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Health Tourism: Light at the end of the COVID-19 tunnel

Health Tourism: Light at the end of the COVID-19 tunnel March 24, 2021

Marketing, research and business development consultant in healthcare, human services and senior living.

Date: 24th March  2021
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    Health Tourism: Light at the end of the COVID-19 tunnel
    Irving Stackpole & László Puczkó

    László Puczkó

    Thank you everyone from all over the world for joining us today for this event, I really appreciate your interest and your participation, I want to give you a short summary of what we will be covering today. We look at what’s happening to the health tourism markets and look at debates on the wellness and on the medical travel markets. We also look at how the vaccination is rolling out in various parts of the world and what kind of impact that may have on the actual traveling for health markets and how this is impacting interest. And we also look at consumer behavior changes and how we need to pay attention to those changes if we want to have travelers interested in health services and health options. And we will offer you a summary and a couple of take-home suggestions.

    I think this is really the moment when we need to understand where the world is, and I personally like this little joke here; which is attributed to many of us being grumpy from a lack of traveling – which is a good thing when you look at it from the future perspective.


    And it’s not a very good thing when you look at where we are right now in terms of services, in terms of lack of travel, even opportunities, and living in a lockdown for a good part of the world over a year. So, what exactly can we do apart from being devastated or scared or even hopeless? Talking to many destinations and service providers around the world, we can observe this array of feelings and attitudes. Today’s session was planned to take into consideration the very complex mixture of attendees. We have government officials, we have destination managers, we have ministry representatives, we have hotel companies, we have VPs for development. We have medical service providers; we have service providers looking at options in terms of hospitality. We have consultants, we have clinicians, we have medical professionals and even therapists. So, we have a large number of people with very different backgrounds. So, we will look at the government side, the destination side, the service side, where you have also the service design side. Also, we want to give you some hope and shed a light at the end of the tunnel – that where we are now really is an opportunity to revisit how things have been and how we are approaching the coming years, not just months or weeks.

    May I be blunt and say that probably we need to forget past consumer and customer reviews? Because if you were fantastic in 2019 and you had great reviews on whichever review site, you may need to forget that. Because two years on, they may not be relevant as the market has changed. Your competitors have changed, some of them closed, or been through major remodeling or redevelopment. So, the reviews could be a good indication, but don’t count on it much. Sadly, you may need to re establish business contacts because companies have vanished, people had to leave, or people have moved to a different place. Whatever you may have had two years ago may not be relevant anymore. So, we have to re-establish contacts. Accessibility has been severely affected, meaning you can’t get there, or your guests cannot get to you, because we don’t have, we don’t have accessibility. Flights canceled, or most of flights have been canceled. International flights are severely impacted. So, there is currently a very different situation. And yes, you might say that as soon as the vaccination is done and Irving will talk about that, everybody will be traveling and there will be a massive spike. Yes, potentially, yes. But that also means that the whole world wants to have the travelers, everybody at the same time attacking traveling consumers with messages.

    So what exactly can we offer? And that takes us to the next point, which is: segmentation has changed. How we define segments, the lifestyle segments, how the mental stress changed; these segmentation characteristics have changed. So, we have a little bit of homework to do in terms of how we redefine and restart all our services. Just as a light entertainment for the discussion, may I quote this great example of where we are: we have studies showing that just because you’re watching a beaver eating cabbage online, that would decrease your stress level by 17 percent. It doesn’t matter if you believe in it or you don’t. I actually did watch that beaver and it really had its impacts, but people change their attitudes. They are open to unusual options. And I quote studies that we did together at the Wellness Tourism Association; I need to give credit to anyone who has supported the project. And we looked at how the business interests are changing in the next couple of years. May I mention, because we have a lot of hospitality people here, that we need to revisit how we look at health care and spa & wellness services in hospitality, and I give you the indication of what we suggest, because this is how it used to be. It’s a satellite.


    It’s a nice to have, it’s lovely on the side. But given the growing interest of the market in anything that’s related to physical, mental, psychological, emotional, health and balance and harmony – I’m selecting my words very, very carefully – and that one is balance and harmony. Then we may need to revisit how these domains work together in terms of service delivery and even service design when we create new properties. So, we need to draw a line. We are really between two worlds. I don’t think it’s a good start if you say, ‘Oh, well, I would like to go back to 2019, my benchmark data is used as 2019, therefore, I want to aim to go back there’. I think we need to restart. And if you think about it from a strategy or C-suite level perspective, this is a good moment. You can revisit how you work and how your strategy really has been going. And may I mention here the examples that we have in terms of segmentation, which is how the services can be attracting people.

