History And Present Position Of Shouldice Hospital Tourism Essay

This case discusses about the history and present position of Shouldice hospital. Shouldice Hospital is a private hospital. It was founded in 1945 by Dr. Edward Shouldice in Toronto and commissioned by the Ministry of Health. In the year, 1953 the facility preceded to Thornhill, Ontario (Chapter 1: A Road Map to the World of Strategic Management, 2006). This hospital is having specialization in abdominal wall hernia repairs. It has been dedicated to the repair of hernias from last 55 years.

The hospital is having 12 full time surgeons who function exclusively within the private hospital and are accredited by the College of Physicians and Surgeons of Ontario. Here, in this paper the discussion regarding different aspects of hospital will be done by analyzing its different services, facilities and value propositions (Heskett, 2003).

At Shouldice Hospital value is integrated into its each aspect. It operates with a rational service culture. It extends several services in the form of expertise of its doctors, commitment of its staff and all inclusive atmosphere that in turn assist its patients with quick recovery. The hospitalaa‚¬a„?s significant value proposition is deliverance of quality through experience (Heskett, 2003). From last 55 years, it is repairing hernias and had treated thousands of patients. This number of patients is increasing day by day and it is because of the effective utilization of its value proposition (Shouldice Hospital Ltd., 2000).

The atmosphere developed at the Shouldice hospital is also one of their unique value adding features. It has two different facilities that are the hospital and a clinic that is situated in the 17,000 square foot building posing on 130 acres. Additionally, the entire hospital is carpeted so that it can render a comfort feeling in spite of cold floor feel. It is also surrounded with a huge open lounge area along with several recreational facilities (Christense, 2008).

In addition to its services, the staffs of the hospital are highly dedicated towards their profession. It is having international recognized authorities. The surgeons working in the hospital has made a lifetime commitment to work in the hospital and their long experience is highly benefiting the hospital in delivering quality to its patients (Heskett, 2003). The procedure followed by the hospital is itself one of the distinctive aspects of benefits offered by it. The utilization of a local anesthetic aggregated with the temperament of the procedure facilitates early recovery following surgery.

In comparison to other hospitals recovery time at Shouldice it is half from others. As well, the local anesthetic is dealt out in the operating room whereas in other hospitals they entirely sedate patients before entering the operating room. Subsequent to the operations, at Shouldice patients are motivated to get down from the operating table and do walk towards the post-operating room (Christense, 2008). The Shouldice allows patients to do exercising that is required for full and immediate recovery. It is not done by any other hospital. At Shouldice, patient is awake and is completely aware about whatever is happening that is not done in any other hospital.

Target Group Customers & Production Process

In the medical field, Shouldice Hospital has established a niche service. It directs only external abdominal hernias or hernias from patients suffering from recurrences. The staffs of the hospital also associate patients in the same room who are from related settings, jobs, or concerns. This also works as an addition to their value proposition. The service process of the hospital is also unique in its own terms (Heskett, 2003). The procedure of operation in which patient is awake and is fully aware about what is going on cannot be seen in any other hospital.

From the time a patient enters the hospital and is discharged everything is planned and well designed. Its service delivery process is quite unique and works as a contribution to its value proposition that can be understood with the help of attached production process blue print. With the all vital formalities a patient is admitted and joins up other 30 to 34 patients and their friends and families in the waiting room. After waiting some time, patient is examined and then his health insurance coverage is checked along with a blood and urine test. Then, he is directed to a room number on the basis of information provided by him. Subsequently patients are given a nurse orientation and next day they are taken for surgery (Chapter 1: A Road Map to the World of Strategic Management, 2006).

After surgery, when patients arrive at facility, they immediately get mingle up with other patients who also had their surgery at the same day. This discussion and gathering of all patients work as a psychological process and allows patients feel comfortable about the after effects of surgery. They get comfortable and start adjusting quickly.

42 Exams
38 Surgery Candidates
33 Surgeries
4 Sent Home
Discharged
Day 1
Day 2
Day 2-5
Day 4-5
116 Extended Stay
89 Beds Available
Incoming Patients

Apart from a hernia, all the target group of customers have similar needs regarding the effect and recovery process of surgery. The query and tension of its patients get abbreviated when they mingle with other patients before surgery and after surgery. The service delivery of Shouldice hospital goes beyond the expectations of its patients and perfectly corresponds with their value proposition (Heskett, 2003).

Analysis of Shouldice Performance on Five Dimensions of Service Quality

The Shouldice Hospital is working effectively from last more than 55 years and this could also be understood by analyzing it on the following five dimensions of service quality:

Reliability:

Reliability pertains to the ability of an organization to carry out the assured service faithfully and precisely. With the discussion of Shouldice hospital and its service delivery process, it can be said that this hospital is perfectly reliable and it delivers whatever has promised by it. The hospital authorities and staff keep up all its promises made by it in concern to schedule, pricing, delivery and problem resolution (McConnell & Huba, 2003). They always follow the same schedule from Monday to Friday and in always make cautious diagnoses from beginning. This reliability among customers assists the company in the creation of positive word of mouth and good image.

Responsiveness:

Responsiveness is related with the readiness to assist customers and to furnish immediate service. Shouldice staff has a unique accessibility. As well, they have high willingness to listen to their every patient on an individual basis. They follow a unique service delivery process that undertakes an immediate attention as soon as a patient enters the hospital (Heskett, 2003). All these aspects of its service delivery process evidence the proficiency of Shouldice Hospital in responsiveness and assist the company in attracting more and more number of customers.

Assurance:

This service quality dimension can be defined as an ability of a firm and its employees to inspire trust and confidence. In the medical field the attainment of this dimension is highly essential due to the high risk factor. At Shouldice Hospital, trust and confidence are evident from the time a patient enters it, when he go for first examination and first counselling session with patients who have just had the operation to the time when he leave the hospital (Shouldice Hospital Ltd., 2000). The experience and skills of its surgeons along with its present reputation are very helpful in assuring its patients and creating a feeling of trust among them. The encouragement of trust and confidence by its staff and surgeons significantly assist the company in attracting increasing number of patients without the use of advertising (Heskett, 2003).

Empathy:

This service quality dimension pertains to the caring and personalized attention provided by a firm to its customers. This service quality dimension is inclusively integrated in Shouldice delivery process. The hospital has positioned itself as specialization in hernia surgery that is completed with high success on the basis of caring and personalized attention. This hospital gives extreme care and personalized attention to its patients. It treats its patients as a family member and gives them homely environment so that they can reduce their worries about the surgery and get recover in shorter time period (Heskett, 2003). This highly empathetic and personalized environment assists the hospital in attaining an exclusive image in comparison to other hospitals.

Tangibles:

Nowadays, the success of a service depends upon its tangibility that pertains to the appearance of facilities or service provided. At Shouldice, the service delivery system of the hospital make use of lots of tangibles in the form of its staff, experienced surgeons, hospital atmosphere, environment, its building structure, facilities and counselling sessions (Christense, 2008). All these different aspects of hospital make its services more tangible that assist it significantly in creating an effective position in the industry and in the minds of its customers.

Shouldice Value Proposition Relative to its Competitors

With the case analysis, it becomes apparent that the Shouldice offer a superior value proposition in comparison to its competitors. Its competitors are not able to compete on its services and facilities. It adopts totally different service delivery system in comparison to its competitors. Shouldice adopts a focussed value chain for managing its service delivery (Heskett, 2003). It makes its patients totally aware with the treatment given to them and they are awake at the time of surgery that is not followed at any other hospital.

All these service delivery aspects of Shouldice assist it in attaining immense success and reputation in the minds of its customers. It is not only successful in increasing its number of patients but it is successful recovering patients immediately in comparison to other hospitals. All the distinctive services of Shouldice along with experienced staff and doctors direct it towards immense success.

Shouldice is able in balancing low cost with high quality in a number of diverse ways. One of its substantial reasons is its low cost of the operation room furnishings that is $30,000. In other hospitals, the cost of operating rooms is four-fold due to extensive equipments (Christense, 2008). As well, hospital is able in decreasing its costs by having only one crash cart at each floor rather having hundreds crash carts. Employee turnover at hospital is also very low.

Additionally, it also makes an appropriate use of time that assists it in its cost cutting measures. In spite of spending on all trivial things, they pay their employees more than the industry average (Eldersveld, 2008). With high salaries they become highly dedicated to their duties that assist in managing high quality with low costs.

Working Environment of Shouldice

A number of factors of Shouldice Hospital make its working environment more effective. In comparison to other hospitals, it provides several benefits of its employees along with a healthy environment to learn and grow in medical field. They work with a fixed schedule along with sufficient breaks (Chapter 1: A Road Map to the World of Strategic Management, 2006). As well, the salaries given to Shouldice staff are more than industry average and turnover at hospital is very low. This low turnover also evidences the effective working environment of the hospital.

Growth Alternatives

For resolving the present problems and attaining more growth, Shouldice should try to identify the ways through which it can increase its hospitals capacity. Subsequent are some growth alternatives that can be adopted by the Shouldice Hospital:

Expand the current capacity of the hospital to fulfil the increasing demands.

It may start operating on Saturdays.

The hospital can expand its services into Toronto or in the United States (Heskett, 2003).

It may offer more kinds of special surgeries like varicose veins, eye surgery or diagnostic services.

On the basis of above proposed growth alternative, I would recommend that the hospital authorities should expand their capacities for fulfilling the increasing demand. They are having an outsized space that can be used effectively for expanding its capacities. By proceeding in this direction, they may also become able in making use of advertising campaign for attracting more patients (McConnell & Huba, 2003). For handling the increasing demand, the hospital should also appoint additional staff and doctors. Appointing extra staff will facilitate in maintaining the present relationships with its each patient. In this way, the hospital can easily and effectively expand its capacities for meeting up with the increasing demands.

History and background of medical tourism

CHAPTER 1INTRODUCTION

The practice of travelling abroad to obtain medical and health care services is called as medical tourism. The benefits of medical tourism are getting widely popular among people because people are getting aware about the benefits of medical tourism like the lower cost of the medical procedures and can enjoy their holiday in a exotic location during the recovery period. This outsourcing for health care is grown as a new trend and many American and European tourists prefer medical tourism for cosmetic and medical procedures. The countries which are lack of advanced medical procedures leads the people living there to fly abroad to get appropriate medical services.

The practice of travelling abroad is a trend which developed from the ancient period and there is a long history of people travelling to other countries for health purposes. In Italy and throughout the Roman provinces, the Ancient Romans constructed resorts with thermal health spas, and the Ancient Greeks would travel ‘to [on the Saronic Gulf] to visit the sanctuary of the healing god, Asklepios, who revealed remedies to them in their dreams’ (Bookman and Bookman 2007: 4-5).

From the 15th to 17th centuries, the poor sanitary conditions in Europe prompted an interest by the rich in medicinal spas, mineral springs and the seaside for health purposes. These wealthy individuals would also travel to renowned medical schools for medical assistance (Swarbrooke and Horner 2007: 16, 33). This continued into the 18th and 19th centuries where spa towns, particularly in the south of France, became popular for health cures, the sun, and escaping the cold climatic conditions in the north of Europe (Holden 2006: 21-23). The rapid urbanisation and social change experienced during Industrialisation aggravated the unsanitary and poor living environments in Britain and some sections of Europe, with anti-urban values and a growing concern for health developing as a result (Holden 2006: 30). The formation of the railways allowed increasing and diverse flows of people to more distant seaside and coastal resorts, which provided a distinctive and escapist environment from urbanisation, and the opportunity to practice what was viewed as a healthy pastime of sun-seeking (Holden 2006: 30; Swarbrooke and Horner 2007: 16,33)

Spa tourism and sun-seeking persisted into the 20th century. Medicinal springs, spas, Beaches and resorts, particularly in warm and dry climates, continued to be considered therapeutic through long exposures to the sun, fresh air and water (Swarbrooke and Horner 2007: 33).Thus it is easy to understand that the health tourism has developed from the ancient age with myths and beliefs and as cure from natural resources to the current stage of various medical and surgical procedures and cosmetic therapies and for alternative therapies like yoga, naturopathy and ayurvedic medicine. Michael Moody (2007) indicates that the medical tourism trend began when residents of one country would go to another country to have cosmetic or dental procedures completed while on vacation or to recover from such procedures in a vacation like destination.

Today, countries like India, the East Indies, South America and South East Asia offer treatment facilities at par with international standards at just a fraction of cost. The factors such as high cost of healthcare in developed countries, long waiting list in government medical facilities and the reduction of air fare are the majority of reasons which contributed for the growth of the medical tourism. The hospitals in India, the East Indies, South American countries and South East Asia offer a high quality medical care which is par with international standards in very cheap money compared to developed nations.

India is one of world’s favorite tourist destinations and has many hospitals of international standard and English speaking staffs and therefore there are less chances of language barrier for the western patients. India has alternative therapies like Yoga naturopathy siddha and ayurvedic medical practices. One of the recent survey conducted in India on the healthcare indicates that the medical tourism in India will grow to US $ 125 to 250 million in the year 2012.(CII McKinsey study).The low cost and high standard treatment and care are the reasons which accelerates the medical tourism in India. The following example will illustrate about the economical as well as tourist benefits of medical tourism in India. Howard Staab, a self-employed carpenter from North Carolina, flew to India for his medically necessary heart surgery, scheduled a side trip to the TajMahal, and returned home to work in North Carolina. He spent a total of less than $10,000, instead of the $200,000 required from the local hospital ( Milstein and Smith 2006).This indicates that India has patients for procedures like heart surgery which requires state of art facilities and highly skilled medical team. Other than that it also shows the money difference when compared with developed nations. Kerala like any other states in India also has lot of potential to be a market leader in medical tourism.

Kerala often described as “God’s own country”is one of the favorite tourist destinations in India. The geography of Kerala is embellished with lush green coconut groves, scenic beaches, tranquil backwaters and enriched culture. There is a pride of place in the field of medicine for this Indian state and medical tourism is the new facet of Kerala.

Medical tourism is very popular in some states of India and this study focuses on a city of Kerala state. Kerala is considered one of the most favorite tourist destinations in India because of its beaches, hills, lagoons, backwaters and enriched culture. This state has tremendous potential to boom its medical tourism and the tourism industry is promoting itself with several ayurvedic and health packages.

This study focuses on the trends of medical tourism in the city of Trivandrum which is located on the southernmost state of India called Kerala. This city is the current capital of the state of Kerala and it is known for its scenic beauties and beaches.This city also has several international standard hospitals and traditional ayurvedic resorts and clinics.

Objective of the Research Study

The principle aim of this study was to investigate and critically analyse the recent trends in the medical tourism in the Trivandrum, the southernmost city of India. This study also analyses the behavior of the medical tourist and their expectations in the services provided by the hospital or the clinic and the tourist operators or agencies. This study also focuses to address the a gap that exists in similar study conducted before. The aim was to address the gap between available literature and demand for further research on the subject by adopting a clearly defined and structured research design, utilizing both quantitative and qualitative research methods.

Find the factors that drive Medical Tourism in Trivandrum
Analyse the issues which determine success of medical tourism in Trivandrum
Identify the problems faced by Medical Tourism in Trivandrum
Make suitable suggestions for improvement of Medical Tourism in Trivandrum
Rationales

The first and foremost reason for choosing the topic of the study is to lay out before the readers the state of the Indian medical tourism sector at a moment in time when it is in great flux. Moreover the author was working in one such hospital which was market leader in medical tourism in the city of Trivandrum. The medical tourism sector is believed to be a great boon of economical growth in Kerala and therefore by doing a study at this particular time may give readers awareness about the situation challenges and scopes. Other than that medical tourism it is an area of interest of the author as he wants to analyse the trends and issues involved in the medical tourism industry in Trivandrum city. The purpose of this research note is to outline some of the challenges and opportunities ahead, as health tourism finds its prominence in the practical and conceptual domains of tourism. Further there are predictions for Trivandrum city to flourish with medical tourism in next five to ten years and it is right time to analyse the challenges and scopes ahead.

Structure of the study

This study explores the trends of medical tourism in Trivandrum city and the issues around it. The need for further research on the topic has been established with carrying out a secondary research followed by primary research and by comparing evaluating the primary and secondary research. According to McDaniels carrying out exploratory research will gave the researcher clarification to understand the magnitude of topic area and thereby permitted a clearer and stronger perception of the environment and the situation which arise within it. (McDaniels, 2001).

CHAPTER 2
LITERATURE REVIEW

The medical tourism has an advantage of providing cost effective medical care collaborating with the health care industry and with the travelling industry to the patients who need medical treatment in a location different to their home town. Thus medical tourism occurs with the combination of healthcare services and tourism and travel domain. The facts that led the growth of the medical tourism are the availability cheap and high quality medical care in one geographical location and existence of long queue of patients for medical procedure and high prices of medical care in one geographical region. The outcome of these factors is the growth of medical tourism resulting in people moving to another geographical location for health care.

DEFINITION

The term medical tourism is a term coined in recent period but the practise seems to exist from ancient period and the trends in medical tourism have changed with the time.

The health tourist travel to their favourite destination for different medical and surgical procedures, cosmetic surgeries, alternative medicine, and spas and health resorts. The considerations and risk for different procedures vary accordingly. The medical tourism has gained social, economical and political interest but it has gained scant attention in tourism literature generally.

Bookman and Bookman (2007) define medical tourism as travel with the aim of improving one’s health, and also an economic activity that entails trade in services and represents the splicing of at least two sectors: medicine and tourism. The health tourism is seen as means of leisure oriented and stress relief as many people opt for sun and spas. Although there is no single definition for health tourism, it could be broadly defined as people traveling from their place of residence for health reasons (Ross 2001). Several demographic, economic, and lifestyle factors are driving such tourism (Handszuh and Waters 1997; Ross, 2001). Bennett et al. (2004: 123) acknowledge a liberal definition of health tourism would be ‘any pleasure-orientated tourism which involves an element of stress relief’, meaning it is an enjoyable and relaxing activity

Pollock and Williams (2000: 165), Laws (1996 in Henderson 2004: 112) and tries to see the health tourism with the view that it is a separation between the ordinary and the extraordinary; the everyday world of work and home versus the combination of health and tourism in ‘leisure, recreational and educational activities’. Then Schofield has a view that health tourism is a means to achieve improvement in physical, mental and social well being. (Schofield 2004: 137). The above all definitions try to define health tourism as a means to escape from every day routine and improve stress free healthful life.

