Destination Strategies for Health & Wellness Tourism + Smart City Urban Innovation
Cities are the future. For the past ten years the number of human beings living in cities has outnumbered those in rural areas. The United Nations projects that by 2050 nearly two-thirds of the world’s projected 9.7 billion people will be urban. That should be no surprise to anyone working day in and day out in urban and regional planning or public health. But most medical tourism stakeholders rarely give it a second thought. Most just keep trying to sing what I refer to as “the medical tourism birdsong”: Cheap Cheap!
That’s why on many medical tourism destination development project assignments and situation assessments, I meet with urban and regional planners associated with projects involving new urbanism and smart city real estate development projects that are popping up worldwide.
Many of these new real estate developments around the world integrate multi-family communities that integrate shopping, open space parks and recreation features, transit-oriented development, retail, office space, and other amenities. These other amenities are trending towards private (and occasionally public health) medical centers and family medical, wellness and dental clinics located in a walkable area. They are co-located within a half mile of new light rail and other high quality public transportation projects and often, they include a few hotels to accommodate business travelers, long-stay guests, and grandparent accommodations. Some also provide for traveling consultants, sales teams and other visitors with business activities within the community.
How does a medical tourism concept project fit into this setting?
Medical, dental and wellness tourism projects can be designed to fit into any destination where people travel frequently and in large, discreet numbers from domestic or international source markets.
What differentiates them and drives success is zeroing in on the ideal targeted consumer or medical tourism supplier/stakeholder that will be attracted to this arrangement. The consumer persona is often upmarket, high net worth, educated, professionals and his/her family and active lifestyle empty-nesters and retirees who call the development their primary or second home.
These consumer personas struggle with balancing career, health and wellness, longevity, and quality of life. For medical travelers of this ilk, the denser, more populous cityscape resonates with them and is highly attractive because it is similar to where they live and work at home. This new trend creates vibrant, livable, sustainable communities where access to health and wellness providers is simply a normal and expected integral part of the built environment. Healthful food and beverage outlets, organic groceries, cruelty-free cosmetics and other products are featured in the retail outlets.
A large number of my most recent consulting assignments in the Middle East, Africa, India, the Maghreb, the USA, Canada, Mexico, the Caribbean, and Asia all have included situation analyses wherein I was requested to survey the project plans, or the development under construction. My task was to recommend what “could” or “should” be done with the area dedicated to healthcare and related services.
Developers, investors and project planners ask me to analyze the project and suggest how the medical and wellness features can be integrated into a health or wellness tourism local or regional destination strategy.
For me, these assignments are at the top of my list for favorite projects that are both interesting and challenge every fiber of my creativity. This sort of challenge causes me want to rise up each morning while at the project destination and suggest 3-5 practical ideas that help developers and investors design a uniquely differentiated product and medical tourism destination strategy.
These medical tourism destination development projects are easily branded and produce a product on the other side of the spectrum from the usual price-oriented commoditized medical tourism marketing and advertising strategies that plague medical tourism in more than 150 countries. The medical tourism strategy that focuses on selling consultation and procedure bookings at cheap prices has proven unsuccessful in both revenue growth and capturing adequate market share to sustain business, worldwide.
Where are these projects found?
While the world’s megacities—Tokyo, Jakarta, Shanghai, New York City—get a lot of attention, for the most part, many of the projects I’ve been asked to analyze and strategize are in medical tourism destinations a tier or two lower in size. In all cases, destination cities are taking some actions that I see as common denominators, including LEED GOLD and PLATINUM sustainable development, CCTV coverage with facial recognition, Internet of Things (IoT) integration with wearable devices and cashless, smart phone apps with beacon proximity technologies, walkability and CPTED (crime prevention through environmental design) principles.
These developments are situated in settings that foster business, promote education and work/life balance, mindfulness, and often manage severely limited environmental resources such as power and water, a situation that cities around the globe will increasingly face. They must be equipped with the infrastructure that can manage to meet the requirements of of health technologies and facilities that will be situated there.
For example, did you know that hospitals require 300 gallons of clean water per bed /per day to operate? Or that power that is not voltage balanced to prevent spikes and surges or brownouts can damage or render certain imaging technologies and dialysis equipment inoperable for hours at a time while the unit recovers and resets from the fluctuation? Problems related to quality of power supply can cause sensitive medical equipment in the home and in professional and institutional settings to require premature replacement and add to running costs, capital equipment budgets, maintenance expense and shorter life cycles.
Did you know that in order to be accredited by most healthcare accreditation schemes, a health facility must have 72 hours of reliable backup power, and be situated in a destination where repair and maintenance technicians can be called in and expected to arrive and begin work within 4 hours on sensitive and complicated medical technologies? That’s actually what makes me tend to recommend against medical tourism destination development at locations where this time limit and power grid infrastructure requirement cannot be met.
Innovation under Constraint
Many of these projects are situated at medical tourism destinations that are forced to innovate under constraint. They must ensure that they are not wasting money, land, transportation access, or water supplies.
