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Vol 20, No. 10, October 2016   |   Issue PDF view/purchase
Hospitality Bridging Healthcare (H2H)©: Medical Tourism and Wellness

by Frederick J. DeMicco
PhD, M.S. P.H., R.D.


This article looks at the merging of hospitality, wellness and medical practices. Hospitality Bridging Healthcare or H2H is a natural progression, as today’s savvy consumers seek timely information about their health and wellness, medical care and the quality of the service they want to experience.


People all over the world are paying more attention to healthful living practices and also when seeking necessary or pre-screening medical care. This book looks at the merging of hospitality, wellness and medical practices. Hospitality Bridging Healthcare or H2H is a natural progression, as today’s social media savvy consumers seek timely information about their health and wellness, medical care and the quality of the service they want to experience. People seeking out good health options such as spas and thermal baths go back to Roman times or before. Given the plethora of information on the internet today, and on social media, consumers now are armed with the latest and best information. This allows consumers to search and seek out the health experiences that will provide the best customized and individually tailored health and wellness programs for them. Health, medical and wellness is about a 2 trillion dollar global industry (Cetron, DeMicco and Davies, 2010; Global Spa and Wellness Summit www.globalspaandwellnesssummit.org (2008))

A depiction of the dichotomy of the relationship of wellness and health (and spa and other hospitality services on the right side) and on the opposite left side of the diagram, the spectrum illness and healthcare is shown in the Figure 1. The y-Axis shows the greater the degree of medical services provided at the top of the axis.

Healthcare includes hospitals, clinics, nursing homes, life care and continuing care facilities. It is a segment that shows no signs of slowing and there will be many career openings for hospitality and healthcare management graduates. This is due to the fact that people are aging and will therefore require more medical procedures going forward into the future.

Graduates from hospitality and health professional programs that join this segment of the hospitality industry, can look forward to solid growth for the future, stable work hours, good pay and benefits (particularly medical insurance), often times day care for employee children, career growth, and making a difference serving people in need. Usually graduates of 4-year hospitality and professional health programs begin as an assistant director, work up to a director of food services, and eventually can become a GM or Vice President for Patient/Guest services. As more healthcare facilities grow to become “medical campuses” and medical Mecca’s for medical tourism, they emulate hotels in their quality and delivery of health and wellness services. In fact, in hospitals, approximately 75 % of the services provided to patients are hospitality/hotel related services. For example, they may add wellness and spa operations, which hospitality school graduates should be prepared to oversee. In addition, more food service directors are becoming General Managers of the entire healthcare campus enterprise who leads not only the traditional hospital facilities but also, the hotel(s), spa and wellness, environmental services (e.g. housekeeping), transportation services, parking, the grounds, snow removal, all dining venues. This is usually a vice president position on the health care campus and can provide challenge, excitement and very good pay and benefits in the six figure salary range. In sum, hospitality schools prepare graduates to be GM’s of hotels and now graduates should think of becoming GM’s/VP’s of health care (non-medical) operations and services in the future (see J. Williams and F.J. DeMicco, JADA, 1999). This is clearly a field for hospitality graduates that provides challenge and future growth opportunities well into the future.

1.2 A New Health Care Concept: Hotels Bridging Healthcare (H2H) and Medical Tourism & Wellness

Hospitals and luxury are two words that just don’t seem to go together. Or do they? In a recent trend where medical recovery meets the comfort of a luxury hotel, the idea of "Hotels bridging Healthcare," or H2H, is gaining ground.

A mixed-use concept, H2H creates a new and innovative business model for entrepreneurs to fulfill the unmet needs of certain patients and their families in a hygienic, complementary and friendly environment that provides quality accommodations, upscale treatments and state-of-the-art wellness centers for recovery.

As part of the broader field of medical tourism, which links medical facilities to hotels and/or spas, H2H strategically connects hotels and hospitals to create a total customer experience.

Medical tourism is a way for medical facilities to differentiate themselves from their competitors. Being able to stay and be pampered at the same place you are curing your ailment is the way many people with medical issues will want to go in the. Furthermore, about 75 percent of all hospital services today are hotel and hospitality-related services (Cetron, DeMicco & Davies 2010).

In the recent economic downturn, hotels connected to hospitals also appeared to be recession proof, which is likely a result of the appeal of completing a medical procedure and getting a vacation out of it at the same time.

Price is a real attraction with the cost of surgery in India, Thailand or South Africa can be one-tenth of rates in the United States. A heart-valve replacement that would cost $200,000 or more in the U.S. goes for $10,000 in India and that includes round-trip airfare and a brief vacation.

Spurring this H2H growth around the globe, U.S. accrediting bodies recognize many health care facilities overseas, more corporations and insurance companies are paying for medical travel abroad.