Henderson (2004: 113) insists that health tourism as ‘travel where the primary purpose is treatment in pursuit of better health’ that may involve ‘hedonistic indulgences of spas and alternative therapies’, while medical tourism ‘incorporates health screening, hospitalization, and surgical operations. Ross (2001) after analysing various factors and literature tries to define health tourism as any kind of tourism that involves a person or his family member for the purpose of wellbeing and he considers that health tourism mainly focuses on two main domains as pampering and wellness. Pampering are services like massage, herbal wraps and exfoliating scrubs whereas wellness involves with improving physical and mental state and sometime it may involve with the treatment.

MEDICAL TOURISM AND ITS TRENDS

The concept of medical tourism have undergone many changes in recent times and there is a change in the trends like people from developed countries moving to developing countries for medical procedures for the difference in the cost. The global medical standards and regulations have been implemented in different countries and this in turn raises the number of people seeking cost advantage and best treatment in their preferred destination. The market of medical tourism depends on awareness and application of significant issues such as social diversities, consumer benefits, branding of products, legal frame work infrastructure, target markets, the actual product and communication channels (Dannell & Mugumba).Therefore it is understood that the people from developed countries choose their destination after analysing various features and therefore there exist high competition between the countries to promote medical tourism.

The one more key component in this medical tourism is the medical concierge services. These are medical travel companies that provide service to the traveller and they act as a link between tourist and the destination (Lagiewski, 2007).They have a vital role in the tourist experience from planning, stay, and post stages of the trip. The medical travel guide meets the tourist at the airport and he is the local agent who works as interpreter, guide and assists the tourist to stay in communication with his loved ones in his home. (Smith and Forgione, 2007).

According to Connell (2006) the ability to the countries to ensure the medical tourist that healthcare is of safe quality is a vital factor and this will be the main barrier for a destination to promote itself as most favourite destination In order to combat this concern, international accrediting agencies are in the process of certifying the quality and safety of global healthcare delivery. The tourist decides to engage in medical tourism on the basis of five a factor identified by Lagieweskii.Her study identifies the first and foremost as the alternative healthcare facility to their country’s facility which should be of high standard and at affordable cost. This factor is the main factor and when the tourist is satisfied with first factor the next will be cost of treatment and travel of great importance. The tourist may seek other country because of the e big waiting list in their home country. There may be some reasons like remote destination for tourist for certain cosmetic procedures. The nature of the country is also an important factor because tourist seeks a country free from risk factors associated with safety, security and actability. ( Lagiewski,2007).

The country trying to make itself as most preferred destination for medical tourism it should emphasize on the fact that its overall appeal and the experiences offered to the other competing destinations. (Dwyer and Kim 2003).Dwyer and Kim insists that the destination should have the competitive advantage to become successful in the medical tourism industry. According to Dwyer and Kim the existence of two type of resource group may lead to achieve competitive advantage. They are the endowed resources and created resources. Endowed resources are natural heritage and cultural attributes to a specific destination and created resources are services associated with the tourist such as accommodation, food and beverage establishments, and manmade attraction. There can be created resources such as special events entertainment and shopping which adds extra value to he destination. There can be supporting factors such as general infrastructure; quality of service; accessibility of the destination; hospitality of the host population; and market ties.

Growth has been facilitated by the rise of the Internet, and the emergence of new companies, that are not health specialists, but brokers between international patients and hospital networks. It has also grown because of rapidly improving health care systems in some key countries, where new technologies have been adopted. Above all it has followed the deliberate marketing of health care (in association with tourism) as medical care has gradually moved away from the public sector to the private sector, ensuring that a growing majority of people, especially in the richest countries, and particularly in the United States, must pay-often considerably-for health care

Finally, the factors like growth in medical tourism is done by the changing life style where people are ready to undergo cosmetic surgery, involving such elective procedures as rhinoplasty, liposuction, breast enhancement or reduction, LASIK eye surgery and so on, or more simply the removal of tattoos, have created new demands. Various forms of dental surgery, especially cosmetic dental surgery, are not covered by insurance in countries like the UK and Australia; hence dental tourism has become particularly common. In Asia these trends are ‘the unlikely child of new global realities: the fallout of terrorism, the Asian economic downturn, internet access to price information, and the globalisation of health services’ (Levett, 2005)

India and medical tourism

India is a country of rich culture and heritage and one of the most favorite destinations for tourism. It is one of the existing oldest civilizations in the world for a period of more than 4000 years and it has fusion of traditions, customs and diversity. (myindia).The survey conducted by lonely planet about the world’s favourite tourist destination among 134 countries ranks India as one among the world’s top 5 tourist destination.(lonelyplanet)

There are similar surveys and rankings for India as National Geographic describes India as “Land of mystery and majesty”. The company i – explore also ranks India as one of the tp 5 destinations in world. The Forbes traveller states India as one the fast growing travel markets. (ICRImedical tourism)

A number of destinations within India developed as havens for rest and recuperation such as hill stations at Darjeeling and the lakes in Kashmir where during the colonial era members of British era would retreat for cool breeze and a change of scenery. Late during the 19th century people began travelling India in search of alternative life style often focusing on yoga or meditation and following the footsteps of celebrities. India is building on these traditions as a wellness destination by a developing expertise in medical tourism (Garcia Altes 2005: conell 2006a).

The main marketing segments for medical tourism in India are patients from USA and European and middle east nations, while growing niche is formed by Indian expatriates ,particularly those live in USA and the UK.(Conell 2006), who combine medical treatment with visits to family and friends.

Medical tourism as a niche has emerged from the rapid growth of what has become an industry, where people travel often long distances to overseas countries to obtain medical, dental and surgical care while simultaneously being holidaymakers, in a more conventional sense. It has grown dramatically in recent years primarily because of the high costs of treatment in rich world countries, long waiting lists (for what is not always seen institutionally as priority surgery), the relative affordability of international air travel and favorable economic exchange rates, and the ageing of the often affluent post-war baby-boom generation. Growth has been facilitated by the rise of the Internet, and the emergence of new companies, that are not health specialists, but brokers between international patients and hospital networks. It has also grown because of rapidly improving health care systems in some key countries, where new technologies have been adopted. Above all it has followed the deliberate marketing of health care (in association with tourism) as medical care has gradually moved away from the public sector to the private sector, ensuring that a growing majority of people, especially in the richest countries, and particularly in the United States, must pay-often considerably-for health care

“Medical tourism” is an important part of the Indian tourism industry and holds immense growth potential. The medical tourism sector had experienced a phenomenal growth in the flow of medical tourists – from10,000 patients in 2000 to stupendous 180,000 by 2005. (Source: RNCOS report on ‘Indian Tourism Industry Forecast (2007-2011)

The Indian government takes meticulous steps in promoting medical tourism and it tries to increase the growth of foreign medical tourist by providing medical visas called M visas. These M visas are valid for one year and it is issued for the accompanies and Indian ministry of tourism has stocked its 13 overseas offices with information regarding these visas.( Meleigy)

In 2002,2.2 million foreigners visited India :those numbers increased by 20 percent the following year(Mathew 2004).The tourist literature produced by the Indian government portrays India as a country rooted in tradition and also sufficiently modern to offer western style amenities (Bandyoupdhay and Morais 2005) A study by McKinsey and Confederation of Indian Industry says that at its current pace of growth, healthcare tourism alone can rake over 8,000 crore additional revenue by 2012.(cii mckinsey study)

There are several states in India and the private hospitals in India target for the medical tourist other than the home patients. The southern state of Kerala which is very rich in culture and heritage and ancient medical practice like Ayurvediac ,Siddha and Yoga leads in attracting the foreign tourist for medical health and leisure tourism.

Kerala

Kerala is a bizarre anomaly among developing nations, a place that offers real hope for the future of the Third World. Consider: This small state in India, though not much larger than Maryland, has a population as big as California’s and a per capita annual income of less than $300. But its infant mortality rate is low, its literacy rate among the highest on Earth, and its birthrate below America’s and falling faster. Kerala’s citizens live nearly as long as Americans or Europeans. Though mostly a land of paddy-covered plains, statistically Kerala stands out as the Mount Everest of social development; there’s truly no place like it. The National Geographic Traveler, which once made Kerala the cynosure of all eyes in the world travel circuit by describing it as one of the 50 paradises in the world. (National Geographic)

Kerala is one of the most visited tourists destination of India. It is globally famous for its enchanting tourists’ attractions that are off beat than any other tourists’ places in the world. Every year hundred and thousands of tourists from all over the world come to Kerala to enjoy holidays in splendor. The state is endowed with palm fringed beaches, verdant hill stations, captivating beaches, emerald paddy fields, historical churches and more of all picturesque backwaters. This makes the marketing medical tourism easier in Kerala.

Accreditation of health centers

The quality of the medical care is the first and foremost factor considered by the medical tourist. According to the medical tourism association the accreditation is the means of way to attain safety and overall positive results to the patients who travel from one country to another for treatment purposes. The medical tourist can look into the accreditation to ensure the safety of the treatment in the hospital. The accreditation program is very essential to help patients, employers and insurance companies who can look into the accreditation status and thereby can find the hospitals with highest quality of care during their entire patient experience. The medical tourism industry grows day by day and therefore there is a necessity to ensure that hospitals, clinic and rehabilitation centers entering medical tourism posses proper infrastructure to meet the medical tourist. There is a need to certify that the center has proper communication facilities, transparency in quality and pricing, informed consent, proper medical care and further follow up facilities. The accreditation is focused on the fact that international patients have special needs and requirements than domestic patients. The accreditation is usually given by bodies which may by government or non government with the panel of expert members to examine and find whether the organization meets the requirements.(medical tourism association)

The accreditation to the allopathic medical practice in Trivandrum is provided by the international accreditation bodies such as Joint Commission International (JCI), ISO 9001 – 2000 etc. Other than the international bodies Trivandrum city has hospitals certified by NABH, a board set up by government of India. (See appendix).These are the major accreditations of medical service in India. The ayurvedic practice is the unique specialty and most popular medical practice in India and they have accreditation done by Body set up by Government of Kerala as “Green leaf” and “Olive leaf” and green leaf is the highest degree of accreditation and its followed by olive leaf and these accreditation ensures the quality of ayurvedic treatment in Kerala. (expresshealthcare)

Ayurvedic tourism in Kerala

Kerala is usually marketed as a health destination for its ayurveda packages. Medical tourism is marketed along with ayurveda and other health packages. Kerala ayurveda tourism has becoming a huge selling point for Kerala tourism industry. State promotes Kerala ayurveda tourism as a part of medical tourism to the world. Today popularity of Kerala ayurvedic treatment has gained such a momentum that tourist from across the world come to Kerala to rejuvenate and for therapeutic treatment.

Ayurvedic medical practice is the most ancient medical system originated in India before 10,000 years ago and in India the ayurvedic practice is more popular in kerala where it is practiced in traditional way. As per ayurveda specialists, the rainy season (June – August) is the best time for ayurvedic treatments as the atmosphere remains dust free and cool, which helps open the pores of the body to the maximum.(Messerli and Oyama 2004)

Ayurveda believes in the treatment of not just the affected part, but the individual as a whole. Kerala ayurvedic treatments and rejuvenation therapies are natural way to refresh and eliminate all toxic imbalances from the body and to regain resistance and good health. Most of the ayurvedictherapies help to strengthening the immune system, preventing and curing diseases without any side effects.

There are number of resorts and hospitals throughout state which are integral parts of Kerala ayurveda tourism and offering customized ayurveda holiday packages which help you to rejuvenate the body and soul and to start a fresh life. Kerala ayurveda provides number of treatments ranging from de-stressing, anti-ageing, weight loss, joint pains and general rejuvenation.

Elements of medical tourism in Trivandrm

Review of similar studies.

History About What Is Travel Agency Tourism Essay

Travel agency is a confidential seller/ public service that present tourism related services to the public on behalf of dealers like hotel, package tour, railways, rentals car, airlines, sea ways, and airlines. addition to trading with regular tourists the majority agencies have a separate department committed to making travel arrangements for commercial travelers and a number of travel agencies focus in commercial travel only. There are also travel agencies that provide as general sales agents for overseas businesses, allowing them to have branches in regions and nations other than where their head offices are placed.

Operation

Agency’s major role is to perform as a representative. Promoting travel goods and services on behalf of a dealer. Therefore, similar to other retail industries, they don’t have a stock in stores. A holiday pack or a ticket is not obtained from a dealer till a consumer desires that purchase. The holiday or ticket is providing to them at money off offer. The revenue is consequently the variation among the marketing cost which the consumer pays and the discounted cost at which it is offered to the agent. This is known as the commission. In countless countries, all persons or companies that trade tickets are necessary to be licensed as a travel agent.

Many British and American agencies license are based on these associations:-

(IATA) international transport association- for who issue air tickets

(ATOL) air travel organizer’s licensing- for who order tickets

(ABTA) associations of British travel agent or the (ASTA) the American society of travel agent, for who trade package holidays on behalf of a tour company.

Ticketing

Reserve and distributing tickets is a most important function of the travel agency. It is necessary for travel agency workers to have familiarity or knowledge about Air travel in the worldwide as well as national segment. This knowledge undertakes a range of other features such as booking methods, class of travel, prohibited matter, special customers, passports, visas, travel directories, hotel guide. Supervisor or an worker have to know the variety of procedures linked to these

Management tasks

Similar to any other business if you have it in mind to set up and run a travel agency company efficiently you have to apply the management concepts and functions not only in scheduling but also in processing. The organization tasks in a travel agency are linked to the character of business process and the services provided. The key responsibility of travel agency is to supply the purchase of travel to the client at a suitable place. It is at these places that the travel agencies act as reservation representative for road or water transport, railways, hotels, package tours, airlines. They also offer convinced additional services such as, traveler cheque, procuring of visas, foreign exchange, travel insurance, airport transport, customer clearances, permits, etc. A travel agency also behaves like a travel advisor suggesting consultancy on ideas like:

How to travel?

When to travel and where?

Where to stay or do shopping, etc.?

Information about rules, policy, safety, etc.

Such suggestions are possible only after identifying the client’s requirements and attitudes. This part has to be completed neutrally by the travel agency in order to provide the best to the client.

Travel agencies are divided in a range of ways. The differences can be based on their memberships such as International Air Transport Association (IATA), Pacific Area Travel Association (PATA), American Society of Travel Agents (ASTA), Association of British Travel Agents (ABTA), World Association of Travel Agents (WATA), Universal Federation of Travel Agents Association (UFTA) or Travel Agents Association of srilanka (TAASL). These recognitions can also be identified by the kind of trade or services they are providing.

Acquiring Product familiarity or Knowledge

If not a director acquires product knowledge or familiarity with products, it is hard to be successful in travel agency industry. This is exactly true because the majority of the travel agencies are small family businesses with proprietor performing as managers and use little workforce. The managers themselves must have a best product familiarity or knowledge in order to lead and direct their workforce. This is related for mutually, outbound as well as domestic travel. A travel agency workforce should have full familiarity or knowledge of-

Destinations:

Whether conditions,

Political environment,

Special events and community holidays,

Customs, culture and cuisine of destination,

Main attractions,

Physical condition and other hazards,

Money exchange rates,

Travel policy regulations and documents,

Lodging facilities,

Airlines:

Reservation system,

Travel Route operations,

Flight agenda,

Charges,

Types of airplanes,

Services offered on board,

Connecting flights,

Airports:

Timings,

Amenities,

Travel Agencies

Product knowledge can be obtained

From a variety of sources. It is equally

Custom and safety regulations,

Distances from city,

Transportations:

Connections or contacts

Car rentals,

A reservation method and procedures.

Other Aspects:

Package tours,

Excursions,

Principal Suppliers:

Image and financial standing,

Services offered,

Quality of service,

Commissions offered,

Forming or setting up a travel agency

To form a travel agency business has to make sure about following aspects:

Monetary and Infrastructural requirement,

Approval from concerned parties,

Recognitions from major suppliers or dealers,

Infrastructural and Financial or monetary Requirements

Forming a new business in this subject the big capital requirements are less. Most require investment are for the following:

Purchase of Suitable office space,

Office furniture,

Communication system and tools such as, computer, telecommunications

Wages for the employees,

Office equipment such as, document, files, tag, letterheads

Before formulate the travel agency business a significant point to be think is the situated place of the agency or the position of agency. The majority of the travel agents have their offices in busy cities. Travel agents vie for business in the place where they are positioned. At the same time selecting on the position of your office, you should make sure that it is in the marketplace with close access to profitable business.

Approvals from Concerned parties

Travel agencies want some approvals for start and function the business such approvals are:

Recognitions From the (IATA) International Air Transport Association is the global association of Scheduled Airlines. To apply for International Air Transport Association approval an application has to be presented by completing out the essential details, Forms, and sent to Sedentary, Agency Investigation, according to agency investigation below aspects will tartan-

Capability to find and procure air traveler transportation

Professional standing

Financial or economy position

Business building, location, etc

Workforce experience

A final inspection is held and the approval is provided by International Air Transport Association. Mainly it is important state here that all International Air Transport Association approved Agents obtain 9% commission on global air tickets and 6% on domestic air line tickets.

Recognition and Licenses

Travel agencies have to look for recognition or licensed from –

Department of Tourism,

Travel agency association of srilanka(TAASL)

Recognition from the major suppliers such as, the airlines, Banks and recognition by the dealing hotels.

