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Presented by: Camille Hoheb, M.S., Healthcare Administration Consultant, Global Spa and Wellness Founder, Wellness Tourism Worldwide Wellness is a Global Language

Agenda: Future of Thermal Tourism Why What Where Who How When

The Future of Thermal Tourism

Importance of Thermal Tourism Leverages existing natural resources Expands tourism portfolio Increases marketability cross marketing to multiple segments Plays up strengths of indigenous offering (specific, local, germane) Differentiator from competitors Compliments and strengthens tourism initiatives Bridges medical tourism & wellness/leisure travel

The Future of Thermal Tourism

Medical & Wellness Tourism: Comparing & Contrasting Medical Tourism (Patient) Solving a health problem: clinical outcomes to improve condition Diagnostic, surgery, rehab Regulated & sterile Wellness Tourism (Leisure Traveler & Wellness Consumer) Improving QofL: renewal of mind, body & spirit Pampering, prevention & lifestyle management Engaging 5 senses to calm, customer-centric

Thermal Tourism: 2 Distinct Approaches Medical Tourism: Ailments Treated by Thermal Providers: Rheumatic Diseases Degenerative Inflammatory Soft tissue Dermatological diseases Psoriasis Atopic dermatitis Eczema Metabolic Diseases Obesity Metabolic syndrome Geriatrics Areas of focus: Rehabilitation Wellness Traditional Beauty Types: Baths Mud Inhalation Drinking Beauty Leisure/Wellness Tourism to luxuriate in the soothing waters of natural mineral baths Stress relief & socialization

The Future of Thermal Tourism

Who? Thermal Tourism & Medical Global Aging Population Increase in those living with chronic conditions for decades Chronic conditions projected to be the leading cause of disability by 2020 Increasing need for prevention & mgmt By 2050 the UN predicts that 22% of the worlds population will be over the age of 60.* Conventional approaches are failing, even in the most advanced nations of the world throughout Europe, Asia, the Middle East, Australia, Canada and the U.S. (PricewaterhouseCoopers)

Baby Boomers & the Aging Population Expectations: Quality of Care Quality of Life Technology Cutting Edge Proficiency Continuity of care Customer Service Communication Speak the same language Knowledge Active Aging -allows people to realize their potential for physical, social, and mental well-being throughout life & to participate in society. Eco conscious Travel/adventure Natural Organic Empowerment

By 2030: More Boomers, Conditions & Tests Global HC Opportunities 6:10 Boomers have 1+ chronic condition. 1:3 will be obese (21 million people) 1:4 (14 million) will have diabetes. 1:2 (26 million) will live with arthritis. 8 x more knee replacements will be performed than today. Implications: If all diabetic Boomers receive recommended care = 55 million lab tests/yr (44 million more) Diabetic need continuous I/P & O/P med mgmt < demand for cardiology services as Boomers live longer American Geriatric Society

Who? Wellness Tourism Social Health Work Increased work load leading to social isolation Escape: every day life Social interaction vs. virtual communities Self improvement Specific goals Spiritual guidance, counseling or quest Increase in CAM Baby Boomers youthful & fit Emotional Environ t QoL Safety Financial Belonging

Worldwide Response of Spas to Wellness Source: SRI GSS 2010

Younger Population: Health & Wellness Needs Infertility Stress Weight Loss Life Balance Cosmetic

The Future of Thermal Tourism

Country Image: Impacts Customer Loyalty Fundamental strategy for competitive advantage Country image s + effect: Perceived quality Customer expectation Perceived value Customer satisfaction Customer loyalty Word of mouth Customer Loyalty: a long-term commitment to repurchase involving both repeated patronage and a favorable attitude. Source Dick and Basu, 1994 Ayyildiz, Hasan,Cengiz, Ekrem

Importance of More frequent purchases Customer Loyalty & Retention Greater margins to the bottom line Retention: ultimate goals for boosting revenue Become advocates & promoters Purchasing patterns. Marketing needs. Emerging opportunities Provide valuable insight Source: Ayyildiz, Hasan,Cengiz, Ekrem, Country Image Effect on Customer Loyalty Model Innovative Marketing

Country Image Customer Loyalty Example Similarities between Turkey and Middle East Cultural Culinary Religious Linguistics Healing traditions of thermal & mineral bath, hamman Turkey is geographically proximal Foreign investments in hotels/resorts, etc.

