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 com-

munication 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 denite

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.


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