Designing a health tourism product structure model in the process of marketing management - ebook

Introduction

Motivation for this research

The highly dynamic changes in the market of health tourism services caused by a need to improve and maintain one’s health and the resulting increasing competition in the market call for creating new methods of managing health tourism enterprises and destinations. Theories of building competitive advantages are crucial in forming these strategies. They allow health tourism enterprises and destinations to become operationally effective and competitive. The specificity of the health tourism industry, which, as well as being service-oriented, is dominated by pro-quality attitudes (oriented towards the customer’s needs, quality of customer service and reliability in providing health services, and towards a constant improvement of the quality of health services offered and the development of innovativeness in the sector of health services) stimulates the development and maintenance of competitive advantages of both firms and health tourism destinations based on the concept of marketing management. The essence of this concept is to achieve targets by satisfying customer needs in the best possible way by identifying a central axis of observations in the theory of marketing. Addressing the challenges of health tourism market through qualitative competitive advantage requires providing an appropriate value (product). As enterprises and health tourism destinations develop, they increasingly focus on marketing and the market. Consequently, it is crucial to adapt the health tourism product (HTP) to purchase preferences. As pointed out by Holloway (2004, p. 130), appropriately tailoring a product to the needs of the market is the most important task of marketing management. Currently, the concept of marketing management should focus primarily on the advantages delivered to the customer rather than the value of sales (Goeldner & Ritchie, 2006, p. 521). If the product is not what the market expects, neither appropriate price, nor efficient delivery, nor effective promotion will encourage customers to buy the product more than once, which is, obviously, the seller’s goal. On the dynamically changing health service market, the success of enterprises and destinations to a large extent depends on their most attractive and competitive products, tailored to clients’ needs and expectations, a ‘key element of the marketing mix’ (Kotler, 1984, p. 183).

A review of the subject literature leads to the conclusion that despite the growing interest of researchers in the issues of HTP management, studies conducted in this area have been rather fragmentary. Explanations provided in major academic studies by leading specialists unfortunately do not explore the subject matter in full, but only indicate the complexity of the issue (Bookman & Bookman, 2007; Bushell & Sheldon, 2009; Connell, 2011; Erfurt-Cooper & Cooper, 2009; Hall, 2013; Smith & Puczkó, 2009, 2014a; Steckenbauer, Tischler, Hartl, & Pichler, 2017; Voigt & Pforr, 2014a). The existing descriptions on the HTP structure are generally limited, superficial and although they often signal how complex the issue is, they do not provide any in-depth structural analyses which would penetrate the specific layers of HTP. So far, authors of studies on marketing health tourism have only acknowledged the existence of HTPs, such as therapeutic tourism products (e.g. Burzyński, 1998; Dryglas, 2006; Dryglas, 2013a; Dryglas, 2014; Hadzik, 2011; Hadzik, Ujma, & Gammon, 2014; Januszewska, 2004; Kapczyński & Szromek, 2008, Kornak & Rapacz, 2009; Krasiński, 2001; Lewandowska, 2007; Romaniuk, 2010; Szromek, 2011), medical tourism products (e.g. Cohen, 2010; Connell, 2013; Hall, 1992; Rab-Przybyłowicz, 2014), or wellness tourism products (e.g. Müller & Lanz Kaufmann, 2001; Voigt, 2010; Voigt & Pforr, 2014b). Furthermore, the existing HTP studies tend to be descriptive in nature (e.g. Bennett, King, & Milner, 2004; Connell, 2011; Douglas, 2001; Goodrich & Goodrich, 1991; Hall, 1992, 2003, 2011; Smith & Puczkó 2009, 2014a) or are based on empirical evidence (e.g. Fetscherin & Stephano, 2016; Junio, Kim, & Lee, 2016; Lee, 2010; Martinez-Alvarez, Chanda, & Smith, 2011; Padilla-Meléndez & Del-Águila-Obra, 2016; Page, 2009; Singh, 2013; Smith & Puczkó, 2015; Voigt, 2010), but there is a paucity of conceptual research which could contribute to the theory of marketing management, especially to the subject of HTP management. What is more, the HTP issues have not been holistically addressed, which would allow to formulate a precise and detailed definition of HTP based on a set of already existing and potential product features and therefore define and study its structure, that is an ordered set of benefits and functionalities delivered by health tourism enterprises and health tourism destinations. In addition, terminological difficulties are deepened by interdependencies between medical, therapeutic and wellness tourism products, which results in the terms being confused or used interchangeably. Furthermore, it is worth emphasising that academic tourism marketing research has paid much attention to the conceptual study of the tourism product, indicating its complex structure (Kotler, Bowens, & Makens, 2006; Middleton, 1988; Smith, 1994), but it has not placed any focus on examining this structure. Although some attempts were made by students to assess each of the five elements in relation to Smith’s generic model of the tourism product based on 15 tourism products (Xu, 2010), no research has been carried out to analyse the content of the respective layers in the structure of the tourism product.