    We used to have this “me too”; that I’m joining [something] because it’s fashionable. “I’m curious”. “I’m doing it as a lifestyle” or “I’m doing it as charity”. And if you ask me, looking at the service developments recently, we really can see that there’s a change and there will be charity, people will buy medical as well as wellness services as charity.


    And we call this Revenge Spending; that you are upset, you have been locked down, you couldn’t spend money, you couldn’t do your favorite things and couldn’t visit your favorite destinations. Basically, you spend, and the market expects revenge spending to start spiking as soon as the vaccination programs in the world may permit that. Instantly, consumers would be very happy to spend money on wellness services, business services and medical services, because many of those may not need to be prescribed. So voluntary medical services, such as dental, plastic surgery, IVF – you will see a demand for those. Irving is going to talk about those. At the same time, interestingly, we also have Luxury Shaming. Luxury – when you show off – luxury shaming is something that at the time of our global epidemic, economic social disasters, as we can see in many countries or destinations, showing off and going, physically to luxury-looking facilities, people may call you names. So, we need to be careful how we define luxury, and that’s why I would like to give you the light and the lighthouse. What options do we have? I would like to call your attention to the study that we did together with the Wellness Tourism Association, and this is a B2B study.

    I really would like to call attention to really focus on these triggers and some others, because we didn’t have more time to look into the various other triggers. I just want to highlight these.


    What really means is that the real trigger may be different and may not be the word ‘wellness’ but more specific such as self-healing, belonging, etc. So next time, visit – or revisit – how you communicate and how you design services at your end and what your destination is suggesting in terms of trigger points, because people may look for self-healing, or may look for flourishing, or may look for de-stressing or rewarding, for that matter

    So this is what you need to provide. And yes, we know at the end of the day consumers do buy wellness services, for example. They’re purchasing wellness services but they’re buying de-stressing or buying self-rewards. And also, I would like to stress the importance of how luxury has been changing. We have several layers of luxury from everyday luxury to bespoke luxury, and we need to be aware that the term and the meaning of luxury is changing rapidly. Don’t forget that the various aspects – even relaxation can now become an ultra-high-end luxury, which was an everyday luxury. Now it’s moving to ultra-high end because it’s so exclusive – you don’t have the chance to do it. So, the re-positioning and the positioning of a service or a destination may totally be different as of now, even in the short term, because of the severe situation in terms of lack of traveling or lack of leisure time. And that gives you options. That gives you opportunities. At the same time, it raises challenges: how can you define your services, how you can position and communicate about your services. Is it luxury? Is it everyday luxuries? Is it a bespoke luxury? Is plastic surgery now a bespoke luxury, although it’s been an everyday one in the past? You need to revisit how you used to be doing services and how you define your packaging, how you define your guest journeys, how you define your communication.

    Just an example, a floating sauna, a natural lake, which is very simple and very easy looking like this, would you call it luxury? What kind of luxury would that be? Would it be wellness, would it not be wellness? Regardless of what you call it, the customers – that family or those men and women sitting on there or going around – they may be calling it bespoke relaxing experience and saying that ‘we feel more balanced’ or ‘in harmony’.

    This is what, let’s say, the post-Covid wellness orientation may mean. And have you been to a Dry Bar? Where you pay more money, for example, for nonalcoholic drinks than you would pay in a bar for alcoholic drinks? Because that’s the new thing, and this is another option. And when you see wellness overtaking alcohol, sobering is the new call – we have so many options here you can’t just rely on, “I have a lovely property. I have my lovely spa. I have the international brand. Therefore, everything is going to be cool.” I don’t think it’s going to be cool, you might have a good run, but I would really suggest you revisit and have a whole screening of how your services are defined and how they are offered.

    Let me give you another consideration here, which is how you review your resources. These are not wellness resources; these are resources that you use or can use them to create wellness-improving services. But, despite how good that sounds, you really need to be more ingenious. You need professionals who can help you in doing that. It’s not just the new treatment on the spa menu. It’s not just a new, let’s say, smoothie in your F&B proposition. You have to really be very systematic and look at what’s available locally – you can have amazing and simple solutions, and inexpensive (as in developed cheaply), but the value proposition is going to be appreciated by the guests.


