Health, Wellness and Tourism: healthy tourists, healthy business ...

Expectations of Health Tourists in Germany – Illusions and Reality
Monika Rulle
Department of Geography and Geology, Ernst-Moritz-Arndt-University Greifswald,
Makarenkostr. 22, 17487 Greifswald, Germany
rulle@uni-greifswald.de
Abstract
Health tourism in Germany was once strongly supported by the social security system. Today,
destinations of health tourism have to attract more than ever the privately paying guests. In a
first step, the paper discusses general questions about modern health tourism. A special focus
was taken on the development of Medical Wellness. With the help of a nationwide
representative telephone survey, Germans were questioned about their interest in health
holidays. In the second step, preferences to different offers and the satisfaction with these
services were researched. In the case study, health tourists in destinations in Mecklenburg-
Western Pomerania were questioned. A comparison between the two surveys reveals much
difference between the mere interest in the offers and the actual use of them. The additional
cluster analysis defined three main target groups: married middle-aged women, younger
unmarried men and persons age 65 plus.
Keywords: health tourism, visitor expectations, customer satisfaction, target groups,
Germany
The situation of health tourism in Germany
The German tradition in health tourism is long and well-known. For centuries, spas were the
centre of tourism activity, however mainly for the well-off people. The situation changed
when in 1957 West Germany passed a law, which made spa treatments part of the regular
benefits of the social security system. As a result of this, slowly the structure of the spas
changed: the once romantic outline of the spas transformed into a setting often dominated by
newly built large scale sanatoriums and clinics (Brittner, Stehle 2000). Simultaneously, the
number of arrivals to spa destinations exploded: in West Germany figures grew from 5.2
million in 1977 to 9.3 million arrivals in 1998. In the German Democratic Republic, spa
treatments were organized stately and the numbers of participants were far lower. After the
reunification much financial support was necessary to develop the infrastructure to be
nationally competitive (Deutscher Bäderverband 1998).
Between 1999 and 2008, the number of arrivals in all German spas grew again from 16.6
million to 19.3 million. However, at the same time, the average number of overnight stays
sank from 6.3 to 5.3. In 1999, the fraction of guests in German spa destination having their
treatments funded by the social security system was only 10.6%, lower than ever (Deutscher
Heilbäderverband 2009).
On the consumer side, the demographic transition with a population growing older fast
created new types of customers in recent years: patients with chronic, but stable diseases like
diabetes as well as persons concerned about their health are searching now increasingly for
medically supervised vacations, paid partially by health insurances or in total privately. Since
the social system pays ever less for spa treatments, new ideas for the destinations become
necessary in order to be attractive for the self-paying guest. In addition, many destinations,
especially in the eastern part of Germany, need to revitalize their offers and infrastructure, as