As a result, the overall picture of the issues is selective in nature and there are no research models which would analyse the structure of HTP. Such models would be an effective marketing management tool for building competitive advantages in the market of health tourism services. The analysis of theoretical and conceptual studies and of works from the analytical and research-based category in the field of health tourism marketing confirms the thesis of a cognitive gap in theoretical and empirical research on HTP and its structure.

In view of the above, the author of the present work has decided to create an original HTP structure model aimed as an effective tool for operational marketing planning used in the process of marketing management. The model will enable health tourism enterprises and destinations to achieve operational effectiveness in terms of HTP design, targeting, placement and promotion, a sine qua non condition to compete.

Purpose of this research

The main goal of the study was to create a new tool for designing and measuring the HTP structure, which will be used to determine the profile of an effective and competitive health tourism enterprise or health tourism destination, and identify marketing management tasks, especially within the scope of product management, for company managers and local governmental units. Bearing in mind that the identified gap in the knowledge on the subject concerns both the theoretical and empirical dimensions, the primary goal was divided into two coherent modules:

– theoretical goal (G1) – to conceptualise and operationalise the HTP structure; this included constructing a theoretical model of the HTP structure for marketing management;

– empirical goal (G2) – to empirically verify the destination-specific therapeutic tourism product (DSTTP) structure platform based on the example of Polish spa resorts, including the development of a research model of the DSTTP structure platform.

In order to attain the thus defined goals in the cognitive, methodological and practical dimensions, the following operational objectives have been distinguished:

G1.1. To identify and systematise conceptual perspectives of health tourism using a historical approach and quantify the notion of HTP (Chapter 1).

G1.2. To conceptualise the process of marketing management from the HTP perspective (Chapter 2).

G1.2.1. To describe and identify the HTP environment.

G1.2.2. To describe and identify the portfolio of HTP based on a hierarchical arrangement of the assortment structure.

G1.2.3. To identify and systematise marketing research on HTP.

G1.2.4. To describe segmentation and targeting of the health tourism market and the HTP placement.

G1.2.5. To determine and formulate marketing goals for entities managing HTP and HTP strategies.

G1.2.6. To develop a methodology of designing the HTP structure, including the development of a theoretical model of the HTP structure.

G1.2.7. To create a framework for implementing and monitoring HTP.

G2.1. To develop a methodology of the HTP structure platform, including constructing and operationalising a research model of the DSTTP structure platform (Chapter 3).

G2.2. To identify methods of measuring the importance of individual levels (layers) within the DSTTP structure platform (Chapter 3).

G2.3. To identify the elements of individual levels within the business-specific HTP (BSHTP) structure platform (Chapter 4).

G2.4. To have individual levels and their elements within the DSTTP structure platform empirically evaluated by tourists visiting Polish spa resorts and managers of therapeutic, wellness and tourist accommodation facilities located in Polish spa resorts (Chapter 4).

Contributions of this research

Within the subject literature, this monograph is one of the few works which conceptualise the HTP structure and empirically verify the DSTTP structure platform. This study aims to further develop the management of tourism product theory (McKercher, 2016; Mrnjavac, 1992; Murphy, Pritchard, & Smith, 2000; Smith, 1994; Xu, 2010) and practice, especially in the field of health tourism product. The added value of the present work, which contributes to the development of economic science within the field of management, in particular marketing management in health tourism, encompasses the cognitive (theoretical and empirical gap), methodological and applied dimensions.