    Is it the new way of doing yoga outdoors or physical exercise outdoors? This is a simple grass field with nothing really on it, but you have the feeling of safety and keeping Covid-related regulations in mind. You have a lovely backdrop and people can still have some social time together, but with a safe distance and at the same time with a pleasing environment. This is not a spa on the 10th floor overlooking some city or urban area. That’s a different proposition. And you still have options there, but you need to be a little bit more careful about how you offer the same treatments and the same packages that you did two years ago.

    I really believe that the choice is yours. It’s really up to you – which direction are you taking? We don’t really have much time at the moment, but we can have a discussion should you wish. We go into the illusion part, which is happening quite prominently when it looks amazing, but when you get there, you recognize it’s more for show and less in terms of content. You have an entertainment part, where you use for example goats for yoga or you use other animals for yoga or create some entertainment value through which you can incorporate new guest segments like Men, or your eminent wireless operator, lifestyle entrepreneur. Or you want to create a new brand-new hotel brand which is focusing on one or only two components, but you do it really consistently and very structurally.

    Or you just say, “You know what, I wellness-ify all my services: provision, B&B, the retreat, the hospital, the clinic, all of it. But I’m not promoting it as a wellness place. I’m just improving my services, taking the various expectations in mind.” You have four major directions, and the call is yours, but you need to make a call. A little bit of Jacuzzi, a little bit of yoga on the side, is not going to be very successful in the near future. So, what you have seen so far, the satellites – instead of these satellites, we need to have an integration. But to really have an integration, you can’t just have a new spa operator come in, this is not a small operation. You need to create a different approach. Where health care, wellness and hospitality, talk to each other, overlap and create a different value proposition. This global pandemic really gives you the springboard to do it either as a new brand or revising your existing brand.

    A couple of our hospitality attendees at the moment may not want to see this because it doesn’t look that great. But based on, honestly, global experience, I can very confidently say that probably you need to introduce a W-suite, not a C-suite, in your organizational structure, where you really look at your services and your services’ contribution to guest’s wellbeing.



    Because we see terribly underestimated TRevPARs, we can see overspend on CapEx and OpEx and under underperforming well-being proposition. On the guest’s side, you really need to revisit how you look at wellbeing at large. And it’s not just hospitality. Health care is about hospitals, so would need to do that too.

    Let me just give you this snapshot overview of how services are in traveling for health. You have the healthy services, where the services which contribute to the guest’s wellbeing, but they could be any kind of guests. And you have health tourism, either the medical side, which is noninvasive or invasive, or the wellness side, which is the holistic end and or more mainstream wellness. And in the middle, you have the medical one, which is fantastic. But what do you need to bear in mind is the following? How it used to be was health services were, “Oh, I’m happy to have it.” / “Yeah, sure, fine, throw it in.” / “I don’t mind.” / “Happy to.” Medical services are “needed to” most of the time, because you were prescribed or your health status required it, so you needed it to do it. And the wellness side was typically, “I want to do it.” Why? “Because I’m holistic. I’m spiritual. I would like to enjoy some wellness treatments, packages”, and so on. This is lovely. But the opportunity here is: what is changing? That health services move from Happy To to Want To. This is not the cherry on the cake anymore, especially not in the short term. This is going to be, when you look at the market in terms of long-term market development and redefining your positioning, redefining your services and really engaging with your past, present and future customers.

    You might find that they want to have health services. This is not just the Happy To, it’s moves to the Want To. The question is, are you ready to do that? Do you really understand? And what I’m saying in this ‘Are you really ready?’ It’s because I’ve been mentoring all the team. We have been mentoring hotels, spas, travel agents, tour operators. And we really can see that they’re really open to having this approach, but we really need handholding to really make it happen and understand how they can put it into practice. That strategy level is a W-suite, not C suite, and operations level when you implement it.

    Now a couple of take-home messages before I pass it on to Irving. We can see that extreme opposites can become very successful, and we need to revisit how we define as well as sell wellness. Guests don’t need spas, but they want to recharge, so you don’t need to sell spas. It’s not what the important thing is, more like what it does and why is that beneficial. Also, I really recommend reclassifying all your operations. And we also know that you can have the international brands, as well as the remoteness and the lifestyle entrepreneurs having options here, as long as you take into consideration whatever is being discussed. And we also know that specialist advisers, especially in North America or in Australia or even Asia, specialist advisers being trained to sell health-oriented services really can expect a great future in terms of business. And as a last point, don’t forget that guests, based on studies – this is not just me talking, but again this is from the tourism associations discussions and also the international medical journal and studies we did together – guests are open. They understand more and they’re willing to learn more about it. So, this is your chance.