Today and in the future these H2H facilities will need hospitality and hotel school trained graduates as the General Managers (GM’s) of these medical campuses with hotels, food services, spas and other hotel like services brought to the healthcare segment.

This hotel hospitality is the focus of the book If Disney Ran Your Hospital by Fred Lee (Second River Press 2004), If Disney ran a hospital it would define your competition for customer loyalty as anyone the customer compares you to.

Additional information on Hotels Bridging Healthcare can be found at https://www.udel.edu/udaily/2013/jul/hotels-health-care-071612.shtml.

1.3 Exploring Medical Tourism

For most of us, getting sick is a good way to ruin a vacation. However, for growing numbers of people, needing to see the doctor is the whole point of going abroad. When they require surgery or dental work, they combine it with a trip to the Taj Mahal, a photo safari on the African veldt, or a stay at a luxury hotel—or at a hospital that feels like one—all at bargain-basement prices. This is medical tourism, and it is one of the hottest niche markets in the hospitality industry.

1.4 Why medical tourism?

With the growing presence of much focused web sites which provide relevant information about the medical tourism destinations, medical procedures with their associated costs, and tourism attractions, the decision making regarding their trip for potential medical tourist will become much more facilitated. Therefore, medical tourists have good cause to seek out care far from home. In some regions, state-of-the-art medical facilities are hard to come by, if they exist at all. For that reason, patients throughout the Middle East are traveling to Jordan or Asia for complicated surgery.

In other countries, the public health care system is so overburdened that it can take years to get needed care. In Britain or Canada, the waiting list for a hip replacement can be a year or more long. And as Dr. Prathap Reddy, the Boston-trained founder of the Apollo Hospitals chain in India, comments, “If you wait six months for a heart bypass, you may not need it anymore.” In Bangkok or Bangalore, you can be in the operating room the morning after you get off the plane.

But for most people, the real attraction is price. The cost of surgery in India, Thailand, or South Africa can be one-tenth of rates in the United States or Western Europe, and sometimes even less. A heart-valve replacement that would cost $200,000 or more in the U.S. goes for $10,000 in India, including round-trip air fare and a brief vacation; a metal-free dental bridge worth $5,500 in the States costs $500.

In Thailand, a knee replacement with six days of physical therapy costs about $5,000, one-fifth the American price; Lasik eye surgery worth $3,700 is available for only $730. And a full facelift that would cost $20,000 in the U.S. runs about $1,250 in South Africa.

The table below shows cost saving estimations of having medical treatment in different countries comparing to the US.

Inferior medical care would not be worth having at any price, and some skeptics warn that Third-World surgery cannot be as good as that available in the United States. In fact, there have been cases of botched plastic surgery, particularly from Mexican clinics in the days before anyone figured out what a gold mine cheap, high-quality care could be for developing countries.

Yet, the hospitals and clinics that cater to the tourist market often are among the best in the world. Many are staffed by physicians trained at major medical centers in America and Europe. Many countries aiming at developing medical tourism now increasingly seek JCI (Joint Commission International) accreditation for their hospitals to ensure the quality of health services to their customers.

Bangkok’s Bumrungrad hospital has over 200 surgeons who are board-certified in the United States. One of Singapore’s major hospitals is a branch of the prestigious Johns Hopkins University, in Bethesda, MD. In a field where experience is as important as technology, Escorts Heart Institute and Research Center, in Delhi and Faridabad, carries out nearly 15,000 heart operations every year. Its death rate among patients during surgery is only 0.8 percent, less than half that of most major hospitals in the United States.

In some areas, these clinics are backed by sophisticated research infrastructures. India is one of the world’s leading centers for biotechnology research, while both India and South Korea are pushing ahead with stem cell research at a level approached only in Britain.

Skilled doctors and state-of-the-art equipment are not the only benefits offered by medical centers specializing in foreign patients. In many, the doctors are supported by more registered nurses per patient than any Western facility could offer. Some facilities provide single-patient rooms that look more like a four-star hotel, with a nurse dedicated to each patient 24 hours a day. Some assign patients a personal assistant for the post-hospital recovery period. There is always the chance for a quick vacation, before or after surgery, to sweeten the deal. Many tourist clinics offer resort-like recovery facilities at a nearby beach for those whose condition or schedule does not allow for an actual vacation. And many of the Asian national airlines offer frequent-flyer miles to ease the cost of returning for follow-up visits.

In some countries, there are even more benefits. Medical tourism is evolving into “wellness tourism.” In this variation, the core medical clinic is surrounded by ancillary services, such as psychological counseling, exercise facilities, perhaps meditation, and more. The idea is that health-minded patients can heal their lives as well as getting treatment for a specific malady. Therefore the medical tourism scope can span the whole following spectrum.