Epistemological dimension

1. At the theoretical level, a classification, delimitation and author’s conceptualisation of the historical perspective on the health tourism concept as well as of the HTP notion were carried out on the basis of a detailed semantic analysis of seemingly synonymous concepts, such as: health, wellness and wellbeing as well as the way of defining and classifying health tourism in the literature. The study is a systematic and comprehensive response to the suggestions in the literature claiming that the historical and semantic aspects of HTP have been thus far described in an ambiguous way.

2. It also significantly contributes to the evolution of the idea of tourism product marketing management, including HTP. The author’s own model of the HTP marketing management process will broaden the scope of discourse based on the existing theory of tourism marketing management by adding a component specific to health tourism management. As part of one of the stages in the HTP marketing management process (HTP portfolio), an original HTP typology, based on a hierarchical arrangement of the assortment structure, was developed (where three HTP families consisting of six classes within which three HTP lines configurations are distinguished, including numerous HTP types). This structure provides cognitive value contributing to the development of a marketing management theory of HTP.

3. The thorough study of the subject literature expands knowledge about HTP by standardising and systematising inconsistent terminology in the field of health tourism and, as a result, makes it possible to quantify HTP concepts.

4. A cognitive gap in the theoretical dimension is significantly supplemented by the formulated concept of an HTP structure model design methodology based on the concept of product architecture design in a modular approach recognised as a developmental research approach in product management.

5. The basic and most important original contribution of the present work to management studies is the author’s model of HTP structure based on a critical analysis of the literature on tourism product and health tourism management. It should also be emphasised that the model is universal and may be used to build and investigate other complex tourism products. The model allows for the conceptualisation and exploration of the HTP structure within the following module paradigms: descriptive, explanatory, relational and prognostic. The literature on the subject lacks a coherent, theoretical construction that could be used as a basis by managers of health tourism enterprises and destinations for detailed research of the HTP internal structure and the related processes within operational marketing planning.

6. An essential achievement of the present research is a critical analysis of the subject literature and coherent synthesis of theoretical foundations for creating the HTP structure model that allows not only to set the concept within the HTP marketing management process, but also to understand the logic underlying the identified dimensions and levels constituting a platform in the HTP structure model. In order to develop a coherent theoretical framework for the studied issues of the HTP structure platform, the concept of tourism product structure was used. In the subject literature, the structure of the tourism product reveals an imprecise construction, which reinforces the critical arguments in relation to its concept. The lack of clear boundaries within the structure of the tourism product leads to an erroneous identification of the consumer’s perspective with the point of view of the producer, and identification of the present with the future. The demonstration on theoretical grounds that categories of demand, supply, the present and the future, which reflect different levels in the tourism product structure, so far treated synchronically in the subject literature,10will contribute to a significant change in the academic discourse on the concept of the tourism product structure. The concept of the tourism product structure involves disaggregating the demand, supply, present and future layers in the tourism product structure into four different dimensions (motives, future motives, offer, innovations) and introducing the resulting need to conduct research in a manner which would be stadial (research on the offer dimension should be carried out jointly or separately among tourists, suppliers of tourism services or local government units based on the previous knowledge on the motives dimension) and continuous (research should be undertaken periodically, taking into account the dimension of future motives and innovations). Previously, due to the ambiguous construction of a tourism product, research has been carried out in a one-dimensional mode. The significance of this transformation is emphasised by the fact that building competitive advantage on the dynamically developing health tourism market requires managers of tourism services entities and organisations which manage health tourism destinations to change their focus from exploring the HTP structure in a non-phased and occasional way towards a phased and constant update and verification of knowledge on the HTP internal structure as well as confrontation of the obtained research results in order to create a competitive HTP. Thus, the rich research material collected and analysed here provides an important argument in the discussion aimed at developing an effective tool for making accurate decisions in terms of designing, targeting, positioning and HTP promotion, allowing for the implementation of a strategic marketing plan. Therefore, the HTP structure model may be viewed as a diagnostic, analytical and prognostic tool for building competitive advantage of health tourism enterprises and destinations.

7. Another aspect which should not be underestimated is the identification and thorough analysis of the BSHTP structure platform adopted in the concept of the HTP structure model, which classifies and organises the existing theoretical and empirical studies on the management of medical, therapeutic and wellness tourism enterprises in a structural perspective, providing them with a new dimension.