    This is the moment to redefine and rewire your services and rewire the thinking of your guests and reestablish contacts with your business partners as well as your future guests, because they really are open, and they really would be happy to learn about it. They just would like to know how and what. I think this is a good summary for this part, so I will pass it on to Irving, who is going to talk about the vaccination and how that is impacting traveling for health. Thank you.

    Irving Stackpole

    Thank you. And I want to echo Laszlo’s gratitude to all of you who’ve taken the time to participate. Laszlo’s done a good job of doing a sweeping review of how Covid has disrupted the classic strategic perspective on the health tourism markets. I’m going to look specifically at how and what is driving the recovery in the global markets in general, and the health tourism market in particular. The best examples, or best proxies, we have for what’s happening in the individual health tourism markets are the global metrics, as accurate or inaccurate as they are. And the specific examples in the health tourism market bring in, as Laszlo was alluding, issues around pent-up demand, issues around a sense of well-being, a lack of a sense of well-being, as we’ve all been wrestling with this extraordinary pandemic. The vaccine’s rollout is a specific example of the disruption in the market and is a measure we can look to as to how to predict how these markets will recover.

    We’re going to be looking at something like vaccine passports. Several organizations and several countries have played with or are toying with the idea of having a vaccine passport. I’ve had my first dose of a vaccine and I’m very proud of my vaccine card. But going beyond that, organizations like IATA, the International Travel Association, has put forth the idea of having a standardized passport that would allow travel. And there are other things going on between and among countries that I’ll talk briefly on. The real issue that we run into, the real issue for health, tourism and the global travel and tourism markets overall is the nature of the response to the pandemic and the uneven nature of the results of those responses. This is what’s really put us in a very difficult position globally and cross-border. The whole purpose of vaccines is to create herd immunity; this concept where there’s enough immunity within a population to protect individuals from transmission from contraction. Predicting herd immunity is complex, but I’m going to walk through a couple of models to that. And what does recovery look like? Is a return to normal really a normal at all? I think Laszlo said it very well, and I concur, that whatever your metric, whatever your benchmark was in 2019, you need to move past that and consider a new model for the future.

    This is a complex slide that attempts to lay out the OECD, which is a club of wealthy nations and the major developed economies in the world, to predict global economic recovery.


    According to this, you’ll see that the standard, the 2019 standard, is reached among many economies roughly in September, the end of Q3, 2021 this year. And then, based on the vaccine projections, it would get even better, say, by March of 2022. These are pretty optimistic projections.

    And while I don’t wish to rain on anybody’s parade, our clients need more reliable, accurate projections and estimations of future activity. I’m going to show you how we’ve done this. Also, the OECD is famous for putting forth very optimistic projections. In 2016, they published a research article that actually talked about how Europe in particular would recover from a global pandemic, and they predicted a very rapid V-shaped recovery from the pandemic. We now know that it’s been anything but that – so predicting this herd immunity is an extremely important function of predicting the recovery or the return of the markets. For individual operators, this is an extremely important planning element. That is to say, “how do I know when to bring staff back?”, “How do I know when to reestablish resources that have put aside for the time being?”

    This model shows an estimate of the date at which herd immunity is achieved in the United States, U.K. and the European zone. This model was created as recently as late February, and as you can see here, the U.S. was predicted to reach herd immunity sometime in June. But indeed, this is based on a certain level of vaccination, and so far, the United States has shown the ability to administer even more vaccines than was estimated in this particular model, (currently about two point four million a day). In that case, the vaccine rollout will achieve herd immunity even quicker. The European zone is a different story altogether, as we’ll see. European countries may not reach herd immunity until March 2022 or later.

    The problem is several fold, but this is a vaccine administration tracker for the United Kingdom, the United States and the European Union taken as recently as of March 14th. As you can see, the United Kingdom has achieved quite a high level of doses per unit of population. The United States is catching up very quickly, and the European Union has lagged. What this means for international travel should be clear to all of us. The economic importance of vaccination, regardless of what your personal public health or political persuasion is, the economic importance of achieving herd immunity and rolling out vaccinations quickly should be very, very clear. We watch the standards of vaccination; we watch that carefully as a proxy for when these markets will open back up. Indeed, the markets are also sensitive to the number of cases. I was just talking about vaccinations, and here we see data from Johns Hopkins about the seven-day rolling average of new cases, and Europe is indeed looking like it’s going to be faced with an uptick. It is facing an uptick of cases and this may indeed represent a third wave, which would have still a greater disruptive effect on cross-border travel and therefore on health tourism.