Civil aviation license registration (according to Srilanka)

Manager prefer the status of that company

Manager and two staffs with qualified diploma certificate authorized institute. (Have to face an interview to recognizes and get the permission)

Original business registration certificate (BRC)

True copy from share holders and shares details. If that company based on one person they will need company details and future achievement

Section 51 form that ,the main one share holders original details including share percentage

MEMBERSHIP PROCEDURE

Membership Entrance Fee Rs. 20,000/-

Membership Subscription for the ensuring year Rs. 10,000/-

Total Rs. 30,000/-

Needed Document’s

Registration Certificate issued by the Ceylon Tourist Board

License Certificate to carry on Business as a Travel Agent issued by the Ceylon Tourist Board for the current financial year

License Certificate to carry on Business issued by the Aviation Authority for the current year

Certificate of Company Registration

A letter confirming the authorized and paid up capital form the Auditors

TRAVEL AGENTS ASSOCIATION OF SRI LANK
APPLICATION FORM FOR MEMBERSHIP

The Secretary

Travel Agents Association of Sri Lanka

COLOMBO

Name of Company: …………………………..……………………………………..

Address: …………………………..……………………………………..

Business: State Nature of Tourist Activities:

…………………………..……………………………………..
…………………………..……………………………………..

Name / Designation of Contact Person: …………………………..……………………………………..

Tel No: …………………………..……………………………………..

Fax No: …………………………..……………………………………..

Email Address: …………………………..……………………………………..

Signature of Applicant: ………………………………………

Date: ………………………………………

I / We wish to apply for election as a member of the Travel Agents Association of Sri Lanka and I/We hereby agree to be bound by the Rules of the Association from time to time in force and by the decision of the General Committee.

Signature of Applicant: ………………………………………

Date: ………………………………………

Services offered

Tour packages(family travel, group travel, adventure travel, incentive travel )

Domestic and international tour packages

hotel and resort lodging to air transportation

car rental needs

travel insurance security

visa procedures

Immunization procedures and other foreign travel requirements.

Urgency toll-free phone numbers

ticketing

airline seating preference

Smoking and non-smoking designation

It all based on personal interests and budget concerns.

License to carry on business as a travel agent

C:UsersSingheDocumentsSri-Lanka-Tourism-Development-Authority-Licence-to-Carry-on-Business-as-Travel-Agent-2010.jpg

het reisgedrag van de nederlanders

Het reisgedrag van de Nederlanders

Nederlanders staan er om bekend dat je ze overal tegen komt, in dit opzicht zou je zeggen dat er een bepaald reisgedrag typerend is voor Nederlanders. Toch is dit wel het geval, ook Nederlanders hebben een aantal belangrijke overeenstemmingen wanneer het gaat over hun reisgedrag. In dit deel van het adviesrapport zal u dit kenbaar gemaakt worden. Hierbij word gebruik gemaakt van betrouwbare bronnen die u terug kunt vinden in dit document.

Vakantieparticipatie
De duur van de vakantie
Bestemmingen binnenland
Bestemmingen buitenland
Vakantieparticipatie

Opvallend is dat een hoog percentage Nederlanders op vakantie gaat. Zowel voor korte vakanties (2 tot 7 dagen) als lange vakanties (8 of meer dagen). Dit percentage komt neer op 82% (2008). Dit percentage is erg stabiel het verschilt namelijk slechts 1 procent als u kijkt in de periode van 2003 tot 2008. Dit percentage komt neer op 12,5 miljoen Nederlanders die jaarlijks op vakantie gaan.

Hoewel wintersport de laatste jaren steeds meer in opkomst is blijft de lange vakantie in de zomer favoriet onder de Nederlanders. Het aantal Nederlanders dat in 2008 op wintersport is gegaan bedraagt 5,1 miljoen tegenover 10,0 miljoen zomervakanties. Hierbij gaat het wel om vakanties die 5 of meer dagen duren. Korte vakanties daar in tegen worden meer gedaan in de winter. Een belangrijke toevoeging hieraan is wel dat de winter periode 7 maanden (oktober – april) duurt en de zomer periode slechts 5 maanden (mei – september).

De duur van de vakantie

Een gemiddelde lange vakantie in 2008 duurde 12 dagen. Buitenlandse lange vakanties duurden gemiddeld 3 dagen langer dan binnenlandse lange vakanties. Korte vakanties duurden gemiddeld iets meer dan 3 dagen. Hierbij was bijna geen verschil tussen het gemiddelde van binnenlandse en buitenlandse vakanties.

Bij het lezen van deze statistieken is het echter wel belangrijk dat u zich realiseert dat zowel de dag van vertrek als de dag van aankomst bij de duur van de vakantie worden gerekend. Zo worden korte vakanties vaak in het weekend doorgebracht.

Tijdens de deze vakanties moest er natuurlijk ook een overnachtingsplaats gevonden worden, hiervoor boekte Nederlanders voor lange vakanties in totaal 253 miljoen overnachtingen. Meer dan de helft van deze overnachtingen vonden plaats in het buitenland. Op alle bestemmingen overtrof de zomerovernachtingen die van de winter. De meeste overnachtingen tijdens lange vakanties werden gemaakt in Frankrijk (17%), Spanje (11%) en Duitsland (9%). Bij korte vakanties waren de resultaten van het onderzoek anders. Hier vonden de meeste van de 70 miljoen overnachtingen plaats in Nederland. Zowel in Nederland als in het buitenland waren er weinig verschillen in het aantal overnachtingen in de winter en de zomer.

Bestemmingen binnenland

Door de statistieken van het ContinuVakantieOnderzoek van TNS Nipo hebben we tijdens het onderzoek een goed beeld gekregen van het Nederlandse Reisgedrag in Nederland. Het toeristengebied ‘Veluwe en Veluwerand’ blijkt in 2008 met 12% het meest bezochte gebied door Nederlandse vakantiegangers. Daarna komt met 11% de toeristen gebieden ‘Groningse, Friese en Drentse zandgronden’ en ‘Noordzeebadplaatsen’ op de ranglijst. Opvallend is dat het laats genoemde gebied de laatste jaren wel steeds minder Nederlandse toeristen trekt. Trokken ze in 2003 nog 1,3 miljoen Nederlanders, nu is dat nog slechts 1 miljoen binnenlandse toeristen. Hieraan kun je zien dat de bosrijke gebieden meer in opkomst zijn en juist de water (zee, rivieren en meren) gebieden minder interessant worden. Dit word ook beaamd door de volgende statistiek. Hierin staat de ontwikkeling van het aantal bezoekers in de periode van 2003 tot 2008.

http://www.cbs.nl/NR/rdonlyres/8665248B-16B7-4C08-B980-4159B7AE0F6F/0/2008g72pub.pdf

Grafiek binnenland verdeling overtypen/invoegen!

Heritage Tourism On Archaeological Sites In Egypt Tourism Essay

Egypt is located in the North- Eastern corner of Africa and South-Western Asia and is commonly known as The Motherland of the World Land of Civilizations and “The Greatest Power in Human History” being reputable for its 7,000-year-old record of civilization and immense wealth of knowledge (SIS, 2011). Amongst all civilizations and nations, Egypt is known to be one of the world’s oldest tourist destinations, possessing one third of the worlds’ ancient monuments within its country. Besides its other archaeological and cultural monuments, the discovery of the Pharaonic antiquities long time ago has added a special appeal to Egypt, therefore boosting Egypt’s tourism industry. However, with the booming increase in Egypt’s tourism, conflicts and issues starts to surface concerning the management and conservation of the ancient Egyptian archaeological sites and treasures.

What defines Egypt is it’s massive number of archaeological sites that can be found all over the country and of course, its extraordinary architectural and heritage attractions such as the legendary Pyramids of Giza, the world-famous Valley of the Kings and the temple at Abu Simbel. These well-known and remarkable sites are the lifeblood of the country’s tourism industry where it attracts over 2 million visitors annually to Egypt (Boniface and Cooper, 2001).

Despite being one of the most highly industrialized country in the Arab region, Egypt’s petroleum and economy is not sufficient to provide adequate amount of jobs to it’s population of 73 million (e.g.: Boniface and Cooper, 2001; MINTEL, 2004). It is also mentioned by Weeks and Hetherington (2006) that tourism has been a key factor in Egypt’s economy for about the last two centuries and over the last generation. It has become a crucial component of the economy and is now the source of 45 percent of the country’s annual foreign currency earnings. Therefore tourism in Egypt plays a critical role of support for its economy where it benefits both the government and to all levels of the society.

One of the main components of the tourism industry in Egypt is heritage tourism. Heritage itself as a concept has entered on to a global stage and penetrated into the local, regional and national arena (Burnett, 2001). The World Tourism Organization (UNWTO) states that heritage and culture have become an important element in almost 40 per cent of all international trips taken (Timothy and Boyd, 2003) and despite of recession, heritage tourism still continued to grow (Hanna, 1993, cited in Timothy and Boyd, 2003). Throughout the world, ancient venues and archaeological monuments have become major tourism attractions (Laws, 2011) and one such destination is Egypt where the impacts of flourishing heritage tourism on ancient archaeological sites are apparent through out the country.

However, in spite of the thriving tourism industry in Egypt, conflicts and issues starts to arise that contradicts Egypt’s own tourism interest. In order to maximize revenue from the tourism industry, Egypt implemented the approach of opening more sites to visitors and promoting visits through advertising and high profile overseas tours of antiquities (Weeks and Hetherington, 2006). Ironically, the benefits of expanding Egypt’s tourism are being out weigh by the negative aspects. Lambert (2011) states that a bustling tourist industry is sadly known to be a double-edged sword. She added that, as most archaeological sites are very fragile and ancient, they were not meant to accommodate thousands of visitors on a daily basis. The overcrowding of tourists visiting, touching and stepping onto these sites, are destroying many archaeological attractions.

One such incident happened in February of 1988. A chunk of limestone fell from the Egyptian Sphinx, the half lion, half man relic built by the ancient Egyptians over 4,000 years ago. Recently on January 2011, Egypt’s Supreme Council of Antiquities had announced plans to close the tomb of Tutankhamen to tourists by the end of the year. The tomb, which was discovered some 89 years ago, was damaged as a result of the overwhelming visits of tourist, particularly over the past three decades (http://www.redorbit.com).

The mass tourism in Egypt has also impacted the Valley of the Kings, altering the physical and natural aspects of the environment. According to Gaetano Palumbo, the program director for North Africa, the Middle East and Central Asia for the World Monuments Fund, a New York-based nonprofit dedicated to preserving and protecting endangered historical sites around the world:

One could say that, the heritage sites in Egypt are victims of their own success. In the Valley of the Kings, Luxor, visitor numbers have almost doubled in the past 10 years, from 1.5 million to close to 3 million, with peaks of 10,000 visitors a day. This creates massive problems in visitor management. … Drastic decisions may have to be taken in order to regulate visitor numbers, including temporary or permanent closures of ancient sites.

Due to poor tourism and cultural heritage management, Bindlegas (1997) states that the decay of some of the world’s most fabulous ancient relics has been happening at a shocking rate. These major archaeological and cultural heritage sites represent the origins of human civilization and provide the best evidences of the historical and cultural development of humanity (Global Heritage Fund, 2010). If measures are not taken to start preserving and conserving the ancient monuments, it will be completely destroyed within centuries.

However, increasing the tourism receipts into Egypt and on the other hand, conserving these heritage sites is not as simple as it seems. Leask (2006) described that balancing the development of tourism opportunities and heritage conservation activities has been a continuous struggle for countries with tourism and cultural heritage management. The different parties involved are unable to decide on the same agreement, resulting in the lack of proper management that can benefit both the tourism and conservation of the ancient Egyptian archaeological sites and treasures.

Therefore this paper aims to identify the variables that constitute and associate to the impacts of heritage tourism on archaeological sites in Egypt.

AIM

To assess the impacts of heritage tourism on archaeological sites in Egypt

OBJECTIVES

– To review secondary literature about the environmental impacts of heritage tourism on archaeological sites in Egypt.

To study the conflict between heritage and tourism in Egypt.

To assess the management and conservation of archaeological sites in Egypt.

CHAPTER TWO: LITERATURE REVIEW
DEFINING TOURISM

According to the Advance Release of the World Tourism Organization (UNWTO) World Tourism Barometer, international tourism showed a strong recovery of almost 7% to 935 million in 2010, from the 4% decline during the global economic crisis in 2009. Through the decades, tourism is now known as one of the largest industry in the world, experiencing dynamic improvements and intense diversification, leading it to become one of the world’s fastest growing economic sector (e.g.: Youell, 1998; World Tourism Organization (UNWTO, 2011)). Therefore, prior to assessing the impacts of heritage tourism on archaeological sites in Egypt, it is first essential to define and understand the term ‘tourism’.

Even in early researches, the term ‘tourism’ had yielded, as many definitions as there were many studies of phenomenon (Cohen, 1974, cited in Wall and Mathieson, 2006). Guyer-Feuler who concentrated on the economical and statistical aspects of tourism, conceived the first definition of tourism in 1905, where it defined tourism as:

“A phenomenon unique to modern time which is dependent on the people’s increasing need for a change and relaxing, the wish of recognizing the beauties of nature and art and the belief that nature gives happiness to human beings and which helps nations and communities’ approaching to each other thanks to the developments in commerce and industry and the communication and transportation tools’ becoming excellent.” (Bahar, 2005: 2, as cited in Esen and Uyar, 2010)

The origin of the term tourism goes back to the 17th century where the root word ‘tour’ is derived from the Hebrew word ‘torah’ which means learning and examining. People who were sent on a voyage to explore distant areas to learn the social activities of the population living in those places are known by the Hebrews as ‘tourist’ and the behaviour as ‘touring’. (Bahar, 2005)

Some other few pioneers who attempted to define ‘tourism’ were Professor Hunzikar and Krapf (1941, cited in Holloway, 1994:1) of Berne University who states that it is:

The sum of phenomena and relationships arising from the travel and stay of non-resident, in so far as they do not lead to permanent residence and are not connected to any earning activity.

Holloway (1994) then continues that tourism, besides being associated as a form of recreation or leisure; it might be where individuals or a group of individuals travel away from home. However, Holloway (1994) also questioned the specificity of the statement on whether tourism is defined by its purpose or the distance travelled. Indeed, it is a common perception and a popular understanding amongst people that the central aspects of tourism evolves around holidays, leisure and tours, engaging in different kinds of activities to have a good time and as long as being in a foreign land, it is considered to be tourism regardless of the distance travelled. However, tourism is more than just a cursory explanation of leisure, recreation and being in a foreign land.

In 1993, after much reviews, researches and further analysis on existing works of tourism definitions, the UNWTO (1993, cited in Youell, 1998:9), with co-operations from many international organizations, finally announced the officially accepted definition as:

“aˆ¦the activities of persons travelling to and staying in places outside their usual environment for not more than one consecutive year for leisure, business and other purposes.”

Therefore with the multitude of tourism definitions given by researchers and studies, which of these, can academics, organizations and professionals use as an accurate guideline in the tourism industry? In spite of the existence of many variations of tourism definitions and the popularity of tourism studies in recent decades, it has been discussed and acknowledged by academic researchers, organizations and industry professionals that there has been no specific means in defining the principal concept of the term ‘tourism’ due to its large complex nature of subject, involving diverse combinations of disciplines and industry sectors (e.g.: Morley, 1990; Youell, 1998; Goeldner, Ritchie and McIntosh, 2000; Dredge and Jenkins, 2007).

Moreover, regardless of the complications of specifying definitions for tourism, tourism is nothing without the tourists. The main factor that drives tourism is the tourists who are travelling and therefore any effort to understand tourism as a concept has to first understand the motivations behind the tourist’s decision to travel. Also, the definition of tourism is dependent on an individual’s perspectives and perception of tourism and also how it will fit into a particular purpose or situation (Dredge and Jenkins, 2007). In addition, the changes of the different definitions since the early 1900s till the present day demonstrates that tourism can no longer be associated to merely economics and geography (Arlt, 2010). As time passes with the continuous growth of the industry, researches into the concepts of tourism will persist to expand, eventually resulting in the creation of more definitions of tourism.

IMPACTS OF TOURISM

Tourism is an integration of close interactions involving the dynamic relationships of different variables or elements in the tourism travel process and thus, it can never be a standalone unit. Hence, any changes or effects to a variable will create a ripple effect within the whole tourism structure. With this, contributions made by the growth of the tourism industry will therefore lead to an increased economic activity within the country. Countries are increasingly becoming dependent on tourism, as it is one of the most rational and sustainable development choices that have the capability of creating employment to the communities and also acting as a main provision of foreign earnings to the economy. (UNWTO, 2010 – Tourism and the Millennium Development Goals)

While it is often the economic impacts of tourism that businesses and public organizations that are usually interested in (Stynes, 1999), the late twentieth century saw the emergence of environmental and socio-cultural impacts of tourism being controversial and critical issues discussed in tourism study (Youell, 1998). As the main objective of this paper aims to concentrate on the impacts of heritage tourism on the archaeological sites in Egypt, this section will therefore provide an overview of the positive and negative influences that tourism, in general, have on the economic, environment and socio-culture around the world.

Economic Impacts

It is predicted that by 2020, revenues earned from the tourism industry will be $1.5 trillion (Kumar and Prasad, n.d). Tourism being declared as one of the world’s largest industry is similar to any other businesses and industries; affecting the economy by generating income for the country’s economy, stimulating job opportunities for the people from the international level down to the local levels. Increasing competiveness amongst countries has also pushed the business capacity of the tourism industry to the level of, or, sometimes even exceeding trade commodities such as oil and food exports (UNWTO, 2011).

Tourism being a major player in the service sector is naturally dependent on labor therefore stimulating a great deal of employment opportunities both in developed and developing countries. The fact that tourism is an intergration of many various individual elements in a tourism travel process, the economic impacts from tourism will therefore affect industries in the construction sector, agriculture sector, commercial services sector such as retail and customer services and also the health and finance sector (e.g.: Wall and Mathieson, 2006; A-nder and Durgu, 2007). Tourist expenditures contributing to the balance of payments through foreign exchange earnings, and revenue generated from tourism developments can represent a crucial source of income for a nation’s economy (Balaguer & Cantavella-Jorda, 2002, cited in Seetanah, 2010). However on a negative note, seasonal tourism also known as induced employment, being influenced by the increase in the demand and supply of tourism causes the increase of low-paying jobs and often creating unemployment during off-peak seasons (Kreag, 2001). Peak periods of tourism can benefit the economy of a country, however on the expense of the locals, who might have to pay for the higher prices of goods and services in the community, thus increasing their cost of living. However, contributions of tourism to a country’s economic benefits is relative to factors such as the availability of facilities and resources, the country’s social and political stability, the host communities’ behavior towards tourist and the amount of investment injected by the government into tourism projects and development (Youell, 1998).