The Future of Thermal Tourism

How? Europe Trans-border Care 2013 (October) to take affect in the European Union Affects medical care & treatment Spa therapies will be covered with a physician RX Subsidized treatment allowances have decreased in Europe as cost savings measure Out of pocket costs have increased More private pay, most likely shorter stays, perhaps more opportunity for increased frequency

Natural Assets & Lifestyle Shape Tourism Cultural traditions, lifestyle approaches & availability of natural assets shape the world in terms of WT services. Most important services vary region to region Natural environment -the most critical comparative advantage or asset. Availability & utilization: key to product differentiating & development

Key Assets by Region N. America: med/surg, CAM. Nature high rating, spirituality > Europe. S./Central America nature, CAM (med assets low rating due to avail vs. local need) Asia: High spirituality ranking, CAM & med S. Pacific: Natural environ. CAM, med had lowest ratings Europe: Nature important in all of Europe, esp. SE. Natural healing assets: significant in WE & CEE Rehab & surgical important in every sub-region (sans SE) Middle East: natural healing & medical Africa: natural environment plus spirituality

Challenges to Development Lack of: Legal arrangements to protect geothermal resources Insufficient investments Management in local government facilities Institutional collaboration Reluctance of investors. Access/transportation Sustainability, resource waste & treatment systems tourism master plan skilled labor force marketing insufficient qualified facilities

The Future of Thermal Tourism

Wellness Tourism Today Most Popular Wellness Tourism Services: Spa & wellness resorts (83% responded very popular or popular), Beauty treatments (89%) Sport & fitness (89%) Leisure and recreational spas (85%) Lack of Information: Occupational wellness (19% of respondents reported unfamiliarity with the term), Thalassotherapy (19%) New Age (15%) Niche products Spa cruises (40% responded neither popular or unpopular), Therapeutic recreation (38%), Nutritional and detox programs (35%).

Job Stress & Health: Studies Suggest Cardiovascular Disease Increase cardiovascular disease risk. Musculoskeletal Disorders Increases the risk for developing back & upper-extremity disorders. Psychological Disorders Mental health problems (depression & burnout) Workplace Injury Decrease safe work practices & increase injuries Relaxation - # 1 reason to spa Suicide, Cancer, Ulcers, and Impaired Immune Function The link between stressful working conditions and these health problems. (Encyclopedia of Occupational Safety and Health) By 2020 top 5 disease conditions share underlying factor of stress Heart disease, stroke, cancer, respiratory disease & cancer who.int

Opportunities Individuals Families Communities States Countries Health as the new Wealth Shift: Passive to active Mind/body stress 24/7 Stakeholders Businesses/Corporations Insurance Companies Government Agencies Associations Executives/Workforce HR/Benefit Specialists Hospitals & H/W Providers Products/Services Travel Agencies. Airlines Meeting Planners &Incentive Travel Wellness Destinations/Hotels Spas Chronic conditions, if not prevented or properly managed will be the most expensive problem, overburdening healthcare systems

Untapped, Under-Utilized & Under Promoted Spas as a Legitimate & Critical Provider Most Popular -Back care WW -Exercise Programs: Most Popular Workplace Wellness Programs: -Stress management -Stop-smoking -Back care (WELCOA) -Stress relief -Fitness -Stopsmoking (WELCOA) Therapies w/clinical Evidence Art therapy Ayurveda Biofeedback Breath work Hypnosis Chinese Medicine Massage Meditation Music Therapy Psychotherapy Thermal Waters In an environment in which health care costs are skyrocketing, the sensible approach is to reduce the need for care, and the most powerful way to accomplish this is by focusing on evidence-based prevention...this will only succeed if spending on prevention is considered a priority rather than discretionary and only if incentives are realigned. (Committee on Health, Productivity and Disability Management, Journal of Occupational and Environmental Medicine, May 2009) Engagement -Clinical Studies Health Promotion- Health Education Lifestyle Management - ROI

Vacation Days Earned by Country Australia Canada New Zealand Great Britain Austria Germany Spain Italy France Vacation Deprivation Study

Wellness Tourism Tomorrow Products available globally may lose their differentiating qualities Thermal tourism natural resource: local & specific Products/Services 2020 Therapeutic services Spiritual & Holistic Wellness Hotels & Resort Spas Lifestyle bases services Most Important Regions Central & Eastern Europe Far East, SE Asia Africa, C & S America, ME, Australia, NZ, South Pacific N, S & W Europe & N. America

Summary: Future of Thermal Tourism Can impact socioeconomic growth Has gained importance & credibility from research on clinical benefits for wellness, treatment & rehabilitation. More needed Poised for global aging population Valuable for workforce wellness Challenges: development & management Sustainability in the preservation of resources Cooperation between the public and private sector Collaboration with thermal bath and tourism industry Competing with other health & wellness tourism products Promotion to underserved markets that don t share similar history or understand thermal tourism.

Parting Thoughts Help consumers find the solution to their health goals & wellbeing travel experiences Requirements for capturing customer base Understanding consumer needs Their motivation for wellness experiences Offering the most needed & desirable services Excellent customer service Marketing. Marketing. Marketing. And Education!

Thank You To participate in industry surveys, networking or for more information, please contact: Camille Hoheb, M.S, Healthcare Administration Business Advisor, Global Spa and Wellness www.globalspaandwellness.com Founder, Wellness Tourism Worldwide www.wellnesstourismworldwide.com camille@globalspaandwellness.com camille@wellnesstourismworldwide.com Skype: camille.hoheb twitter.com/camillehoheb Wellness is a Global Language