    This is information about the IATA Travel Pass initiative, an attempt by the International Association of Travel Agencies.

    Many of our clients are discovering that consumers within their countries or within their regions are now willing to travel (within reason) within countries to consume services at their location. That is a strategic opportunity for providers and destinations. This vaccination issue, while impacting that, is less relevant if you’re staying within the borders of your country.

    The critical element to which markets and which types of consumers will access health tourism or health travel services has to do with the acuity level and the types of services being sought. We know that the health tourism markets are not a single market – Laszlo pointed that out very well in one of the slides when he was talking about want to / happy to / need to. At one level of these markets are high volume, low unit value. On the other side are low volume, high unit value. The markets on the left, the high volume, low unit value markets: cosmetics, noninvasive treatments, dental treatments and the like. And of course, the low volume, high unit value, very often what is thought of when people talk about medical tourism, these are: orthopedic procedures, cardiac procedures and complex cancer treatments.


    There’s certainly a lot of pent-up demand. There’s good clinical evidence of pent-up demand in that diagnostic tests that are being conducted 11-12 months post-lockdown are showing higher incidence of more advanced illnesses. And this is being pointed to as evidence that treatment delays are indeed increasing the acuity of clinical conditions and increasing the demand for especially those low volume, high unit value procedures.


    Health tourism, as we know, is a journey. Covid-19 is going to add aspects to issues of trust and uncertainty. We as providers and destinations are going to need to find a way to address those concerns in order to attract consumers who may be still nervous about their willingness to travel for services.

    The strategic options, Laszlo addressed those new markets, other ways of looking at your service lines and new source marketplaces. Tactical options, which I’ve been alluding to, have to do with reducing consumer’s fear and demonstrating or showing safety. Historically, in health care marketing, we never used to talk about safety. Safety is what is referred to as a Kano quality.


    That is to say, if the quality is there, you’re in the game. If it’s not there, consumers won’t even consider you. Therefore, “safety” wasn’t something that we ever encouraged clients to actively discuss before the pandemic. But now it’s very clear, since the fear and concern about infection, the fear and concern about the safety of travel; these are issues that we absolutely need to display.

    For a bit of prediction – the crystal ball gazing – we believe that there are two segments, and there’s good evidence that  two segments that will come back first. The first one is the vanity or cosmetic segment. Across the globe and across the segments, we’re now seeing consumers travel for cosmetic surgery, augmentations and things like hair transplants, buttock augmentation, breast augmentation. People are indeed traveling for this. Some of that is driven by the very fact that during the lockdown we’re all on Zoom, we’re looking at each other, and there are many people thinking, “Oh, gee, my hair’s getting a little thin there”, or “Gee, won’t I look good with a face tuck or chin tuck?” Neck procedures are of increasing interest and will be over the next 12 to 24 months a huge opportunity for cosmetic providers. The other end we’re seeing coming back is the high acuity end. This is the side of the market distribution that is the truly complex care. As I said before, there’s very good evidence coming out of the UK and the US that diagnostic delays in progressive treatment of certain types of illnesses is resulting in higher acuity in those illnesses, such as more advanced stage of the cardiovascular disease, more advanced stage of the cancers.


    That is a challenge and an opportunity for providers and for destinations. These high acuity services are indeed in increasing demand; the Google search activity and other measures clearly show that. So, we see two ends of the market coming back first, and this is indeed what we see happening.

    Laszlo and I talked about this as early as January last year when we conducted our first webinar on this subject. For many providers and for many destinations, the middle part of this marketing distribution has been the most profitable, has been the most important. The orthopedic procedures, knee replacements, hip replacements, the more complex cosmetic procedures. These have been very important service lines for many providers and many destinations. We see those procedures coming back, those service lines reaching recovery levels much later than either end of the market distribution.