Many cities I’ve examined, including London and Singapore, for example now charge for “congestion pricing,” charging motorists for driving into the central business district during morning rush hour. Quota systems restrict the number of new registered vehicles and hired cars. Some destinations elect to require all vehicles (owned, leased and short hired cars) to have a satellite-linked device that can calculate exact driving distances and make it possible to adjust tolls depending on traffic and the time of day. In these developments, cars are parked in an (often underground) car park area and all business is conducted above surface and connected via trolley, pedestrian only areas, and above or subway light rail for journeys of longer distances and often directly connected to the airport arrivals and departure centers.
The growing need for clean water will be among the biggest challenges this century, and many cities must extract more use from limited supplies. Desalination plants can produce about 50 million gallons a day from seawater, but often that represents only 25% of the city’s needs. Cities can funnel rainwater to be treated for drinking, and high-rises can use it for flushing toilets. In areas with adequate rainfall, water runoff is collected to water the plants in the development and irrigate outdoor landscaping. Ambitious wastewater-reuse systems are installed that utilize advanced-membrane filters and ultraviolet light as a disinfectant produce water that is potable for drinking. The recycled water is mainly used for air-conditioning and for industry, including situations (such as healthcare) that require water even purer than drinking water.
Pro-growth policies and light regulation
Pro-growth policies and light regulation, especially the lack of traditional zoning. make these projects easier and faster to build—and help keep housing and commercial space more affordable for families, pensioners and investors than land parcels developed in many coastal cities.
Middle East destinations that once banked on their oil and gas supplies are now going through a painful phase and must be more aware of affordability while not crossing the line into cheap products that attract a consumer that is not ideal for the project. Tourism attractiveness (gastronomy, natural and man-made attractions, historic centers, art and cultural activities, and hospitality outlets) must also be interesting to this particular consumer persona. Clinical settings must be of a healthcare Center of Excellencecaliber targeted to the upmarket self-pay and insured consumer with the preference and ability to afford premium services and amenities. These standards, criteria, and benchmarks are embedded into the growth policies, regulations, and design standards so that the built environment for health facilities and clinics are not a hodge-podge of mixed quality and service levels that fail to align with community design and operating standards. That’s a political tightrope in some settings that can add lawsuits, injunctions and delays to launch and add significant startup costs to a project. Non-traditional zoning regulations must be addressed at the master planning level to provide for the right mixed use combination prior to contracting for a space within the development, so that Covenants, Conditions & Restrictions (CC&Rs) are set forth in advance as to who can purchase or lease space and set up a healthcare business there.
Streets must be designed so that parking does not interfere with Emergency Vehicle access (ambulances, medical evacuation helicopters, fire apparatus, and other first responder equipment). I had to withhold approval one beautiful medical tourism clinic situated on the first floor of a bank building in the Central Business District of Seoul for this reason because it had an operating theater in the clinic and intended to use general anesthesia for surgeries. Why? Because if the patient suffers an unexpected episode of malignant hyperthermia (an allergic reaction to the general anesthetic) and requires transportation to a full service hospital, there was no way to fit an ambulance on the little side street where the entrance was in addition to bilateral parallel parked cars, and no way to land a copter on the roof for medical evacuation. The patient would surely die. Not all medical tourism patients are veterans when it comes to surgery. Often, malignant hyperthermia arises as a surprise to all concerned. My question was quite basic: Why was the zoning approved such that a clinic with surgical operating theater was permitted to be commissioned there in the first place? That’s easy! Often zoning authorities and builders don’t know what they don’t know about the healthcare operations that are intended for the site.
That’s where my assessment and recommendations at the early stages of these projects raises my value to the developers and investors and zoning authorities significantly. There are few (if any) other medical tourism business development consultants in the world with my unique mix of expertise in clinical, health administration, health law, marketing, tourism, and medical tourism destination development. That comes from more than 35 years in the business.
Many medical tourism consultants who compete with me simply want to aggregate local, regional or national clusters of hospitals, clinics and hotels so that they can convince larger groups and their combined mega budgets to buy huge medical tourism conference exhibitor stands and large exhibitor pavillions and sponsorships. Some have an agenda to sell the client dubious proprietary certifications and accreditations. I don’t have horses in those races. My focus is product and brand differentiation strategies to grow revenues and return profits to investors or margins to charitable NGOs. It is up to the client to decide what guidance they want to hire and which strategy to pursue.
Blighted areas and land bargains into community redevelopment
Many blighted land parcels in former high crime and poor neighborhoods are situated in “food deserts” and “healthcare deserts”. Cities like Medellin Colombia are examples of what is possible when these new urbanism projects open. They revitalize the community, provide skilled jobs at every level from service workers and skilled maintenance positions to healthcare and other professionals, and lower crime rates associated with high poverty levels. Medellin has fantastic, accredited, world-class healthcare facilities, spas and hotels, art installations, botanic gardens and is situated in an interesting topography and biospehere. What makes this Andean city different, however, is that it has placed some of its highest-profile projects in some of its poorest and previously crime-ridden neighborhoods.
Perhaps the most ambitious project has been a system of outdoor escalators built in one of the city’s poorest districts. The escalators, which extend about a quarter-mile up steep hills and feature several small plazas, have won international innovation prizes. Tourism has grown, and the projects bring visitors to neighborhoods they might otherwise avoid.