Empirical dimension

1. From the empirical point of view, the pioneering character of the research in both Polish and European economic studies, in particular health tourism management studies, may serve as a solid and reliable basis for further research, considering the high credibility of data collection, measurement and analysis.

2. The conducted research has led to cognitively valuable findings, which fill an important gap in terms of empirical content in evaluating the significance of individual layers in the DSTTP structure platform in three-dimensional terms.

Methodological dimension

1. At the methodological level, the contribution to the development of the tourism product marketing management theory is expressed in an innovative methodology applied in studying the DSTTP structure platform.

2. The research tools have been adapted to the need to evaluate and analyse particular levels (layers) and their elements in the DSTTP structure platform.

3. An original empirical model of the DSTTP structure platform research has been developed.

Application dimension

1. In terms of application, the developed model structure can be used for permanent monitoring and diagnosis of the HTP structure.

2. The conclusions formulated on the basis of the results of empirical research on the DSTTP structure platform can be used in business practice, including entrepreneurs, self-regulatory organisations (as recommendations for business circles), central administration and local governments (as implications for HTP policy at central, regional and local levels).

Outline of this research

The structure of the study and its logic were dictated by the conceptualisation of social sciences proposed by Burrell and Morgan (1979), which entails four sets of assumptions related to ontology, epistemology, methodology, and axiology. Therefore, this study comprises four chapters included in three parts: theoretical-conceptual (Chapters 1-2); methodological (Chapter 3); and analytical-empirical (Chapter 4), as well as an introduction and summary of the research study.

The introduction outlines the background of the study, explains why this research is needed, identifies major gaps in the literature, and specifies research objectives. It concludes with a discussion on the potential contributions of this research and the outline of the work.

The first chapter aims to systematise conceptual perspectives of health tourism using a historical approach and quantify the concept of HTP in the theory of a tourism product, integrating the concept of a tourism product and a health product. The purpose of this chapter was to delimit the concept of HTP taking into account the way of understanding the meaning of related concepts such as: health, wellness and wellbeing, determined by the socio-economic context, as well as defining and classifying health tourism in the literature.

Chapter 2 conceptualises the process of marketing management from the HTP perspective by combining the existing theory of marketing management with the theory of health tourism product. The starting point for this chapter was the issue of the multi-aspect and interdisciplinary nature of the macro and micro-environment of HTP. While discussing the issues of the portfolio of HTP, emphasis was put on HTP type classification based on a hierarchical arrangement of the assortment structure. Other analysed aspects were marketing research on HTP, segmentation and targeting of health tourism market, HTP positioning, marketing goals, marketing strategies, and implementation and control theories from the perspective of HTP managing entities. Such an approach distinguishes this part of the study from other studies in the field of marketing management in tourism. The chapter focuses on developing a methodology for designing the HTP structure model. An attempt was made to systematise and delimitate the HTP structure and present the main conceptual approaches to the structure of a tourism product based on available secondary studies. The chapter proposes the author’s innovative construction of the HTP structure theoretical model, including the modular paradigm.

The third chapter contains a detailed description of the research paradigm for the conducted research and a detailed description of the research object. The starting point of this chapter is the issue of a research model of the DSTTP structure platform constructed on the basis of the previously developed original concept of the theoretical HTP structure model, which was operationalised and simplified for the purpose of the empirical study. After formulating research hypotheses resulting from the theoretical assumptions of the analysed phenomenon, the use of the research paradigm and test methods is explained and justified. The presentation of the method of data collection and measurement as well as the presentation of the research methods used for data analysis are included. The chapter ends with a profile characterisation of the research sample.

Chapter 4 presents the results of an empirical study carried out in all Polish statutory spa resorts which exemplify the DSTTP. The results are analysed according to the adopted research model of the DSTTP structure platform along with hypotheses testing. In addition, the elements of individual levels in the BSHTP structure platform are diagnosed and analysed on the basis of secondary research.

The summary presents the results and final conclusions of the research. It also defines the theoretical and practical implications of the research that can be used by the academic community, managers of tourism companies and representatives of local government units. Finally, some limitations resulting from the adopted research methodology are discussed, forming a starting point for further research.