Environmental Impacts

The relationship between tourism and the physical environment, natural or man-made, is firmly interlinked and complicated. Controversial debates of tourism and the environment have been going on in determining whether they are “friends or foes”. The physical environment is an important aspect of tourism; it ensures the sustainability of attracting tourism in the long run. In fact, it is impossible to define the different types of tourism without the inclusion of the environment (Safakli, n.d). A tourist’s decision to travel and the duration of stay depends on the physical environment of the destination. According to Olali (2000), the estimation given by academics states that in the next 100 years, the environment will be the only option that will determine the demand of tourism. The environmental impacts of tourism can be categorised into two categories which are postive and negative impacts, and finding a balanced relationship with the environment is uncommon, if not, there is hardly a balanced relationship (Holden, 2000).

The negative impacts of tourism on the environment caused by the increased in tourist visitations are visible through the changes, damages and depletion of natural resources, causing the destruction of wildlife habitat, improper waste disposal, air and water pollutions, and also erosion of the natural landscape such as the mountains and historical sites (e.g.: Youell, 1998; Holden, 2000; United Nations Environment Programme (UNEP), 2001; Wall and Mathieson, 2006). The lack of facilities and space to accommodate the increase in tourist visitations results in the overcrowding and the over usage of an environment, therefore also increasing improper waste disposal, loss of significant attractions and unethical behaviors’ due to the lack of supervision over the large number of visitors. The detrimental state of the environment will then lose its beauty and attractiveness to these tourists therefore causing a decline in tourist visitations.

Despite of the attention on the negative impacts of tourism on the environment, there are still positive impacts of tourism that benefits the environment. Contradictory to the cause of degradation of these natural resources, the motivating factor behind a tourist’s decision to travel to these places are based on the sentimental attachment they have with the environments (Kreag, 2001). And because these environments are what attracted tourists visits in the first place, preservation efforts are heighened to keep them well managed, and protected from further deterioration. The positive environmental impacts of tourism are sometimes associated to the ‘economic value’ of tourism earned revenue (Holden, 2000). The increase of tourism travel to a destination also increases the tourism funds flowing into the country’s economy. This additional funds allows governments to use the added revenue from its tourist industry to implement measures into proper management and invest in the restoration of the environment such as construction of new roads to accommodate overcrowding of vehicles, building and upgrading facilities to attract or accommodate the influx of visitors and installing modern technologies into the conservation and preservation of sensitive areas (e.g.: UNEP, 2001; Kreag, 2001). And as tourism travel increases, the impacts on the environment are also increasing. Therefore, it is of utmost importance for government agencies and tourism organizations to focus on the preservation and conservation of the environment.

When the environment is restored to its original state or even better, the flow of visitors into the destination will resume once again. However if there is a lack of proper management or close facilitation of the situation, the environment will eventually return back to its damaged state. The attempt to balance the positive and negative aspects of the impacts of tourism on the environment tends go round a vicious cycle. This is where the importance of strategic planning intervenes and it is a crucial part of sustainable tourism of a destination.

Socio-cultural Impacts

The inclusion of social impact studies is an essential criterion for any tourism industry and tourism government agencies planning for a sustainable tourism industry as it provides an insight of the support for tourism development within host communities (e.g.: Nyaupane and Thapa, 2006; Zhang et al., 2006; Tovar and Lockwood, 2008; Deery, Jago and Fredline, 2011). Social cultural impacts on a destination’s society such as traditions, identity, lifestyle, values and customs, are the results of the direct and indirect interactions between the host communities, the tourists and the tourism industry. These impacts of tourism development on the local society are identified through the evaluation of residents’ perceptions and behaviors towards tourism (Tovar and Lockwood, 2008). Regardless of the magnitude of the fluctuations of tourism demand, the impact on the host community will not only be dependent on the number of tourist arrivals but the type of tourist (Holloway, 2002). Of which, these impacts can either have a positive or negative influence on the society.

Firstly, improvements of infrastructures resulted from tourism development such as clean water and stable telecommunications, improved transportation and banking services, and new business investments are positive impacts that contributes in enriching the local communities way of life (http://www.gawler.sa.gov.au). Tourism also helps in boosting the quality of life in the society and provides opportunities for locals to experience cultural exchange and interactions with the rest of the world. The accumulative experience gained from engaging in the cultural exchange with visitors enhances the host communities ability to interact comfortably and confidently with future potential visitors in the long run. Having an influx of tourist arrivals to a destination can also encourage the preservation and conservation of cultural values and traditional customs which are in danger of losing its identity. The increased interest of tourists into the culture and traditions of the local society also helps to push the demand for historical and cultural education and local tourism agencies will be pressured to step up on preservation and conservation of possible endangered ancient sites, monuments or artifacts (Kreag, 2001).

Despite of the positive and inspiring socio-cultural impacts of tourism on a host environment, the negative impacts of tourism, on the other hand, can equally cause a prominent damage on a culture. Ironically, instead of riviving a lost culture, the continuous development of tourism driven by the influx of tourist demand can very well cause the same cultural identity and value of the host communities to change and this issue has raised concerns amongst tourism organizations. This normally happens when local communites conformed to the needs, wants and desires of tourist’s expectations in the bid to respond to their growing demands. As such, this conformity leads to the commercialization of local culture into a commodity and the modification of traditional art and craft forms, resulting it to become “reconstructed ethnicity” which might end up causing the eradication of cultural goods (www.coastlearn.org).

One of the negative aspect on the social status of a culture is the social differences between the host and the tourists. According to Mathieson and Wall (2006), more often than not, social tensions between host communities and tourists happens in developing countries whereby the tourist market are from a country with higher foreign currency rate than the host communities and thus unintentionally highlighting the disparity of wealth. They also mentioned that since the nature of tourism involves the movement of people around geographical locations, social conflicts occur as a result of differences in cultures, values, lifestyles and languages.

TOURISM AND HERITAGE
Defining Heritage in Tourism

With the growth of the tourism sector, the types of tourist are also diversified and the collection of individual experiences of these tourists influence the different types of tourism offered today, thus the formation of the different types of tourism (Timothy and Boyd, 2003). Heritage tourism has been one of the oldest forms of tourism offered since the early ages, however in recent years, it has grown to popularity in the industry. It is the inheritance of the unrepeatable products of life from the past that is worth preserving for the benefits admiration and education of the current and future generations (e.g.: Nurick, 2000; Timothy and Boyd, 2003; Sethi, 2005; National Trust, 2011). Heritage could be anything that is tangible or intangible left behind by the past such as archaeological or historical sites that have been preserved, natural landscapes which are of a destination’s significance, artifacts and documents, culture, values and sometimes even the people of the past such as the indigenous people. However over the years, heritage has been modified and commercialized to suit tourists demand and expectations, allowing it to be more accessible, attractive, educational and entertaining (Fyall and Rakic, 2006). Heritage itself as a concept has entered on to a global stage and penetrated into the local, regional and national arena (Burnett, 2001). The World Tourism Organization (WTO) states that heritage and culture have become an important element in almost 40 per cent of all international trips taken and despite of recession, heritage tourism still continued to grow (Hanna, 1993, cited in Timothy and Boyd, 2003). The different types of heritage attractions offered now are varse and wide, examples includes natural history attractions, religious attractions, sociocultural attractions, art galaries, ancestral dwellings, and genocide monuments.

Fyall and Rakic (2006) adds that the demand for ‘heritage based’ tourism has been on the rise because Lowenthal (1979) states that people’s sentimental reminensce of the past is deeply affected by the parallel ongoing eradication of historical antiquities while on the other hand, Hannabuss (1999) also claims that heritage enthusiasts are immersing themsevles in heritage for the purpose of finding a rational explanation for their post-modern lives. With the controversial issues happening in everyday life, it is no wonder that heritage behaves as a touchstone in reminding people the primary essence of life. Hence, an attempt to understand the demand of heritage tourism could best be determined by initiating a study on visitor psychographic characteristics as these visitors are the primary factors pushing the demand for heritage tourism. Determining the visitor demographics can also aid in better planning and management of visitor capacity control in relation to preservation and conservation of the heritage sites which will be discussed further in the next section.

According to Hall and McArthur (1993a, as cited in Timothy and Boyd, 2003), the significance of heritage can be categorised into four different areas in relation to its economic, social, political and scientific significance. The economic significance of heritage refers to the value of the heritage to visitors, in terms of the amount of revenue earned from visitations to the sites. The social significance refers to the personal identification that individuals have to associate themselves with ‘their’ heritage. In terms of its political significance, the representations of heritage can behave as an aid in managing political issues due to its political nature behind its existance. Finally, heritage educates visitors on its history, culture and the population of a destination. It also acts as a benchmark for ecological studies on the environments and ecosystems, therefore presenting itself as a scientific significance to the people (ibid.).

Impacts of Tourism on Heritage

Through the globalization and increasing competiveness of the tourism industry, governments, tourism organizations and agencies are continuously pushed into the whirlpool of sustainable tourism development. Bramwell and Lane (1993) states that sustainable tourism development can be implemented if the balance of the economic, environmental and social aspects of the development is realised.

It is certain that every country in the world will definitely have a heritage background attached to them, however, what makes heritage tourism in a country unique is the exclusiveness of the actual heritage product itself. The characteristics and uniqueness of that particular heritage product dictates the different types of visitors and the demand of heritage tourism in the destination.

With tourism, comes impacts. As mentioned in earlier sections, tourism impacts the economy, environment and the socialcultural aspects of a destination. Likewise, heritage tourism being categorised into the four different aspects of significance, will therefore impact the economy, evironment and socialcultural aspects of a destination. An influx of tourist visitations can positively or negatively affect the destination in many aspects. Prosperity of the economy, job creations, improved quality of life are some of the positive impacts whilst seasonal unemployment, social tensions, pollution of the environment are some of the negative impacts. However when it comes to heritage, tourism is known to be impacting the environmental and sociocultural aspect of the destination more often than the economical aspect, unless otherwise, the country’s tourism economy is highly dependent on heritage tourism. Tourism is known to have an intitmate relationship with the matters of heritage conservation and preservation; a significant element in deciding the survival of a country’s heritage

Hence, the impacts caused by tourism on heritage sites are in ways similar to that of a natural environment (pollution, lost of habitat, lost of attractiveness), however, the results and repercussions are amplified due to the uniqueness of the heritage enviroment that can never have an exact replica elsewhere in the world.

CONCEPTUAL FRAMEWORK
Heritage Sites in Egypt
Demand of Tourism in Egypt
IMPACTS OF TOURISM ON HERITAGE IN EGYPT
Politcal Issues in Egypt
CHAPTER THREE: ANALYSIS
GROWTH OF TOURISM IN EGYPT
Tourism and Heritage in Egypt

The term “history” can be best epitomized by the ancient Egyptian civilization than to any other ancient culture (Grimal, 1994). Egypt is probably the world’s oldest civilization from the Nile Valley since the 3,100 BC and is reputable for it’s extensive collection of historical record on civilization and the immense wealth of knowledge (SIS, 2011). Five thousand years ago, a glimpse start of Egypts’s tourism began with the start of cruising (Goeldner, Ritchie and McIntosh, 2000). Queen Hatshepsut’s first cruise journey is recorded on the walls of the Temple of Deit El Bahari in Luxor, where it states that the purpose of cruising at that era was for peace and tourism (ibid.).

However the genesis of heritage tourism in Egypt could mainly be attributed by the smart and innovative grandeur infrastructure of the Pharaonic burial tombs such as the Sphinx and the other ancient Egyptian pyramids, which saw the first early arrivals of tourists. The start of tourism playing as a core role in the economy of Egypt came with the completion of the Suez Canal in 1869 and after being announced by Khedive (Viceroy) Ismail that Egypt was to be part of Europe (www.thelonelyplanet.com). The Nile, Luxor, the ancient Pyramids of Giza and temples are what defines Egypt as a heritage destination.

Egypt’s ancient civilization is an evidence of the evolution of mankind from the prehistoric days till the present. The rich history of Egypt acts as a connection to the distant past of humanity, which reveals mankind’s greatest glories and achievements.

Current Status of Egypt’s Tourism Industry

Tourism in Egypt is a huge lucrative business that has flourish and become a major component in the economic development. Millions of tourists are travelling to Egypt each year, for the purpose of appreciating the abundance of the natural and historical phenomenon within the country (www.greenstarhotel.net). In 1995, international vis

Heritage Conservation: Collective Memory And Urban Developmen

Recently, a well-know movie “Echoes of the Rainbow” has once again arouse the public’s awareness of heritage conservation. The government planned to redevelop Wing Lee Street as a dwelling house in order to advance the urban development. However, after “Echoes of the Rainbow” was filmed at that street and won the award at the Berlin Film Festival 2010, that plan was discarded. (Apple Daily) This time, the government held the totally different view point than before. Three years ago, in spite of the intense protest, the government still destroyed Star Ferry Pier, Queen’s Pier and Wedding Card Street for achieving more new developing areas. From my point of view, I strongly think that if the heritages can be well conserved, it can also boost Hong Kong economy. Balancing both our collective memory and urban development are the job of the government and the real purpose of heritage conservation.

Preserving the heritage is very important as it has lots of advantages. Firstly, local heritage possesses symbolic meaning to the unity of a society. Undoubtedly, historical heritage is memorable to the local people in a city. (TV programme’Hong Kong Story’ of RTHK). As urban theorist Aldo Kossi says, ‘the city is the collective memory of the people’ and ‘memory is the basis of self identity’ (Betty S F Ho, 2000). Local sentiments for the home city bring up self identity and the unity of a society. Destroying historical heritage could mean pulling down unity within a city since the sense of belonging is deteriorated.

Keeping the historical heritage can also maintain cultural diversity for the future generations. As suggested by the Conservancy Association, heritage conservation is also a matter of sustainable development and cross-generational equity. We do not have the right to deplete our natural or cultural resource, especially if they are non-renewable, to the detriment of our future generations (The Conservancy Association, 2003). Our education system mainly focuses on logical training but this is not enough. Creativity is important for sustainable development. However, the development of creativity is not just about reading different books, but also to experience in person. We cannot count on imagination only. By keeping the historical heritage, the new generation learns that a society can accommodate different culture and also the development from the old Hong Kong to the new one.

In an ecological point of view, heritage conservation is an environmental friendly act. Pulling down old buildings for renewal produces tons of waste. As pollution problem in Hong Kong is getting more and more serious in recent years, we should learn to conserve our resources when they are still useful. Renewal of the old buildings would be better for the earth and cost-efficient than pulling down them.

The advantage of urban renewal

On the other hand, urban renewal and buildings brings advantages. It definitely provides more land use, and there would be less need for landfill areas, which might further narrow our Victoria Harbour. As a crowded city, a more spacious living environment would improve the living quality of Hong Kong residents. People will be more happy and healthy when their living space expands.

Renewal of old areas provides better living conditions for residents. According to the Development Bureau, Planning and Lands Branch of the HKSAR Government, at present there are about 9,300 private buildings in the Metro Area (i.e. Hong Kong Island, Kowloon, Tsuen Wan and Kwai Tsing) which are 30 years’ old and above. In ten years’ time, the number of buildings over 30 years’ old will increase by 50%. The problem of ageing buildings is most serious in older urban areas (Planning and Lands Branch Development Bureau, 2008). Old buildings do not only affect the outlook of a city, they can also be a threat to the residents’ safety. Occasional accidents caused by old buildings can be a proof of this. Apparently, there is an urgent need to work on this issue to avoid similar accidents.

Urban renewal creates a new outlook for Hong Kong as a cosmopolitan city. Pollution problem in dilapidated urban areas in Hong Kong is rather serious, which is a big contrast comparing with the developed urban areas. To build up and sustain the ‘Asia’s world city’ image, urban renewal sounds to be a necessary action to be taken.

The ways to balance heritage conservation and urban development

Heritage preservation and urban development may go hand in hand.

The best thing is we can be able to strike a balance between heritage conservation and urban renewal and buildings. For example, more frequent and careful check and renovation can be a way to avoid accidents caused by urban decay. Or we can develop different areas according to their existing unique characteristics, instead of characterize different districts in one style. It is grateful to see the government has been putting more efforts in listening to the citizens’ voices when executing policies concerning urban renewal in recent years. But it’s a long way to go, more channels can be opened to collect and encourage more valuable opinions. I believe, with our care and attention, the old buildings can be attractions of the city, but no longer dilapidated areas and buildings.

In recent years, the government has been proposing different development plans of the city and many of them involve the areas, where some historical buildings or backstreets are situated, therefore the demolition of the buildings or backstreets become necessary for the plans. For instance, according to the Conservancy Association, the “Woodside” in Quarry Bay was planned to be pulled down in 2005 for the development of high rise residential uses. Luckily, due to the request of the Conservancy Association and the support of the community, the “Woodside” was preserved in the end (Conservancy). Another example is the demolition of the Queen Pier. Due to the Central and Wan Chai Reclamation Project of the government in the 1990s, the Queen Pier was planned to be pulled down in 2006. The aim of the project is to extend the waterfront from Sheung Wan to Causeway Bay, so as to improve the traffic in these districts. But it arouses lots of public concern and objection when it came to the step that the 50-year-old Queen Pier had to be pulled down. As Hongkongers can see that, the government is having different kinds of redevelopment plans in the city so as to boost the economy and competitiveness of Hong Kong. But once these plans are announced or progressed, objection and negative comments come quicker than the ultimate result as all these plans have one common requirement – the scarification of the heritage sites. It seems that this is a big problem that all these plans bring along. It is time for the Government and citizens to think about whether economic development and preservation of heritage sites are mutually opposed, or can be mutually beneficial.