    The question is: what about fear? What about the consumer behavior has changed? When you think about it, as I tried to display in the trust and uncertainty graphic, it takes quite a lot of courage, quite a lot of fortitude, quite a bit of risk tolerance to travel some distance to a destination in order to consume medical services in particular, or even wellness services at a lower acuity level. This fear, this concern has been stoked by a media frenzy about variants, about reinfection, and about contagion. It’s very popular in the media now to portray individuals, health care providers, social services providers, politicians with masks and personal protective equipment. The net effect of those images in the body rhetoric in the public domain, the net effect of that is to remind people that there’s a pandemic going on and (from a good sense) remind people to observe personal hygiene, wash your hands, socially distance and use masks. The downside of that is that it reminds people that they need to be concerned. So, we’re caught in this communications-cultural ping pong match.

    But there are segments who seem not to be afraid. Which segments are not afraid, and which segments are risk tolerant? It’s clear that countries and destinations are attempting to address this by talking about ways to protect the traveling public during the pandemic and during the recovery period from the pandemic, an enormous amount of effort is going into both preparing for and protecting travelers during the summer holiday season.

    This article is taken from the Financial Times. There’s also, of course, the students – and as we all know, many students / individuals of student days / young folk see themselves as invincible and they are indeed traveling, even traveling aggressively. Laszlo used the term revenge spending [to describe this].


    What can nations do to overcome or counterbalance consumer fear and what can providers do? I’m going to offer a few more take-home messages. First, there will be (and we’re seeing) a surge of pent-up demand. It’s here, or it’s imminent. The important thing to keep in mind is that while we get ready for it and while we deal with it, pent up demand is not a stabilized business. It surges and then it receives.



    The uneven response between countries and even within countries is delaying recovery. If you’re keen to monitor the harmonization of recovery responses, I would suggest that you look at the Covid-19 tracking project and keep an eye on vaccination rates. Certain segments in the market are indeed more risk-tolerant than others, and if we’re encouraging people to travel, we’ve got to have the systems and responsible programs in place to do that. We can speak to those market segments who are more risk tolerant. Some segments are risk averse. We need to continue to show safety. Quite a contrast from before in 2019 and rearward. The standards – we need to look for proxies, for safety certifications, accreditations, et cetera. With that, I will stop, and we can see what questions there might be.


    Question:  Do you think innovative ideas for wellness tourism are welcome to help spark interest in this recovery a year from the pandemic? My focus is on respite tourism for family caregivers, and I welcome any support of this concept from any organization or university and travel tourism, be it your own company.

    Laszlo Thank you, Bob. I believe we have been in discussion with Bob for years. I think now really is the moment when the world recognizes respite travel, as we call it. It’s such an important field and such an overlooked field because quite sadly and quite tragically, so many people now experience or have been experiencing, what that actually means. It’s not just a remote somewhere, some certain situation happens, it’s really happening in very large numbers. This absolutely is the case, and the mental fatigue and the Covid impact on mental as well as physical balance and health is going to be overwhelming to a very large part of the society and the world, not just the ones who are personally involved. As to your question, can it be more to the point, that it may or may not be called respite travel? Because that makes it kind of siloed, but the objective: why we would need to pay attention and more attention to all those related issues to respite and respite travel, as well as people who take care of others is absolutely paramount. How the service providers will respond to that, is a different question, as most of the time demand will be as such; “Yes, you may be stressed, they may be tired, but when you do go through such emotionally, personally, psychologically stressful situations, one full body massage may not do the job.” So that really requires a different approach to it. And I think the industry really need to recognize this is not just a small niche, but very important small niche scenes all across the board and the population. We have people going through such tragic or stressful or really draining situations, so your question cannot be more topical and timelier, Bob, thank you.

    Irving In long term care, which is a big part of our practice, something called respite care is very important because a substantial number of people who care for persons with disabilities or their family members or close friends – these folks need a break, and when destinations promote themselves as an attractive destination, historically one of the assumed benefits to the traveler for that is a break; to rest, relax at, recover and re-energize or take care of yourself. Those messages can be not just brought down in the third paragraph, but those messages for certain segments could be brought forward as a way of validating the need for people to take care of themselves and to mitigate the effects of the stress. As Laszlo said, it’s enormous.

    Question: I’d like to mention that one of our problems is to find staff and medical wellness due to lack of staff in Germany. Is there any international staff pool? Any idea?