1.5 Medical and Healthcare Scope

Under the circumstances, it is no surprise that the medical tourism market for such a wide variety of services is growing rapidly. Ten years ago, it was hardly large enough to be noticed. In 2012, something over 850,000 foreign patients visited Singapore alone; nearly half arrive from the Middle East. Perhaps half a million annually travel to India for medical care; in 2002, it was only 150,000 but the industry has grown consistency with only 21% growth from 2012 to 2013 and further growth will be expected in the future. Argentina, Costa Rica, Cuba, Jamaica, South Africa, Jordan, Malaysia, Hungary, Latvia, and Estonia all have broken into this lucrative market or are trying to do so, and it seems that a few more countries join the list every year.

Some important trends guarantee that the market for medical tourism will continue to expand in the years ahead. In the near future, the health of the vast Baby Boom generation will have begun its slow, final decline. There are something over 70 million Boomers in the United States, over 150 million in all when Canada, Europe, Australia, and New Zealand are taken into account. They represent an overwhelming market for inexpensive, high quality medical care.

Medical tourism will be particularly attractive in the United States, where an estimated 43 million people are without health insurance and perhaps 120 million lack dental coverage. The number of uninsured or underinsured Americans is likely to grow quickly, as many companies cut back or eliminate their medical and pension programs. Baby Boom workers who find themselves with little or no health care coverage will welcome any chance to cut the cost of care. Patients in Britain, Canada, and other countries with long waiting lists for major surgery will be just as eager to take advantage of care immediately available a plane-flight from home.

1.6 A Systems Model Approach to H2H

A Systems Model approach used in manufacturing and services can be applied to the medical tourism integrated model with H2H.

A system model is the conceptual model that describes and represents a system. A system comprises multiple views such as planning, requirement (analysis), design, implementation, deployment, structure, behavior, input data, and output data view. A system model is required to describe and represent all these multiple views.

In summary, the pre-planning of the medical journey leading up to the arrival at the medical/health/wellness destination begins a cascade of multiple H2H services to create an entire satisfying experience for the patient/guest which can lead to loyalty if performance in the entirety of the process is at the highest level.


Cetron, M; DeMicco, F.; Davies, O. (2010). Hospitality and Travel 2015: The Future of Hospitality & Travel. The Educational Institute of the AH&LA. Orlando, FL.

Excerpt from a chapter which is first published in October 2016 “Medical Tourism and Wellness: Hospitality Bridging Healthcare (H2H)” by Apple Academic Press Inc.

About the Author

Dr. Fred DeMicco is the ARAMARK Chaired Professor in the Department of Hospitality Business Management at the University of Delaware. Formerly, he was Associate Director in the School of Hotel, Restaurant and Recreation Management at Penn State University, where he was Professor-in-Charge of the HRIM undergraduate program (and the Master of Science and PhD graduate program for five years), and he presently is a Conti Distinguished Professor at the Pennsylvania State University's School of Hotel, Restaurant and Recreation Management. Dr. DeMicco is President of International Academics at the SIAF Campus in Volterra, Tuscany. He has worked in Healthcare at the Massachusetts General Hospital, Boston and at Walt Disney World in hotel and restaurant management.

Dr. DeMicco’s scholarly interests are in; International Strategic Management, Medical Tourism, Wine & Beverage Management, Managerial Accounting and Innovation. He has worked on projects with ARAMARK at four Summer Olympic Games (living in Atlanta, Australia, Athens and Beijing) and has taught and lead dozens of [email protected] cruise ship management courses around the world. Since 2007, Dr. DeMicco has been supported and is working with the Foundation of the Bank of Volterra to open a new 25 million euros campus in the center of Tuscany for hospitality management and students in the Arts & Sciences.

He completed his Ph.D. in Hotel, Restaurant and Institutional Management at Virginia Polytechnic Institute and State University under the direction of Dr. Michael D. Olsen. In 1996, he worked in Hotel Management at Walt Disney World, Florida. Dr. DeMicco also obtained his Ducktorate Degree from Disney University. Dr. DeMicco also served as the Chief Dietitian and Associate Director of Dining and Technology responsible for all menu planning, technology and nutrition in the Virginia Tech Dining Services for five years. He has also been employed by Aramark International, Marriott Vacation Club International and several healthcare operations including assisted living facilities.

He has authored or co-authored nearly 100 refereed articles in the area of tourism and hospitality management and he has co-authored several books including Restaurant Management: A Best Practices Approach with Kendall-Hunt Publishers (2015) and Hospitality 2015: The Future of Hospitality & Travel (2010) with the Educational Institute of the American Hotel and Lodging Association. Dr. DeMicco is on the Editorial Advisory Board of the Journal of Hospitality & Tourism Research and several other notable research journals.

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