Economic development and preservation of heritage sites can be mutually beneficial, because historical buildings and backstreets can help boost our tourism industry. As they are all of high historical value and characteristic of our culture, they can, in fact, attract a lot of foreign visitors. The foreigners would love to understand Hong Kong culture and history more through looking at these buildings and backstreets. Some of these buildings and backstreets may even show some of the unique Chinese traditional practices and customs, such as the Wedding Card Street that do business by helping people to design traditional but special wedding cards (Tourism Board). If these heritage sites are successfully restored and much better preserved, they could be converted into more popular and attractive tourist’s spots, such as the Wedding Card Street, Queen’s Pier, Ladies Street, etc. In this way, it is an important economic pulse and we would all benefit from it. On the other hand, if the historical buildings and backstreets are demolished, the foreigners would then lose the opportunity to understand the culture of Hong Kong and thus they may lose their interest in visiting Hong Kong. Hence, it harms the tourism industry and the economy of Hong Kong as well.

A good example about a better policy in preserving the heritage sites so as to make them become famed and attractive tourist spots is Macau, as more than 30% of its economic income comes from the hotel and catering industry (Macao). On the other hand, only around 20% of Hong Kong economic income comes from the hotel and catering industry (Census statistics). According to the Conversancy Association in Hong Kong, the Macau Government has been giving much attention to heritage sites’ conservation since the 1970s (Conservancy). The authority looking after conservation policy and implementation is the Cultural Institute (Conservancy). In the policy, not only the individual heritage site is preserved, but also the whole district around a central square, or along a street, and all these historical interests are then linked up with pedestrian walkways (Conservancy). In that way, tourists and visitors can check out all those historical buildings or backstreets one by one according to their own interest and thus understand more about Macau’s background. While Macau and Hong Kong both rely much on their tourism industry, Macau has already proved that preserving its own heritage sites does benefit to the tourism industry and thus help boost the economy. Therefore, Hong Kong Government should really start learning from Macau.

While preserving the heritage sites can preserve the history and culture, help boost the tourism industry and thus improve the economy, the demolition of them, on the other hand, brings objection from Hongkongers and some related problems. Hongkongers object to the idea of demolishing the historical buildings and replacing with new developments. They also object to the Government’s view, that the heritage sites are of no importance, and that the value of each heritage site can be ignored. The reason why Hongkongers object to the demolition of the historical buildings and interesting backstreets is that the heritage sites are of high historical, cultural and architectural value and importance (Conservancy). They “witness the changes of Hong Kong” (AMO) and are displaying the history, people behaviour and culture in the past. They represent a bridge between the present and the past of the city. Government House in Central is one of the examples, which is representative in witnessing the political change in Hong Kong. The heritage sites are irreplaceable landmarks that symbolize the image and culture of a city. In other words, they are representing Hong Kong and helping us to build up Hong Kong’s image!

Apart from the “historical and cultural value” (Conservancy), these historical buildings and backstreets also help enhance the sense of belongings of Hongkongers. You may be surprised to know that there are lots of historical legacies in Hong Kong and they can be found in nearly every district. For instance, Wong Tai Sin Temple in Kwun Tong district, clock tower in Tsim Sha Tsui, Old District in Tai Po, etc (Tourism Board). Therefore, people living in different districts, are having some special collective memories with different of these heritage sites, which means they share a collection of memories with a common culture about the heritage sites and they would then be able to remember the events related to those heritage sites in the future (Answers). Thus, the historical buildings and backstreets in turn provide people with unique social roots. These built heritage sites also help cultivate people’s culture identities and even record some significant historical events. That is why people would have a strong sense of belongings due to their collective memories with these heritage sites and they also pick up their identities through these memories. By preserving what remains, it can also serve education purposes by giving our next generation chances to experience and explore.

Of course, some people, especially the businessmen, entrepreneurs and industrialists, would support the development plans proposed by the Government and think that it is worth to demolish the heritage sites when necessary. The first argument that they would raise is, of course, preservation of heritage sites would hinder the economic development in the city. As a world-class city, Hong Kong should and had better have sustainable economic developments so as to maintain its competitiveness among different renowned trading cities. Yet, as Hong Kong is such a small city with a peculiar and rugged landscape, there are limited places or areas for further economic development. Also, due to the high density of population of Hong Kong, there is a need or demand for more lands. Therefore, these reasons prompt the exploration of lands and development of more high-rise buildings (Conservancy). For certain, historical buildings occupying some potential sites, which are planned to be developed, become barriers. A recent good and controversial example should be the Fa Yuen Street (South), which is commonly called the Sport Shoe Street. It is located on a potential site in Mongkok which has already been planned for the development of a brand new Sports City. However, once the plan was announced, the shop owners and citizens living around immediately showed their unwillingness to be removed. They objected to the plan due to their collective memories related to the street. For this reason, the project is now hindered and couldn’t be progressed smoothly. In fact, the project can be cancelled, because it is not necessary to have this redevelopment plan if the Government wants to boost the economy. Better preservation of the Fa Yuen Street and making it become a more popular tourist spot can also help boost the economy by improving the tourism industry, so do the other heritage sites.

In addition to the collision with the economic development, the Hong Kong Government would also argue, that the conservation of these cultural and historical heritage sites makes the burden of the Government even much heavier. As citizens all know, preservation of heritage sites is not an easy or cheap task, it requires loads of money and resources. As there is not adequate outside funding for preservation of the historical buildings and backstreets, the government is in fact paying most of the cost in the conservation process of the historical buildings, including the maintenance fee, repairing fee, restoration cost and management cost. This is, in fact, as well, hindering the development of other aspects in the society, like education or environment protection. While we are talking about spending more on better preservation of those precious heritage sites, there are, as well, inadequate resources available for the development for a better education system, or for better environment protection in Hong Kong so as to fight against the global warming. The Hong Kong Government should, therefore, think carefully about what their final choice should be. Yes, it is true that preservation of heritage sites requires loads of money and resources. But if the heritage sites can be converted into popular tourist spots, they can help boost the tourism industry and thus the economy. Then they are no longer the burden of the Government, since the economic income they bring would far outweigh the preservation fee they require.

In addition to the businessmen, entrepreneurs and industrialists, some Hongkongers are also opposed to the preservation of the heritages and backstreet. The reason behind is that the living condition of them may be adversely affected due to the heritage sites. In Hong Kong, the land use in the historical areas like Sheung Wan, Sham Shui Po and Yau Ma Tei were not well-planned many years ago. Lots of mixed commercial and residential areas can be found in these urban areas. Problems like over-crowding, serious noise and air pollution are commonly found in these districts and are getting worse gradually. In that way, preservation of the historical buildings in these districts does not favour the efficient urban planning of alleviating the poor living condition. On the other hand, demolition of buildings and redevelopment of these areas seem more important and necessary since more open and green areas, and a better plan of land use are needed. Thus, residents in these districts would support the Government proposal of demolishing the heritage sites and redeveloping the area as they would like to have a new and better living environment. While it is necessary to solve the living problems in the urban areas, it does not mean that demolishing the heritage sites for redevelopment is the only solution. Reallocation of the population in the urban districts is a more effective and a win-win solution to the problem, as it can not only solve the problem but also let the heritage sites escape from the fate of demolition.

All in all, whether to preserve the heritage sites in Hong Kong depends major on its influence on the Hong Kong economy. And from the arguments mentioned above, you can see that preservation of the precious and memorable heritage sites would not hinder the economic growth in Hong Kong, but in fact help boost the economy by boosting the tourism industry. Moreover, it can help conserve the history and culture of Hong Kong’s past. Therefore, the historical buildings and backstreets are really worth preserving and should be better protected. However, in Hong Kong, there is only 85 historical buildings are well preserved now (AMO), when comparing with about 600 in total. It seems that the organizations responsible for this, which include the Antiquities and Monuments Organization (AMO) and the Home Affairs Bureau, are not doing enough. Other countries and cities in the world, such as Macau, have already established their own system in preserving heritage sites and maintaining a balance between the preservation work and the economy. Hong Kong, as an international renowned and world-class city, should catch up with them and start setting up its own system about conserving the heritage sites so as to meet the international standard.

Economic development is not the only factor that determines Hong Kong future and status, preservation of historical and cultural heritage sites also counts. They can even be mutually beneficial. Hongkongers should try their very best to maintain a balance between these two key factors. It is hoped that Hong Kong Government would soon realize this and do more on preserving the important parts of Hong Kong’s past before it is too late!

health tourism report

3.0 Executive Summary

Health is always become a major concern for everyone, as a results people trying to find the best and affordable solutions of treatments and healthcare options that available to them. However, the solutions and healthcare options they are looking for might not available in their own countries and therefore, the concept of health tourism is become appealing to people who interested in having a high quality and affordable healthcare in abroad. This report discusses mainly about health tourism, health tourism in Singapore includes the push and pull factors that drive people to Singapore for health treatments, and the challenges facing Singapore healthcare industry.

4.0 Introduction to Health tourism

Over the last few years, we are seeing a huge increase in demand and new phenomenon in the healthcare industry known as health tourism. It is one of the fastest growing industry and economic growth areas globally, as people today demanding for better quality, faster and cheaper alternatives of healthcare offered in their own countries. Health tourism is also known as medical travel or global health care, defined as the act of travelling to foreign countries with purpose of gaining healthcare treatment and services. Some of the various types of healthcare treatments and surgeries being offered in health tourism are including dental surgery such as teeth whitening, heart surgery, cosmetic surgery such breast lift, knee and hip replacement surgery, eye surgery, and stem cell therapy.

In addition, the rapid growth and major development of today’s modern health tourism industry is being driven by the globalization, advances of technology, eased affordability of travel, and the difference of healthcare costs in developed and developing countries.

Health tourism has gain huge popularity especially highly among the developed countries such as United States, United Kingdom and Europe. According to the National Coalition on Health Care, 500,000 to 750,000 Americans traveled abroad for healthcare in 2006. While countries such Thailand, India, Singapore, and Malaysia are the leading Asian health tourism destination growing rapidly exceeding in 4-6 percent growth in general travel bookings in 2006. The high popularity of health tourism is influenced by several major factors. The first greatest factor is cost. People travel abroad to obtain healthcare treatment is due to the lower cost of health treatment in countries like India or Thailand compared to the one in US. For instance, the cost a heart surgery in US would be $100,000, the same procedure in India would only cost around $10,000. This low cost of treatment would save 30-80 percent of the cost that you would normally pay in US.

The second major factor is due to the shorter waits in a popular health tourism destination. This allows the patients to be scheduled for surgery and treatment a lot faster and convenient for only within few days or weeks. Besides, people also seek health treatments abroad because of high quality of healthcare in terms of the improvements and better procedures in both technology and standard quality of care all over the world. Many popular health tourism destinations such as India, Thailand, and Singapore offered world-class healthcare services which acquired international accreditation as well as received numerous accolades to show their dedication to excellence. Other major factors are also due to the ease and affordability of travel today and travel opportunities that people can experience from health tourism.

5.0 Contents
5.1 Health Tourism in Singapore

Singapore is one of the major leading health tourism destinations in the Asian health tourism market which popular among foreign patients. In 2005, about 374,000 international health tourists travel to Singapore to obtain healthcare. Most of the health tourists come from countries such as Indonesia and Malaysia as well as patients from South Asia, and the Middle East. Even patients from US and UK are sought healthcare in Singapore as it is relatively affordable fine quality healthcare services in a clean and safe cosmopolitan city.

However, Singapore has also experienced a decline in number of visitors during the global economic downturn especially among the Indonesian patients. Based on Singapore Tourism Board (STB), Health Minister Khaw Boon Wan revealed statistics of medical tourism sector of Singapore that the number of health tourists in 2007 (348,000) has decreased by 15% from the previous year, 2006 with 410,000 visitors resulted from higher patient admissions and patient days in all hospitals in 2007. Though numbers of tourist dropped, the dollar value went up by 30% to $1.7 billion in 2007.

Furthermore, there are also some several push and full factors that drive people to Singapore for healthcare. Firstly, due to the long waits for medical treatments or surgeries in their home countries because of the overburdened health systems. The higher cost of treatments in their home is another important push factor that makes them choose Singapore as their destination for the comparatively affordable healthcare services. For instance, a face lift in US may cost $20,000 whereas in Singapore cost $7,000. The huge price differences are primarily arising due to high costs of medical insurance and liability in US. Moreover, Singapore is known its reputation for efficiency and effectiveness in terms of cleanliness, good infrastructure that the access and transport within the country is equally easy and convenient for everyone, as well as its high standard of quality medical care offered.

Besides, Singapore it’s a safe and stable country with low crimes rate thus it is safe for international tourists to travel. It is also a multicultural diverse country that welcomes people of all cultures, fluent English speaking country and English is the official language of business which has significant appeal to those people with specific needs and problems. Even visitors will find Singapore a fascinating country with great local tours, entertainment, shopping areas, and leisure activities that allows them not only to have a relaxing medical treatment yet the opportunities to enjoy the various attractions. Singapore also known for its world class healthcare services through its 11 JCI accredited hospital and 11 Singapore hospitals certified with International Organization for Standardization (ISO) and has received numerous accolades including in 2007 voted the “Best Medical/Wellness Tourism Destination” by Travel Weekly Asia Industry Awards 2007. Singapore also makes world headlines for successfully performed complex and complicated separation surgery of conjoined twins in 2001 and tooth-in-eye-surgery in 2004.

Moreover, Singapore has a target to attract one million foreign patients annually and push the GDP contribution from this sector above US$1.6 billion. And recently on news, Farrer Park Mediplex is the future medical hub being introduced as the fist and new concept of “medical hotel” which will be built in Singapore by 2010, comprising a hospital, specialist suites and a hotel. And this medical hotel is aiming to attract more than a quarter million of foreign patients.

5.3 Challenges facing Singapore healthcare industry

The healthcare industry will constantly change over the years to come as this industry becoming increasingly global followed with the advances of technology. While health will still remain a basic need of human being and there might probably be more demand for healthcare in the future. Singapore as one of the major leading destinations for health tourism may also faces some challenges in the future. The major challenges facing healthcare industry in Singapore are an Ageing Population and Management of chronic diseases, healthcare manpower issues, and hospital infrastructure.

Singapore has one of the lowest fertility rates in the world and one of the fastest ageing populations with 8.5% of the population was aged 65 years or older in 2007. With longer life expectancies and an ageing population in Singapore as will results in the increase of chronic diseases such as pneumonia, cancer, and cardiovascular events caused by the demographic and epidemiological shifts.

Besides, due to the longer life expectancies and ageing population in Singapore, people become more demanding in better, higher quality of healthcare to treat specific healthcare problems. This will lead to even more demand for manpower or doctors as well as for hospital beds. The lack of manpower for doctors and nurses in Singapore healthcare makes the country actively recruits from countries including Philippines and China. Singapore also having insufficient specialist manpower by currently has 2,781 specialists with 58% working in the public sector and therefore the Ministry of Health together with the Singapore Medical Council (SMC), will be recognizing more top foreign medical schools to attract a larger number of good foreign doctors to work in Singapore. And the more demand for hospital beds makes the government also actively building more public hospitals and released more land for private hospital development.

Conclusion

Health tourism known as the act of travelling abroad to obtain healthcare treatments, has become an international phenomenon and increasingly popular as people begin to realize its benefits. With lower costs, faster treatments, ease and affordability of international travel, advancements in technology and high standard quality of healthcare in developing countries makes more and more people are willing to travel abroad. And Singapore has distinguished itself as one of the major medical destination which also moving towards the best choice for health treatments as it is known for its world-class medical services and well trained doctors.

7.0 References
Discover Medical Tourism (2008). What is Medical Tourism? Retrieved 31 August, 2009 from the Discover Medical Tourism website: http://www.discovermedicaltourism.com/what-is-medical-tourism/

In -text citation: Discover Medical Tourism (2008)

Discover Medical Tourism (2008). Medical Tourism Singapore. Retrieved 28 August, 2009 from Discover medical tourism website: http://www.discovermedicaltourism.com/singapore/
Singapore Medicine Initiative (2007). Singapore’s accreditations and accolades. Retrieved 25 August, 2009 from the Singapore Medicine website: http://www.singaporemedicine.com/healthcaredest/accolades_acred.asp

In-text citation: Singapore Medicine Initiative (2007)

Hoe Yeen Nie (2008, 16 August). Farrer Park Mediplex to be ready by 2010. From Channel NewsAsia. Website: http://www.channelnewsasia.com/stories/singaporelocalnews/view/368726/1/.html
Chiang Yin WONG & Hsien Chieh LEE (2008). Healthcare in Singapore: Challenges and management International Medical Community, Vol. 51, No. 5. Retrieved 8 September,2009, from www.med.or.jp/english/pdf/2008_05/343_346.pdf
Koncept Analytics. (2009). Medical Tourism Market Report: 2009 Edition — A New Report by Koncept Analytics. Retrieved August 30, 2009 from Koncept Analytics website: http://www.prlog.org/10290964-medical-tourism-market-report-2009-edition-new-report-by-koncept-analytics.html
Hotel Marketing. (2006). Medical Tourism, Asia’s growth industry. Retrieved August 30, 2009 from hotel marketing website: http://www.hotelmarketing.com/index.php/content/article/060410_medical_tourism_asias_growth_industry/
Research and Statistics Department Planning Division (2007, October 31). Annual Report on Tourism Statistics 2007. Singapore Tourism Board, (ISSN 0218-4567) 4-11. Retrieved from Tourism Statistics Publication.
Medical Tourism Guide (2007). 12 reasons medical tourism is so popular. Retrieved 28 August,2009 from the medical tourism guide website: http://medicaltourismguide.org/12reasons/
MedRetreat (2009). Treatment Types. Retrieved 26 August, 2009 from MedRetreat website: http://www.medretreat.com/procedures/treatment_types.html
Hospital.sg (2006-2007). Singapore’s Medical Tourism Figures Revealed by Health Minister. Retrieved 30 August,2009 from hospital.sg website: http://www.hospitals.sg/singapore-medical-tourism-figures

Health and Safety Regulation in Hospitality Industry

POLICY DEVELOPMENT IN THE HOSPITALITY INDUSTRY

Question 1: In the context of the CDM Regulations and the refurbishment of a floor of bedrooms in a multi storey hotel, critically outline the purpose and content of the ‘Health and Safety Plan’ and ‘Health and Safety File’. Discuss the relationship between the two components and how the Health and Safety File will be of benefit to contractors in the future. Critically assess the merits of the Building Regulations application process and construction technique utilised for Mcdonalds modular drive through restaurants.