It is still too early to know whether such expensive investments—the escalators cost about $6.7 million to build—will do much to improve the economic lives of those in poor neighborhoods. But they have done much to reconnect severely disadvantaged areas, which helps the whole city, to thrive and connect services and access that was not possible in the past. These innovations connect not only locals, but also medical tourism visitors.
Examples in the USA or in Tunisia come to mind when a medical tourism destination being developed tells me about its financial limitations. Projects must be able to attract and incentive developers. Take for example, Detroit, which emerged from bankruptcy in 2014, and hasn’t got a huge budget for revitalizing all of its neglected areas. So it is trying something more radical: setting aside areas where normal development rules don’t apply. The city hopes to encourage startup businesses and small-scale redevelopment projects by creating ‘pink zones’ with a simpler approval process.
Developers and designers complain that, like many cities, Detroit’s onerous and outdated rules make it too difficult to rebuild or repurpose long-neglected retail areas. The projects I am hired to assist are not business as usual projects by any means. To try to reduce those obstacles without a time-consuming and expensive rezoning process, the city can designate select pink zones, where red tape will be cut to help small developers and entrepreneurs open new businesses and revive aging commercial strips. In the UK this is called “pink planning”. The goal is not to eliminate zoning but to ease some of the constraints faced by new projects, like minimum-parking requirements or environmental-impact reports. I bring the healthcare nuances to light about integrating medical, dental and wellness tourism requirements to their zoning regulations so that health and wellness tourism is a planned possibility. Depending on creditworthiness and backing, money can come from development banks, investors, and clinic and hospital owners, charitable foundations who want to invest to grow money, tax-increment financing, or a combination of other sources. It all depends heavily on the product and marketing strategy, the land available, the project overall theme, and other elements. None of the projects I have been hired to consult are ever the same, nor are my recommendations. All of them have elements of “lean urbanism” to reduce the regulatory quagmire that can hinder new business development for health facilities, tourism and hospitality, and health-related retail outlets.
Lean urbanism is a term used to describe projects where young entrepreneurs and artisans gravitate to spaces where work and residential mixed use is possible. Lean urbanism and pink zoning go hand in hand for financially challenged redevelopment and revitalization projects are planned. These are also places where urban planners visualize placemaking that aims to make the city or the development project easier, safer and more enjoyable to get around by foot. This approach combines aspects of public health and “green city” goals. Roadways are built and redesigned to favor pedestrians, for example, by installing pedestrian-controlled traffic signals on busy streets or eliminate the usual vehicular traffic (cars, buses) altogether and replace them with other means of transportation (bicycle sharing, pedicabs, tramways, and trolleys, for example).
Zoning rules encourage density which places more destinations including health facilities and health-oriented retail outlets within walking distance. Many of these new urbanism projects feature storefronts or clinics and restaurants on the street level, with residences up above on higher floors.
If your planned or existing medical tourism destination is interested in exploring the feasibility for a new urbanism or smart city integration with medical tourism destination development, schedule a brief call with me. I am interested in new projects like these because they have so much potential. I can guide you and provide practical recommendations and innovative strategies for your planning and zoning, tourism, economic development, and financing and investment authorities, developers, investors, and stakeholders.
Usually what is involved is for me to chat with you briefly, and fix a date to come to assess the project, meet with interested parties, and orally debrief your team on my findings over a period of a few days. I follow with a written report which concludes the initial assignment. It is simple and straightforward and not expensive.
From there, you have the option to call on me for future guidance as needed to set standards, CC&R criteria, plan to pass accreditation inspections, etc. and develop brand messaging and refine ideal buyer personas and market penetration strategies to prepare for marketing, advertising, launch and start generating revenues. I hope to hear from you soon!
About the Author
Maria Todd has been a strategic adviser to healthcare businesses, physicians, health systems, investors, and government leaders.
She leads a team of consultants and contractors on six continents who are knowledgeable about health policy, healthcare delivery reforms, health tourism, pharma, biotech, medical device, m-health, global health and insurance industry issues. She has mastered strategic and problem-solving consultation and performed short-term contract work and professional skills training in a variety of healthcare settings in the USA and abroad.
Her firm focuses on health policy and finance, benefits design, business startup and operations strategy, reimbursement, and healthcare organizational development. Maria helps clients solve complex problems and leverage new business opportunities in Concierge Medicine, Physician Integration, Health Tourism, Third-party Payer Negotiations, and Contracting with Hospitals for Government-paid Treatment Abroad and Healthcare Reforms.
Her background includes a combination of clinical, administrative, insurance, marketing, and health law and expert witness project experience. She has led more than 2800 workshops, seminars, master classes, and short courses in the past 35 years, and trained more than 65,000 healthcare professionals, executives, and investors on a variety of the topics listed above. She is the author of 19 professional and technical books on healthcare business and health tourism. She has been selected for medical tourism destination development and situation assessment assignments in over 35 countries.
Contact her at +1.303.823.4662 (office) or via email, to inquire about her availability to help make make your next event a success.