    Laszlo Well, I think it’s going to be an issue all over. Referring to this particular field, which is very country specific or health care specific, since this is a thing in Germany or Austria or even in certain other countries as a small thing. In other countries it may not be registered or may not be even offered as such. The US understanding of medical wellness is a different ballgame, therefore it may not be necessary among them to do so. At the same time, as people lose their jobs their international travel options are limited. As such, you can’t just have a pool and have new staff because of various governmental or other barriers or limitations. First of all, I don’t know, I cannot really help you with that. Second, what you mean by medical wellness may be a barrier because of the various trainings that people have in other countries and licensing and even certifications that may not be appropriate. Third, you can’t travel, I mean, literally, and you don’t quite know when. Fourth, we do have an issue that medical wellnesses still up in the air and still floating around. Some do it rather well, some talk about it, some may not even know about it. Having staff and having a pool, which now you have a pool for therapists because that’s become so mainstream. But medical wellness is still a very niche proposition because of different understandings, depending on where you are. This makes your life a little bit even more difficult. Sorry, I cannot give you a very positive answer at the moment.

    Irving The companies that are making a lot during the pandemic include the delivery companies, Amazons of the world, and staffing companies. The staffing companies are having very good years because of the difficulties associated with people becoming ill. Even if staff don’t become ill, they can’t travel or they need to stay home with someone for whom they’re caring, so the staffing agencies done very well. I don’t know of a staffing agency serving the German marketplace. There isn’t a solution that’s accessible by individual destinations or individual providers, so this is a political issue that could and should be brought to a governmental macro level. How can we solve the staffing issue? There are millions of people out of work and among those millions of people, there are probably individuals who would qualify, by psychological or physical characteristics, as being good prospects for employees in the sector. That’s the kind of solution that needs to be brought forward now, so that during the recovery there is the workforce to handle the demand.

    Question Does wellness-ification apply to invasive medical care? And if so, is there an example of how that happens?

    Laszlo Oh, absolutely. This is the trick, because every hospital or health care professional knows how to deliver a certain protocol when delivering an invasive treatment. Especially when you go to a different country, a different language, different culture, you have added concerns that are not just Covid-related, but cultural, language, food, distance, everything. How to improve that given service and how to improve the comfort or the happiness of that patient – this is why you need to have this wellness-ification aspect. No, I cannot really give you a long list of excellent examples because health care professionals are not necessarily very welcome when someone comes in to test improving ideas in the hospital. They will say that “All right, my friend, this is a hospital. I am the chief physician. This is my little kingdom.” That’s what happens when you say that. “Well, but how about changing the towels?”, “How about talking about invasive care like plastic surgery?” First, I give you a 3D printed nose. Try it, do you like it? If you like it, I can do it for real. Or I can create a 3D printed breast. Do you like them? Don’t you find them heavy? “I can do it for you”. But this is not health care as such, it is service design, it is guest journey, and sometimes we speak two different languages. One example is a French clinic opened a wine bar for cancer patients and it was a big thing. Everybody talked about it because they’ve got a wine bar in the hospital. It’s not because they wanted to be drunk. For a stage three cancer patient, what impact do you think a glass of wine will have? You can’t do any such thing, but this is a different approach. We need to be able to revisit old days. And obviously, I will be more than happy to have more examples from everywhere, literally. But it’s a very hard task because of the silos, because of regulations, because of licensing, because of understanding that health care professionals don’t necessarily have guest journeys in their curriculum when they go for training the CME points that they can’t get from guest journey design. Well, we need to start from somewhere.

    Irving Yes, Laszlo’s spot on with this. That’s why in our book we talk about value co-creation with consumers. Even in hospitals or high acuity healthcare situations, it’s possible to co-create with the consumers a benefit of value. The attitude that Laszlo is referring to, of most doctors and most hospitals, that they know best, and the consumer will take it or leave it. That is an approach to service design / service delivery that simply is so yesterday, and it will not succeed in creating value or in creating consumers who are loyal, and it won’t help with consumer engagement. Engaged consumers are clearly happier consumers and their outcomes are better. If you want to engage consumers, as Laszlo suggested, you as a service provider need to be involved in value creation with them. We talk about that in the book, Marketing Handbook for Health Tourism.

    Stackpole & Associates is a marketing, research & strategy consulting firm focused on healthcare and seniors’ services markets. Irving can be reached directly at

    Health Tourism Worldwide provides solutions for every component of the health tourism spectrum from leisure to medical and wellness tourism.
    Laszlo can be reached directly at

    Marketing, research and business development consultant in healthcare, human services and senior living.

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