The following will evaluate the best way of refurbishing a floor of bedrooms in a multi storey hotel so that the renovated building complies with all relevant health and safety legislation and regulations. The requirement to meet all the relevant health and safety legislation and standards means that the designers and the builders of renovations are as legally responsible as the hotel owners for all breeches of those requirements. Failure to meet regulatory standards could leave the constructors liable for civil prosecution or prone to litigation by the hotel owners, the hotel staff besides the hotel guests. Prosecution or litigation that could take years after the original renovation was actually completed (Youell, 2003 p. 99).

The best way to develop a renovation plan that will receive planning permission from the appropriate local authority is to know exactly which health and safety regulations the proposed renovation needs to fully comply with. If the hotel is exempt from any of the health and safety regulations or the hotel owners believe that it is exempt from those standards it is always best to double check. Besides ignorance of the law is not an excuse for breaking it, and it will not protect contractors from legal action been taken against them. Of more immediate concern for contractors tasked with renovations a failure to abide to all building or health and safety regulations could result in the refusal of planning permission. After all it will only cause delays if the renovation plans are refused planning permission or if such breeches of the health and safety standards are missed at that stage and leave the design firm as well as the hotel owners liable to prosecution or litigation. Renovation work that does not reach the required health and safety standards might not be good enough to last over the long-term without the need to be repaired or eventually replaced due to its low quality (Youell, 2003 p. 99).

Therefore to ensure that the renovation proposals receive planning permission and are legally sound a Health and Safety Plan as well as a Health and Safety File are necessarily developed and maintained to safeguard the building contractors and the hotel owners from both accidents and legal proceedings. The purpose of the health and safety plan is to ensure that the hotel will be fully compliant with the health and safety regulations that it is required to meet so as to function legally as a hotel. To make a fully functioning health and safety plan not only needs a strong knowledge of relevant regulations; it also requires the blueprints or plans for the hotel itself. An understanding of the hotel’s layout is essential with regard to making the health and safety plan practical and well designed. The objective of the health and safety plan is to make sure all the safety measures within the hotel are clearly accessible thus allowing both hotel staff and all hotel guests to remain safe in any emergency situation. The content of the health and safety plan would include the design layout and the exact location of fire fighting equipment, first exits, fire alarms, and any available first aid facilities. The plan should also include where hotel employees and guests meet, should the hotel have to be evacuated, especially in the event of a fire taking hold of the premises. Consideration should also be given to the fitting of smoke alarms, fire alarms, and sprinkler systems (Youell, 2003 p. 99).

Besides considering fire safety procedures, and first aid measures the health and safety plan should include measures to maintain hygiene standards in the kitchens, toilets, dining areas, and the guest bedrooms. Good hygiene standards are needed to ensure that the hotel remains clean, tidy, and free of dirt, allowing the hotel staff and all guests to avoid food poisoning or infection. The plan needs take into account the location of the kitchens, rubbish bins, and toilets in relation to the bedrooms used by guests. Poor hygiene standards and food poisoning could prove to be very bad for the future of the hotel, as it may bring it to the attention of environmental health officers that have the power to close it down until the hotel meets the minimum required regulatory standards (Bloomsbury, 2005 p.124). Another factor for maintaining the good hygiene of the hotel is the straightforward one of guests not wishing to return to dirty and unclean accommodation (Bloomsbury, 2005 p. 155).

The purpose of the Health And Safety File is to record how the hotel complies with all relevant regulations before, during, and after the proposed renovations. The file is meant to ensure that the hotel sticks to the measures it set out in the Health and Safety Plan. The file should record the health and safety performance of the hotel with regard to the maintenance of equipment, facilities, as well as all the procedures that enhance safety standards or good hygiene. The Health and Safety File should also keep a note of all the training that the staff at the hotel is given in respect of maintaining and implementing safety measures and all hygiene standards. The hotel staff should ideally be given training to use fire fighting equipment when it is safe to do so, to provide first aid when needed, and carry out practice fire safety drills. When necessary staff will need to be given extra training should they not perform their duties to a high enough level to comply with the standards set out in regulations. The Health and Safety File should also ensure that all hotel guests have access to information about the location of fire safety equipment, first aid facilities, and the assembly point in case of the hotel being evacuated (Youell, 2003 p. 99).

There should be a strong relationship between the Health and Safety Plan and the Health and Safety File. The two items should compliment each other, as together they provide the means to plan and implement safety and hygiene standards at the hotel. The Health and Safety Plan sets out how the safety and hygiene standards will be achieved, whilst the Health and Safety File is intended to record what is actually happening at the hotel in terms of complying with regulations. The Health and Safety File by itself could be very useful to any contractors that need to carry out any building or renovation work at the hotel, as a means of checking the record of the hotel in meeting regulatory requirements. Contractors would be able to consult the Health and Safety File if they have any queries regarding the equipment, facilities, as well as the safety and hygiene procedures used by the staff at the hotel. If the Health and Safety File has been kept up to date consulting it will allow the contractors to know whether or not the hotel has been adhering to the regulations it is legally supposed to do at all times. Knowing if the hotel is not complying with regulation would give the contractor the opportunity to suggest building alterations or changes in safety and hygiene procedures that if implemented mean the hotel does comply with all relevant regulations (Bloomsbury, 2005 p. 155).

There are ways of ensuring that a company only has to pay minimal attention to completing Health and Safety Plans and Files without breaking the regulations or ignoring the spirit of the law. The fast food company MacDonalds has probably devised the best way of minimising the planning permission required whilst adhering to the statutory safety and hygiene standards set out in regulations and legislation. As a company MacDonalds has made its fortune and its reputation by the mass standardisation of its restaurants, equipment, staff training, marketing image, and finally but by no means least its food products. People know what they are going to get when they go into a MacDonalds anywhere in the world, and more of them like it than dislike it (www.LHC.ORG.UK). MacDonalds believe that the standardisation process is definitely a successful strategy when it comes down to gaining rapid planning permission and complying with safety and hygiene standards. Planning authorities will be made aware by the company that their restaurants are pr-designed to pass safety and hygiene standards, whilst all new staff will be fully trained to make sure that standards are always adhered to (Mason, 2005 p.44). The senior management are well aware of the benefits of standardisation, if one design passes safety and hygiene standards it is adopting that design for all its restaurants as that makes financial, marketing, and practical sense to do so (www.LHC.ORG.UK).

MacDonalds have developed modular drive through restaurants as a method of constructing new outlets quickly at the same time as passing the Building Regulations application process. As a company MacDonalds has always set out to have all its ordinary and drive through restaurants designed to look exactly the same as each other as well as also having the same features and equipment. For MacDonalds having restaurants that look the same everywhere they are constructed has been a highly successful branding strategy and exercise that has allowed the firm to expand impressively across the globe. To be more precise it is a global franchise which, has expanded due to its high profits and relatively low capital costs (Mason, 2005 p. 44). However the merits of using modular designs go beyond marketing ploys and serve pragmatic purposes. When MacDonalds set out to design its modular drive through restaurants it certainly took the Building Regulation application process into account. The modular drive through restaurant was designed to meet safety and hygiene standards in as many countries as possible, so that they could be constructed in as many places as the company would like. The low cost of construction when combined with the ease of gaining planning at the same time as being able to pass all safety and hygiene standards makes buying into the MacDonalds franchise a good investment. The prefabricated structures have the advantage of not requiring a high degree of planning permission than buildings wholly constructed on site (www.LHC.ORG.UK).

MacDonalds have found that with experience that prefabricated designs that already fully meet planning requirements and regulations will undoubtedly gain full building permission quickly wherever the proposed restaurant is located. The rapid gaining of building permission allows MacDonalds to have all its new drive through restaurants trading sooner rather than later. The new drive through restaurants thus quickly re-coup their modest construction costs and go into profit. Profits are not only made quickly; they are also made over a long-term basis as well. The use of prefabricated designs and materials therefore allows MacDonalds to expand its total number of restaurants at a much lower capital cost than many of its competitors. The beauty of the modular drive through restaurant design is that it is cheap and durable, yet it could also be quickly modified if it needed to be (Mason, 2005 p. 44). The modular design allows for standardised equipment to be fitted, equipment that could be easily updated modified or completely replaced should building regulations alter, or if the company purchases improved equipment. The modular design is meant to be really simple to construct, maintain and keep clean. The simplicity of the kitchen areas is intended to make it easier to train staff to cook and prepare food as well as cleaning areas to maintain hygiene standards. The training of staff does not take long as all processes and procedures, as well as equipment and food is standardised. The simplicity of the whole operation means that food is prepared, cooked, and served faster (Bloomsbury, 2005 p. 117). Simplicity and standardisation keep costs low, product prices highly competitive, and the company’s profits high. Providing that all staff are trained and keep to the procedures they are taught the company should always be able to maintain safety and hygiene standards whilst never having to wait long for planning permission (www.LHC.ORG.UK).

Question 2: Explain how the analysis of a local authority Development Plan can help the senior management team of a national hotel chain identify a suitable site for a new budget hotel in a particular locality?

The majority of local authorities in Britain will have development plans to control where and whether new businesses or retail units would be constructed within the areas they control the planning for. Local authorities make up Development Plans as a means of generating wealth, creating jobs and regenerating run down districts and would wish to include such firms within their Development Plan. Development Plan would include the precise locations of where the new offices, hotels, and retail units would be sited. The Development Plan provides further useful information for the senior management to consider besides the proposed or the approved locations of other companies. For instance, every Development Plan should give the location of roads, motorways, railways, and rivers near or within the locality controlled by the local authority concerned. Other information that could be relevant to the locating of the new budget hotel could include local tourist attractions or places that would make hotels less attractive for potential guests, like waste ground, factories, or prisons. If the new budget hotel could be located near the most attractive features of the town or city it is a bonus in terms of marketing the hotel before it opens and expanding the number guests once it has opened. If the company has to locate the hotel in a less attractive site the company could consider pulling out of its construction or consider different ways of marketing it if it is actually built. The company would however wish to avoid being located in areas where it could not guarantee the safety of their guests and their staff, as more would have to be spent on security measures such as fencing or patrolled car parks. The company could find it useful to contact local people and possibly the Police to find out which parts of the town or city they need to avoid when picking the locality of their new budget hotel. Local authorities will make the Development Plan available for the public and businesses to examine which allows any firms that wish to open premises within the area to apply for a place within that plan. For the Senior Management of a budget hotel chain that would want to open a new hotel inside a particular locality being able to analyse the local authority’s Development Plan would offer definite advantages when it comes to making the new budget hotel a long-term success (www.LHC.ORG.UK).

The exact location of any new budget hotel could make all the difference between it being a successful part of the firm or it being a loss making failure. From a study of the Development Plan the Senior Management should be aware of the alternative sites available for the location of the proposed new hotel, as well as the placing of other new businesses within the development area. Senior Management should have a strong knowledge of the best places and the worst places to locate new budget hotels when it comes down to maximising the number of guests that stay there. Analysing the Development Plan would make Senior Management fully aware of the local authority intentions of which firms to allocate land to, for the construction of their new outlets, offices, or hotels. The most prestigious firms will want to locate in the most prime positions possible to fit in with their corporate image, whilst a low budget hotel firm might not need to do the same. A low budget hotel does not have to obtain a prestigious land site, it does however have to be based if at all possible on land that is near to town or city centres, and ideally is easily accessible for as many potential guests as possible. The senior management would find it useful to locate the new budget hotel near the main roads, the railway, close to local businesses, and preferably with free secure car parking spaces available. Such a location would be a good selling point to business travellers and tourists a like. If they could gain an accurate analysis of the Development Plan then it increases the chances of securing a good locality for the new budget hotel (www.LHC.ORG.UK).

The hotel company could benefit from examining the Development Plan as it would allow them to know if they could use prefabricated designs that permit the construction to be finished earlier and thus earning revenue sooner. If the hotel chain already uses prefabricated designs and construction techniques then it will them greater flexibility when it comes down to the precise locality of the new budget hotel. Flexibility that stems from the savings in construction costs being able to provide a bit of leeway if the price of being in a better location is higher than first anticipated. A sound understanding of the development plan would enable senior management to have the locality and the rapid construction of the new budget hotel finalised as soon as possible. Such an understanding would thus grant the company more time to advertise the opening of the new hotel at an early stage to maximise the number of guests upon its opening. The evaluation of the Development Plan would also give senior management a precise idea of the number of hotels within the town or city that are already built and those hotels that are planned. Knowledge of the hotels within the district gives senior management invaluable information when it comes down to the marketing, and pricing strategy for the new budget hotel which could make all the difference between success and failure. Knowing the nature, location, as well as the strengths and the weaknesses of all its rivals within the locality could certainly prove very beneficial to the senior management in selling the merits of the new budget hotel in relation to its competitors. Senior management could also take advantage of the company’s brand name and its reputation. Marketing for the new budget hotel should emphasis that the locality will soon be able to benefit from the arrival of a low cost hotel that happens to provide high quality service (www.LHC.ORG.UK).

Bibliography

Bloomsbury Reference, (2005) Dictionary of Leisure, Travel, and Tourism – 3rd edition, Bloomsbury, London

Mason P (2005) Tourism Impacts, Planning and Management, Elsvier, London

www.LHC.ORG.UK

Youell R, (2003) Complete A-Z Travel & Leisure Handbook – 2nd edition, Hodder & Stoughton, London

Growth Of The Medical Tourism Industry Tourism Essay

CHAPTER 2LITERATURE REVIEW

In the previous chapter a brief introduction to the meaning of “medical tourism” and the “medical tourism industry” has been given to develop a basic understanding of the subject for this dissertation. This chapter deals with the review of the literature for developing a conceptual and theoretical background for further research and identifying the research areas required. Literature review is an essential part of any research as it not only helps the researcher understand the research areas required, but also develops a conceptual background of the study for the reader. In survey and experimental research, the review of literature serves as a variety of background functions, which helps in the preparation of the collection of the actual data (SINGH, 2007, pp-61).

The literature review in this dissertation has been designed in a systematic and a conclusive way for the reader to understand the subject clearly. The literature review has been divided into three main parts which are:-

(Part A) Introduction:-This part deals with the literature required for understanding the concept of medical tourism as an industry and the medical tourism industry in India.

(Part B) Medical Tourism in India: Strategic Implications and Growth:-This part consists of literature required to study the strategic implications and factors influencing growth of the medical tourism industry in India. This part is related to the second and third objective of this dissertation and also helps in developing a research area required for the fourth and fifth objective.

(Part C) Conclusion:-After understanding the concept of the strategic implications and growth of the medical tourism industry the main conceptual framework can now be made and the main research areas can now be identified.

The reason for this literature review is not just to review the related literature but to identify the concepts that will be used in the research. The importance of a literature review cannot be matched by an understanding as to how a review of literature can be done but how it can be used in the research (HART, 1998, pp-1).This chapter will help in finding the questions that needs to be answered in the research.

PART A
Medical Tourism: Background
(A.1)Defining Medical Tourism

Since ancient times, travellers have left their homeland in search of the best health care possible. Historical records show that early civilizations, such as the Romans (about 4 to 400 BC) were drawn toward the healing properties of “bath” or “spring” waters (KHAN, 2010).Although Medical tourism seems to be an entirely new concept which is now being acknowledged as an industry itself it has existed from the 18th century. Some of the earliest forms of tourism were directly aimed at increased health and well being for example, the numerous spas that remain in many parts of Europe and elsewhere, which in some cases represented the effective start of local tourism, when ‘taking the waters’ became common by the 18th century (CONNEL, 2005).By the 19th century spas were found in the most remote colonies such as the French Pacific Territory of New Caledonia while the emergence of hill stations throughout the tropics further emphasized curative properties of tourism (SMYTH,2005 cited in WOODSIDE,2007).History proves that medical tourism has existed for a long time. According to John Connell (Cited in WOODMAN,2007) recently travellers have travelled in search of yoga and meditation as the search for cure took on more spiritual and holistic perspectives. Today people not only travel long distances for spas and relaxation but for complicated medical procedures in search for affordable and quality medical care.

Globalisation, it is said, lifts nations out of their isolated existence and makes them part of one “knowledge society”. Today, outsourcing of activities like labora­tory investigations, medical transcriptions, software de­velopment, and telemedicine to countries like India, China, Korea, Japan, has become easier with business process outsourcing(QUADEER and REDDY,2010) . The globalization of healthcare services has given rise to a new phenomenon called “Medical Tourism.” It is also called “Healthcare Globalization,” “Health Vacation,” “Wellness Tourism,” “Medical Outsourcing,” or “Generation Next Health Holidays”. The term Medical Tourism can be defined as travel outside one’s home country in search of healthcare that is either less expensive or more accessible (KHAN, 2010).Carrera and Bridges (Cited in LUNT and CARERRA, 2010) identify health tourism as the organised travel outside one’s local environment for the maintenance, enhancement or restoration of an individual’s well-being in mind and body.

Definitions and the seeking to know meaning of terms and words can put things right elementarily between people and their words (JACKSON, JACKSON and HARMON, 197, pp-235). Although there are many definitions of the term “Medical Tourism” the definition must serve the general purpose of understanding the meaning of the term “Medical tourism”. The term “Medical tourism” can be divided into two words “Medical” and “Tourism” as shown in the figure below (JAGYASI, 2008).

MEDICAL TOURISM
MEDICAL
TOURISM
The word “Medical” means treatment of illness, disorder or injuries.
The activities of persons travelling to and stay in a place outside their usual environment for leisure, business and other purposes.
+
Figure 1: Defining Medical Tourism
Source: – JAGYASI, P.2008.Defining Medical Tourism ~ another approach. Medical Tourism Magazine .July 15 th

According to Dr Prem Jagyasi (JAGYASI, 2008) understanding of the words “medical” and “tourism” individually will not be sufficient to define the term “Medical Tourism”. Considering the definitions of the words, medical tourism can be defined as a set of activities in which a person travels often long distance or across the border, to avail medical services with direct or indirect engagement in leisure, business or other purposes.

Today medical tourism has become a huge industry itself.According to a report by Mckinsey and company and the confideration of Indian industry(2005) the medical tourism industry is expected to become a hundered million dollar industry by the year 2012.The figure below represents the projected growth in the earning in revenues of the worldwide medical tourism industry.

Figure 2

Some of the internationally know hospitals for medical tourism such as Bumrungrad in Thailand and Apollo in India, report revenue growth of about 20 percent to 25 percent annually (ROTH, 2006). McKinsey & Company (2005) estimates that Indian medical tourism will grow to $2.3 billion by 2012.In 2005 approximately 250,000 medical tourists sought care in Singapore, and 500,000 travelled to India for medical care(HUTCHINSON,2005).According to these reports the medical tourism industry is expected to grow at a large scale. A commonality in all these reports concludes that the three main destinations where growth of this industry is expected to be the highest are India, Thailand and Singapore which are countries in Asia. Therefore before the medical tourism industry in India can be seen it is important to identify the key factors influencing growth of the medical tourism industry in Asia and the different destinations gaining popularity in this industry who will eventually are the competitors.

(A.2) Medical Tourism in Asia

Table 1: Popular medical tourism destinations around the world.

Source:-NATAN, M and SEFER, E.2009.Medical Tourism: A New role of Nursing? .OJIN: The online journal of Issues in Nursing. July 22 .Vol 14 There are many countries that are now competing in the medical tourism industry all around the world. The table given below indicates the major destinations for medical tourism in the world. As it can be seen Asia has a lot of countries that have established themselves as medical tourism destinations. According to an update in a report given by Deloitte (2008) the number of medical tourists visiting Asia will grow at a rate of 20% annually and will create an industry worth US$4 billion by the year 2012.India is estimated to account for half of the medical tourism industry, countries like Singapore, Malaysia and Thailand are already promoting their medical tourism industries.

Asia
The Americas
Europe
Africa
Oceania
China

Argentina

Belgium

South Africa

Australia

India

Bolivia

Germany

Israel
Jordan

Brazil

Columbia

Hungary

Lithuania

Malaysia
Philippines
Singapore
Thailand

Cost Rica

Jamaica

Mexico

United States

Poland

Asian Governments are now supporting medical tourism through organizing awards and promotional events such as Asian Spa and Wellness tourism in 2006 and the establishment of dedication promotional boards (HENDERSON,2004 cited in COCHRANE,2008) The four main countries identified as medical tourism destinations in Asia are Thailand, Malaysia, Singapore and India. In 2002 Thailand became home to the Asia’s first JCI-Accredited hospital which was Bumrungrand in Bangkok and presently has six other hospitals which have been given this accreditation (WOODMAN, 2009). In Thailand according to the Kasikorn Research Centre, about 1.28 million foreigners visited hospitals in 2005 generating revenues of about thirty three million Thai baht (DELOITTE, 2008).Another important destination for medical tourism is India a country that has pioneered the outsourcing industry is now quickly gaining popularity as a medical tourism destination. Before the medical tourism industry in India can be looked at it is important to understand the factors that promote Asia itself as a caterer to the medical tourism industry. As seen below a SWOT analysis on the medical tourism industry is given which analysis the strengths, weaknesses, opportunities and threats of Asia itself. Organizations use the SWOT analysis as the first step in developing their marketing plan as it is relatively an easy process and helps in describing the major considerations to be taken in designing an appropriate strategy(BRIGGS,2001,p-47). This SWOT analysis plays a significant part of this research as it outlines the significant strategic implications of the Medical tourism in Asia.

SWOT ANALYSIS OF THE MEDICAL TOURISM INDUSTRY IN ASIA
STRENGTHS
az More mature medical tourism markets, facilities, and practices.
az Government sponsored tax breaks and open environment for foreign private investments in healthcare infrastructure.
az A relative surplus in the labour pool due to large populations and strong emphasis in education in some countries.
az A history of using complementary and alternative e.g., yoga, Ayurveda, herbs, TCM/TKM.
az In close proximity to Middle Eastern medical tourists.
az Asia also has a booming tourism market with many scenic locations and various types of geography (beaches to mountains) to choose from.
az Asians are known for their culture of hospitality and service.
az Services and procedures such as: wellness/CAM, eye-care, musculoskeletal care, cardiac care, transplants, haemodialysis, and general/plastic surgery.
Source:-VEQUIST, VALDEZ and MORRISON, 2009
WEAKNESSES
az The length of travel for many European and North American tourists.
az Some fears of travelling to Asia because of a reputation of social unrest, corruption and violence.
az The lack of European and North American language (e.g., English, German, French, etc.) ability.
az The culture in Asia is arguably very different from occidental cultures.
az Difficulty in seeking legal remedy in the event of malpractice.
az Large disparity in the healthcare systems for the poor and rich/medical tourists.
az Several Asian countries are trying to serve too wide a swath of the market to maintain a sustainable industry.
Source:-VEQUIST, VALDEZ and MORRISON, 2009

As it can be seen above the strengths and weaknesses of the medical tourism industry in Asia have been identified. These factors play an important role in identifying the strengths and weaknesses of the medical tourism industry in India as the Indian medical tourism industry is a part of the Asian medical tourism industry. These factors also develop a contrast between the positive and negative features of the medical tourism industry in Asia. As it can be seen above Asia also has a booming tourism market and is known for hospitality and service. The health care facilities in Asia are well developed. Asia also has a history of using complementary and alternative medicines which will support in developing wellness tourism .Although there are many positives of this industry in Asia, it also has some negatives such as a weak legal system in the case of malpractice. People also have the fear of the unknown as there is a change in the social climate. These factors relate to the Indian medical tourism industry in many ways but some of them may not apply such as the language barrier as India has a large English speaking population and the legal system which is developing rapidly. After a comparative study of the strengths and weaknesses of the Asian medical tourism industry a comparison of the opportunities and threats is discussed in the SWOT analysis.

The next two factors of the SWOT analysis are the opportunities and threats which draw a comparative study on the external capabilities of the Asian medical tourism industry.

Source:-VEQUIST, VALDEZ and MORRISON, 2009

OPPORTUNITIES

az Large populations in the region offer many advantages (e.g., more regional medical tourism, lower cost of labour, more healthcare professionals, etc.).

az Increasing strength and diversity of Asian economies and many fast-growing areas.

az Many strong governmental initiatives supporting medical tourism.

az Shrinking cost of fuel (i.e. gas prices) which makes airfare lower and encourages medical tourism.

az The wealth in the Middle Eastern could lead to more tourists travelling to the Asian region.

az The Asian expertise in off-shoring of various industries to add to their chances to capitalize on this market.

az The emphasis on education and healthcare in many countries in Asia.

az Strong private investments will build the infrastructure of the region.

THREATS

az Disease (particularly pandemics), social unrest, terrorism, overcrowding, dirty environments in some areas of Asia are perceived negatively and hurt marketing efforts.

az Competition from Latin America, Eastern Europe, and the Middle East for North American, European, and Middle Eastern medical tourists.

az Due to the economy, many consumers simply do not have large enough cash reserve to pay for services or airfare.

az Limited numbers of insurance carriers that have comprehensive relationships with medical providers in Asia.

az Fast growth of medical tourism in other regions and countries outside of Asia.

Source:-VEQUIST, VALDEZ and MORRISON, 2009

As seen above the opportunities of the Asian medical tourism industry is huge and a major advantage is the increasing strength of the economies which fuels the development of stronger governments and health care infrastructure. Asia also expertises in off-shoring servicing as seen in the case of India which is also considered the off-shoring capital of the world. Although there are many opportunities there are threats to the Asian medical tourism industry as there is an increasing competition from Latin America and certain countries in Europe. Asia is also perceived as a continent of social unrest, terrorism and unhealthy environment which impacts negatively on the marketing strategy.

In the above SWOT analysis the strength, weaknesses, opportunities and threats of the Asian medical tourism industry can be highlighted. These factors explore the internal and external capabilities of Asia itself in this industry which brings out a contrast between the positive and negative features of this industry in Asia. These factors adversely affect the medical tourism industry in India.

(A.3) Medical Tourism in India.

The Indian government’s commitment to providing compre­hensive healthcare to the citizens, irrespective of their paying capacity, as part of its welfare policies was given up after 30 years of independence when the Sixth Plan opened up medical care to the voluntary and private sectors (QUADEER and REDDY, 2010).The involvement of the private sectors in the health care industry in India helped in the emergence of a corporate health sector in the 1990’s.After opening up to the corporate sector in healthcare policies the government emphasised on healthcare to the poor and their involvement in it which was seen in the eighth and ninth year plans given by the government of India in 1992 and 1997 respectively. The acceptance of the new economic policy, of the health sector reforms by 1992 increased cutbacks in public sector investments in health as well as the commoditisation of health services (RAMA and NUNDY, 2008).The cutback in public sector investments led to the breakdown of the public healthcare institutions with more collaboration from the private healthcare sector. When the healthcare services became dominated by the private sector, a new phenomenon of healthcare services becoming a form of market expansion and financial gains rather that welfare could be observed. This gave rise to the medical tourism industry in India.

The government policy of merging medical expenditure and tourism was announced by Finance Minister Jaswant Singh in his 2003 annual budget speech when he described India as a global health desti­nation”. He identified the potential of complex health care services that are offered at relatively cheaper rates and yet earned profits. In this report he also mentioned the possibilities in investing in large chains of medical institutions and creating medi-cities. After this report heavy investment in improving medical institutions continued and today India has become of the fastest growing medical tourism destinations. This country is usually viewed as one of the most important global leader in the medical tourism industry, and it advertises itself as offering everything from alternative ayurvedic therapy to coronary bypasses and cosmetic surgery (CONNELL, 2006).Some hospital executives in India use the phrase ‘value medical travel’ to promote India as a high-quality, low-cost destination for international health care travellers (TURNER, 2007).The medical tourism industry has grown at a large scale with companies like WellPoint Blue Cross Blue Shield to handle their pilot program of offering medical tourism for Americans travelling to India (KHAN,2010).India has made its mark in the medical tourism industry in the world by providing world class medical care at cheap and affordable prices.

In a nutshell it has been predicted that the Indian medical tourism industry will rise rapidly and will continue to grow at a fast pace. There are many growth drivers involved in the evolution of this industry in India; some of them include cost factors, government policies and quality health care. After a brief understanding of the emergence of the medical tourism industry in India it is important to understand the factors involved in the growth process. The next part deals with an in-depth review of literature on the growth drivers and strategic implications of the medical tourism industry in India.

PART B
Medical Tourism in India: Growth and Strategic implications
(B.1)Medical tourism in India: Growth

Professor Michael Porter from the Harvard University is one of the well know strategic writers and describes the industry lifecycle model as the grandfather of concepts for predicting the industry evolution (LYNCH, 1997).According to this model an industry goes through four major stages which are introduction ,growth, maturity and decline. The figure shown below is the diagrammatic representation of the industry lifecycle with the four steps.

Figure 2: Industry Lifecycle Stages

Source:-LYNCH, 1997, p 126

This concept helps in describing any industry as it goes through the stages as a result the strategy of the industry changes as the stage changes. It also can help in formulating the correct strategy required at a particular stage in the industry lifecycle in an entrepreneur perspective. This concept is very well relevant to the medical tourism industry as it helps in identifying the stage that the industry is in. Identifying these key aspects at an early stage will lead to formulating the right strategy for the success of a business entering this industry. It is important for companies to understand the use of the industry lifecycle for businesses to compete in the industry effectively and successfully (BAUM and MCGAHAN, 2004).

In 2007, an estimated 750,000 Americans travelled abroad for medical care and an estimated growth to a staggering six million was expected by the end of 2010(BALIGA, 2006).According to a study carried out by Deloitte in 2008 there will be a large amount of significant growth in the medical tourism industry. In this study the numbers of medical tourist from the United States of America going to foreign countries for treatments will increase. This report also indicates that the medical tourism industry may reach the maturity by 2016 where the growth will start decreasing. This report basically proves that this industry is growing and can therefore be place in the growth sector of the industry lifecycle. The growth sector of the industry lifecycle represents that the market is expanding and customers have become more informed about the products. In this stage there will be more competitors that will enter the industry market (CARPENTER and SANDERS, 2009).The figure given below is the estimated growth given in the Deloitte report (2008) of the medical tourists going to foreign countries for medical treatment.

Figure 3: Annual growth and patient volume growth in major countries in the medical tourism industry

Source: – Deloitte report (2008)

GROWTH
INTRODUCTION
TIME

Figure 4: Predicted Growth of the medical tourism industry in India The figure represents a huge rise in the patient volume growth in major countries over the next few years which indicated the amount of growth and demand in the medical tourism industry. These statistics affect the medical tourism industry in India in terms of growth planning and understanding that growth potential of this industry in India. After witnessing the immense growth of the medical tourism industry in the world, India felt the need for this industry and entered into this market in late 2002. India’s efforts to promote medical tourism took off in late 2002, when the Confederation of Indian Industry (CII) produced a report in collaboration with McKinsey & Company which outlined the immense growth potential of this sector in India (KURIACHAN and BASANTH, 2008).In this report they made future predictions of this industry in India considering the economic and political factors. There were many strategic points highlighted in this report which concluded that the forecasted growth of the medical tourism industry in India will be from US $ 18.7 billion in 2001 to around US $ 45 billion by 2012 which is equivalent to 8.5% of GDP. The figure below represents the predicted growth according to the Confederation of Indian Industry (CII) and McKinsey & Company.

Year
US $’Billion

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Source: – Confederation of Indian Industry (CII) and McKinsey & Company (cited in KURIACHAN and BASANTH, 2008)

As it can be seen above the medical tourism industry in India is expected to grow to a 45 billion dollar industry by the year 2012 which is a 26.3% rise from the year 2001. The worldwide market for medical tourism is estimated in 2004 was estimated to be US $ 40 billion with India market share 1%.In 2012 the world medical tourism industry will be US $ 100 billion with India market share being 3% (KURIACHAN and BASANTH, 2008).These figures represent that the Indian medical tourism industry will grow at a fast pace .At a strategic level it is important to understand the factors which will affect the growth of this industry in India.

(B.3Factors influencing growth of medical tourism industry in India

The previous section showed the predicted growth of the medical tourism industry in India and the SWOT analysis of Asia that affect this industry in India. To analyze the medical tourism industry in India on a strategic level the competitive advantage of India must be analyzed. In reference to this context of global competition was given by Michael Porter in his book “The competitive advantage of nations”. He conducted a study of ten nations to develop an analytical framework at a strategic level, which tries to explain why a nation succeeds in particular industries but not in others (PORTER.1990).Porter suggests that the national home base of an organisation plays a very important role in creating an advantage on an international scale (JOHNSON, SCHOLES and WHITTINGTON, 2005).The study on this model can clearly help in distinguishing the factors that may influence the growth of the medical tourism industry in India. The model basically describes the four main attributes that individually and as a system constitute the diamond of national advantage .These attributes are:-

Factor Conditions:-The nations position in factors of production, such as skilled labour or infrastructure necessary to compete in a given industry.

Demand Conditions:-The nature of home market demand for the industry’s product or service.

Related and Supporting Industries:-The presence or absence in the nation of supplier industries and other related industries that are internationally competitive.

Firm Strategy, Structure and Rivalry:-The conditions in the nation governing how companies are created organized and managed as well as the nature of domestic rivalry.

Source:-PORTER, 2008

“Chance” and the “government” are two factors that influence these four determinants, but are not determinants themselves (OZ, 2002).

FIRM STRATEGY, STRUCTURE AND RIVALRY

RELATED AND SUPPORTING INDUSTRIES

DEMAND CONDITIONS

FACTOR CONDITIONS

CHANCE

GOVERNMENT

Figure 4: Michael Porter’s Diamond Framework: Competitive Advantage of Nations

Source: – PORTER (1998, p. 127)

(B.4)Strategic implications

Figure 4: Strategic implications of the Medical tourism Industry As described by LYNCH (1997) there are many strategic implications for the industry lifecycle .These can be modified in terms of the medical tourism industry as shown in the following figure. These Strategic implications will also help in the clear understanding of the drivers responsible for the growth of this industry.

MEDICAL TOURISM

INDUSTRY

Customer strategy

Research and Development strategy

Company Strategy

Competitor strategy

Source:-Modified from LYNCH (1997, p 127)

The first strategic implication is customer strategy which is one of most important implications as it tends to understand the customer strategy for selecting the product and the factors which are involved in it. This is also a significant factor that a business in this industry should try and evaluate on a continuous basis to complete efficiently and effectively with the growth of the medical tourism industry in the industry life cycle. By understanding customer strategy a clear view on the factors affecting the growth of the medical tourism industry can be identified.

Joseph Woodman (2008) in this book “Patient beyond Borders: Everybody’s Guide to Affordable, World-class Medical Travel” gives a guide to consumers interested in going abroad for medical treatments. In this book a step by step guide is also given and the factors influencing consumers to choose medical tourism have also been identified. According to this book there may be many reasons why medical tourists travel to attain medical care but there are seven main reasons as shown in the figure below. It is important to explore the customer strategy as it tends to understand why medical tourists choose certain particular locations as their medical tourism destination. The figure given below represents the customer strategy and the main factors influencing it.

Figure 5: Customer strategy for the Medical Tourism Industry
Cost saving
Better quality care
Customer Strategy
Shorter waiting periods
Other Treatments

Inpatient friendly

Excluded treatments

Speciality treatments

Source:-WOODMAN (2008, pp 51-63)

Cost Saving

As health care costs in developed countries like the United States of America and United Kingdom escalate individuals, small businesses, and state governments are all attempting to control health-related expenditures. Outsourcing health care to countries where surgical procedures and other forms of treatment are available at substantially lower prices is attracting interest from individuals and businesses (TURNER, 2007). With the continuing health care cost increases in developed countries, it is likely that patients, insurers and employers, particularly in countries where employers share the costs of private health insurance, will continue seeking low cost treatment abroad (FORGIONE and SMITH, 2007). There many ways in which service costs are kept low for example most provider countries, malpractice litigation costs are much lower than in most highly developed countries, which has helped to reduce the cost of medical care(HADI,2009,p.11).

Table 1: Major Medical Tourism Destinations: Cost Comparison
Medical procedures
USA
India
Thailand
Singapore
Costa Rica
Mexico
Korea
Heart Bypass

$80,000

To

$130,000

$6,651
to
$9,300

$11,000

$16,500

$24,000

$22,000

$34,150

Heart Valve Replacement

$160,000

$9,000 to
$9,000

$10,000

$12,500

$15,000

$18,000

$29,500

Angioplasty

$57,000

$4,998
to 7,500

$13,000

$11,200

$9,000

$18,000

$19,600

Hip Replacement

$43,000

$5,800
to
7,100

$12,000

$9,200

$12,000

$14,000

$11,400

Hysterectomy

$20,000

Growth Of Hospitality Industry In India Tourism Essay

CHAPTER 2LITERATURE REVIEW
Introduction to Travel and Tourism

Tourism is travel for leisure, recreational and business purpose. Tourists can be defined as people who travel to and stay in places outside their usual surroundings for more than twenty-four hours and not more than one consecutive year for leisure, business and other purposes by the World Tourism Organization. Tourism is a known affair in human life. It has been an industry of vast dimensions and eventually supports economic and social growth. Tourism worldwide has experienced phenomenal growth. With more than 600 million people travelling annually, tourism is the world’s largest industry, with revenues of about half a trillion dollars a year, and averaging five percent annual growth.

India, being a vast and diverse country has always something to offer, and its glorious traditions and rich cultural heritage are linked with the development of tourism. Its magnificent monuments attract large numbers of visitors from all over the world. Tourism is the largest service industry in India, with a contribution of 5.68% of the national GDP and 8.78% of the total employment in India. India witnesses’ more than 13.72 million annual foreign tourist arrivals and 650 million domestic tourist visits. The tourism industry in India generated about US$ 100 billion in 2008 and is expected to increase to US$ 275.5 billion 2018 at a 9.4% annual growth rate.

Booming IT industry and outsourcing industry has led to growing number of business trips made by foreigners to India, who often add a weekend break or longer holiday to their trip. Foreign tourist spends more in India than almost any other country worldwide. Tourist arrivals are projected to increase by over 22% per year through till 2010. Tourism minister has also played an important role in the development of the industry, initiating advertising campaigns such as the ‘Incredible India’ campaign, which promoted India’s culture and tourist attractions in a fresh and memorable way. This campaign helped create a colourful image of India in the minds of tourists all over the world and directly led to an increase in the interest among tourists.

The tourism industry has helped growth in other sectors as diverse as horticulture, handicraft, agriculture, construction and even poultry.

Both directly and indirectly, increased tourism in India has created jobs in a variety of related sectors. Almost 20 million people are now working in the India’s tourism industry.

Growth Of Hospitality Industry In India

The hotel industry in India is going through an interesting phase. One of the major reasons for the increase in demand for hotel rooms in the country is the boom in the overall economy and high growth in sectors like information technology, telecom, retail and real estate. Rising stock market and new business opportunities are also attracting hordes of foreign investors and international corporate travellers to look for business opportunities in the country.

The hotel industry in India is going through an interesting phase. The industry has a capacity of 110,000 rooms. According to the tourism ministry, 4.4 million tourists visited India last year and at the current rate, the demand will soar to 10 million by 2010 to accommodate 350 million domestic travellers. The hotels of India have a shortage of 150,000 rooms fuelling hotel room rates across India. With tremendous pull of opportunity, India has become a destination for hotel chains looking for growth.

Due to such a huge potential available in this segment, several global hotel chains like the Hilton, Accor, Marriott International, Berggruen Hotels, Cabana Hotels, Premier Travel Inn (PTI), InterContinental Hotels group and Hampshire among others have all announced major investment plans for the country. The Government’s move to declare hotel and tourism industry as a high priority sector with a provision for 100 per cent foreign direct investment (FDI) has also provided a further impetus in attracting investments in to this industry.

It is estimated that the hospitality sector is likely to see US$ 11.41 billion rise in the next two years, with around 40 international hotel brands making their presence known in the country by 2011. Simultaneously, international hotel asset management companies are also likely to enter India. Already, US-based HVS International has firmed up plans to enter India, and industry players believe others like Ashford Hospitality Trust and IFA Hotels & Resorts among others are likely to follow suit.

Niche Tourism

The concept of ‘niche tourism’ has emerged in recent years in counter-point to what is commonly referred as ‘mass tourism’. In a globalising world of increasing sameness, niche tourism represents diversity and ways of making difference. It plays on the pejorative connections that have accompanied the evolution of mass and package tourism and their, often cited, negative impacts in relation to environmental degradation and socio-cultural disturbance. For destination managers and planners seeking to utilise tourism as a mechanism for economic development, the niche tourism approach appears to often greater opportunities and a tourism that is more sustainable, less damaging and more capable of delivering high spending tourists.

The term niche tourism is largely borrowed from the term niche marketing, which in turn has appropriated the niche concept from the language of the relatively recent discipline of ecology.

Tourists, as consumers have developed increasing levels of expertise and experience of being tourists. Whilst this developmental pattern of tourists may not always be linear or simplistic.

Figure 2: Niche Tourism Components

Types of Niche Tourisms

Niche tourism has broadly been divided into following components:

Cultural Tourism: Cultural tourism is the subset of tourism concerned with a country or region’s culture, specifically the lifestyle of the people in those geographical areas, the history of those peoples, their art, architecture, religions, and other elements that helped shape their way of life. Cultural tourism includes tourism in urban areas, particularly historic or large cities and their cultural facilities such as museums and theatres. It can also include tourism in rural areas showcasing the traditions of indigenous cultural communities (i.e. festivals, rituals), and their values and lifestyle.

Environmental Tourism: Environmental tourism, ecotourism, or nature tourism provides an opportunity to visit undisturbed natural areas, scenic vistas, and observe plants and wildlife. Ecotourism is responsible travel to fragile, pristine, and usually protected areas that strive to be low impact and often small scale as an alternative to mass tourism. Its purpose is to educate the traveller and provide funds for ecological conservation, directly benefit the economic development and political empowerment of local communities and foster respect for different cultures and for human rights. Generally, ecotourism focuses on volunteering, personal growth and environmental responsibility. Ecotourism typically involves travel to destinations where flora, fauna, and cultural heritage are the primary attractions. One of the goals of ecotourism is to offer tourists insight into the impact of human beings on the environment, and to foster a greater appreciation of our natural habitats. Responsible ecotourism includes programs that minimize the negative aspects of conventional tourism on the environment and enhance the cultural integrity of local people.

Rural Tourism: Any form of tourism that showcases the rural life, art, culture and heritage at rural locations, thereby benefiting the local community economically and socially as well as enabling interaction between the tourists and the locals for a more enriching tourism experience can be termed as rural tourism. Rural tourism is essentially an activity which takes place in the rural areas.

The term “rural tourism” was adopted by the European Community to refer to all tourism activities in rural areas or as an economic activity, which depends on and exploits the countryside.

Figure 1: Rural Tourism Approach

Forms of Rural Tourism

Agritourism: Agritourism or farm tourism refers to an organization working on farm or agricultural plant made for entertainment of tourists or visitors, thereby generating income for farm owners. This may help the farmers to interact with the visitors, thereby benefiting the visitors to enrich their knowledge regarding agritourism.

Sports Tourism: It involves tourists to participate or observe rural sports. It teaches the local rural people how to get scope/chance in international game and to compete with opponents. It enables the people of different cultural background to mix with other people and exchange cultural activities between the parties and thereby they are culturally rich.

Pro-Poor Tourism: Pro Poor tourism is set up in developing countries as a means to improve the local economy for local people. It enhances the linkages between tourism businesses and poor people; so that poverty is reduced and poor people are able to participate more effectively in tourism development. The aims of pro-poor ranges from increasing local employment to involving local people in the decision making process.

Introduction to Rural Tourism in India

Majority of India is among the rural category with the sanctity and subtleness intact in the very essence of the village soil. This pious environment of the rural India attracts lot of interest among the tourists in India and thus rural tourism is a fast emerging category.

A national tourism policy was introduced in 2002, with rural tourism identified as a focus area to generate employment and promote sustainable livelihoods. The government in its 10th five year plan has focused on the subject of rural tourism. With a rich diversity in culture, heritage, food, crafts, and tradition, India has immense potential and opportunity. It has identified certain areas across the country, which can immediately be developed as the rural destinations.

The government partnered with the United Nations Development Program (UNDP) for an Endogenous Tourism Project. Some 30 rural sites were selected in 20 states to develop as destinations for rural tourists. The UNDP pumped in an initial US$2.5 million. Those proposals that were selected by the government were entitled to assistance up to US$100,000.

Divining Forces in Rural Tourism

Industry stakeholders define the rural tourism experience by what they offer as product. But they are simply responding to what they perceive as an increasing demand for experience of rural communities, and interpreting it via their own world views. This demand is driven by a range of forces that combine to create tourist interest in rural experiences. These forces have been identified by many authors and can be summarised as:

Tourist generating regions for rural tourism are highly developed and urbanised. The stresses of urban living and the remoteness from the natural environment has created a desire for escape from the monoculture of city living.

Baby boomers are driven to tourism experiences that yield increased self-awareness in their drive for “longed for perfection” that compensates for lives “destabilised by uncertainty and insecurity” (Mackay, 1997)

Demand fuelled by media, over-familiarity and congestion with traditional tourist resorts and increased interest in alternative attractions with its voracious appetite for content and the resultant over exposure of many traditional tourist destinations.

Increasing environmental awareness and interest in the relationship between humans and the environment. Green issues have raised the attractiveness of rural experiences as ecologically sustainable tourism.

Transport, communication, and the removal of political and economic barriers to travel have facilitated accessibility of rural areas.

Increase in number of free independent travellers due to the increased capacity, especially in long-haul transport modes. When combined with increasing discretionary incomes, greater awareness of the range experiences on offer, the accessibility and attractiveness of rural destinations has been dramatically improved.

Changing work patterns have increased the popularity of shorter breaks that minimise the absence from work and the effect of absences on work flow and involvement.

An increased interest in heritage can be satisfied through rural tourism as rural areas are often the repositories of remnant heritage.

Rural areas are perceived as healthier, offering fresher air, cleaner water and the opportunity for outdoor recreation. Rural areas offer fresh and speciality food. (Bartmann and Baum, 1998)

Issues with Rural Tourism
The lack of statistical base:

It is difficult to establish volume and value of rural tourism as a specific market sector in nations, even harder on an international scale. Many countries have different definitions of ‘rural’ and will therefore collect different data. Data on rural tourism are not easily obtainable.

Rural communities:

These tend to be non-uniform for example remove versus accessible rural areas contain very different types of settlement, employment opportunities, socio-demographic characteristics. Different community structures with diverse responses to tourism exist.

Tourism development strategies may not benefit all rural areas:

Where there is an inadequate supply of attractions or accommodation, tourism may not flourish. However marketing strategies must be good to attract tourists. Likewise, development of tourism provision by local people may not be feasible in a depressed rural economy.

Impact of Rural Tourism

The aim of tourism development in rural areas is, in general terms, to provide opportunities for economic and social development. In some areas, tourism provides the main source of income and employment, as well as providing social and economic benefits. Inevitably, negative aspects of rural tourism are evident as well. (Gannon 1994)

IMPACT
POSITIVE IMPACT
NEGATIVE IMPACT
Economic

Assists viability of existing tourism and non-tourism business.

Encourages dependence on industry prone to uncontrollable change

Creates new employment

Creates part time, seasonal employment

Attracts inward investment

Incurs development costs and public service cost

Socio-cultural

Assists in viability of local service

Creates feeling of invasion by tourists

Creates sense of pride

Increases crime

Revitalises local culture, traditions, events and crafts

Reduction in local services

Environmental

Leads in environmental improvements in settlements

Increases wear and tear on landscape features

Provides income for conservation of buildings and natural environment

Creates need for new developments which may not be in keeping with local area.

Fosters awareness of conservation as worthwhile activity

Increases pollution and affects local biodiversity

Table 1: Positive and negative impacts of rural tourism

Niche Market: A Place in Rural Tourism

If the importance of the products one buys lies largely in their potential as social markers, tourism marketers must focus both on tourism’s social signification and on meanings attached to spaces in which these occur. Explanations of tourism consumption cannot be derived in isolation from the social relations in which they are embedded. New users of the countryside are redefining what constitutes ‘rurality’, and there is a need to take postmodernism and the construction of the rural much more seriously. Contemporary social construction often transcends the countryside’s tangible characteristics and qualities of open space or fresh air by representing it as the setting for the achievement of a range of personal goals. The need for a wider sociological approach to tourism studies has been emphasised by Sharpley, who argues for the recognition of broader social and cultural influences that shape consumer behaviour as a whole and influence consumption patterns. In the interests of the rural environment, therefore, and of the small businesses trying to meet the needs of emerging markets, it is necessary to look beyond classical marketing theory to gain a useful understanding of ‘rural tourism’ consumption and to evaluate the existence of niches for marketing purposes.

The increasing need for analysts to focus on consumption as an improved means of understanding contemporary forms of ‘rural tourism’ demand requires a dynamic framework within which the analysis can be conducted. A continuum to measure the relative importance of the countryside to the consumption of tourism in rural areas is proposed to indicate the importance of the countryside to the purpose of the trip and to tourist satisfaction. The significance of the model lies in its recognition of the primacy of neither tourism nor tourist types but the ways in which the countryside is consumed as a recreational resource.

Challenges and Opportunities in Rural Tourism

The major problem in rural areas is that there is not much scope for working. Most of the People are engaged in agricultural activities, some of them in forestry and others are artisans. Villages are struggling with large families with one or two earning members in the family and high consumption expenditure. Due to less scope in villages most of them started migrating to cities.

There are 638,691 villages in India as per the Census Report 2001 and the rural population is 741,660,293 with average population of 1,161 per village. Many of these rural communities have the potential have the potential resources, ability to attract the growing tourism industry. The scenic beauty, historical importance may appeal the urbanites, caught up in today’s fast pace of lifestyle.

Challenges in Rural Tourism

The major challenges are the need to preserve the environment and natural resources and the need for proper education.

Legislation Problems

Respondents have pointed out that there can be legal problems. Tourism is a part of entertainment industry. All hotels, motels and cottages having license pay taxes to government. Rural tourism should have a tax holiday or it should be tax free. The government should encourage rural tourism to grow.

Lack Of Trained Man Power

The ruler people require to be trained for discharging their duties, decorating the cottages and maintaining them, serving food to the visitors and to understand the taste of the costumers, either the local cuisine or different type of Indian cuisine. The success of rural tourism totally depends on the quality of service provided to the tourists. To develop the manpower government has to take initiative to open various short training courses for imparting knowledge and skills.

Insufficient Financial Support

To start rural tourism, sufficient fund is required to promote it in introductory phase. Rural tourism is still uncommon to many tourists. This is because the government has just started promoting rural tourism. Central and state government should encourage rural tourism by providing financial support to start the project. As it will create employment in rural areas and will help the inflow of funds from rural areas to urban areas.

Lack of Local Involvement

Since rural people do not have knowledge and skills to involve hem in different activities. They may get the job of unskilled workers. The rural people need to develop the knowledge and skills to have a higher involvement in rural tourism. The basic concept behind the rural tourism is the participation of rural people. But in practice local people are seldom involved in decision making, planning and implementing policies. Most of rural people do not have much knowledge of tourism, and are misled by outside investors who hope to take most of the economic benefits from rural area.

Language Problem

There are 16 recognized languages and 850 dialects in India. Although ‘Hindi’ is an official language, in many parts of India people do not understand it. The rural people have to upgrade themselves to communicate with the urbanites. The villagers not only have to educate themselves but they have to understand hindi to interact with the Indian costumers and English to communicate with the foreign costumers.

Opportunities in Rural Tourism

The tourists look for quality environment and meaningful experience. Marketing of rural is a specialist job. For rural tourism, rural people have to surrender themselves to professional marketers who understand the complexity of their task. The business depends on the development of networks, creation of trust and loyalty and information system, all of which takes money and time to develop, which is beyond the resources of most individual.

Tourists have become more educated, more aware of facilities available and more experienced, their expectation has also increased. People are interested in exploring new places. Rural tourism in India has great future, since it not only provides natural elements of beauty but also the indigenous local traditions, customs and foods. Direct experience with local people can be a unique selling proposition to attract tourists. Every state in India has unique handicraft, traditions and foods. The rural tourism not go for mass marketing, rather different strategies should be under taken for different segment to make it successful.

Introduction To Laksh Farms, Mangar Village

Situated in Village Mangar, off the Gurgaon-Faridabad Highway, Laksh Farms is just a 30 minutes drive from Chattarpur Mandir, Surajkund, Gurgaon and Faridabad. Spread over 15 acres, Laksh is located in a picturesque valley nestled in the Aravalli Hills, on the once-famous Dhauj Jheel. A unique example of the restoration of a degraded ecosystem, it offers a fulfilling experience in rural eco-tourism. With more than a few thousand indigenous and ornamental fruit trees and shrubs, Laksh is a naturalist’s delight, propagating organic farming using vermi-compost and bio waste. For animal lovers there are dogs, dairy cattle, goats, ducks, and geese, as well as an abundance of peacocks and deer throughout the area and also in the ‘sacred forest’ around the Gudariya Baba Shrine.

All in all, Laksh offers a magnificent rural experience with activities such as rock climbing, camping, organic farming, trekking, and nature walks, bird watching and cycling in the ancient and awe-inspiring Aravallis Khandavprastha of the Mahabharata.