Urban Planning and Medical Tourism Destination Development



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Urban planning and health tourism As Health Tourism intersect at several points: well-being, walkability, cpted principles,  needs assessment & service delivery, managing complex social systems, population health, and reliance on community-based stakeholders.

About the Author

About the Author

Maria Todd is frequently hired as a consulting expert and trusted authority on health tourism destination development. She helps medical groups, individual physicians, hospitals and ambulatory surgery facilities and health tourism management services organizations (clusters) and government authorities develop their destination to thrive with health and wellness tourism destination development.

Maria believes that working closely with urban and regional planners enhances the infrastructure of a health and wellness tourism delivery initiative. By examining the destination assets and gaps from the perspective of the basic tenets of urban planning, stakeholders reach beyond basic hotel bookings and appointment setting to kickstart their medical tourism development initiatives. Learn why she argues that zoning, greenbelt, housing and accommodation, public safety and crime prevention, recreation centers, road systems, water use, energy efficiency and transport facilities. all play critical roles in the success or failure of a coordinated and well-planned health or wellness tourism program.

For this reason, she routinely consults with and engages urban and regional planners in the early stages of health tourism destination development consulting assignments.

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Talk is… expensive

There are many medical tourism “consultants” who advertise that they offer guidance on destination development for health and wellness tourism. That talk is something they fling out from the dais as they delivery their 20-minute shallow infomercials from the podium at various medical tourism congresses, showcases, and conferences around the world. But where is their portfolio of completed projects?

If you’ve attended one of these events by paying little or nothing to attend, YOU were the product. When you pay nothing or very little, the event organizer has no budget to pay working professionals who would have to take time off from remunerative client work to fly, research and prepare a presentation, deliver the presentation, attend the event and fly home. So instead, the organizer finds these freebie, “fake it till you make it” presenters hoping to pitch from the podium for the exposure.

That sort of talk is expensive. It is fraught with bad advice, lack of tested theories, devoid of operations management theory and best practices, and puts the client in the position of being their lab rat.  If the project fails, the “consultant” is long gone and their deliverable is satisfied.

Destination development planning for health and wellness tourism is no exception.  Ask yourself this question: Are you ready to risk the waste of resources of time, budget, opportunity, and stakeholder buy-in to become a belt notch for a fledgling consultant you listened to for 20 minutes on the dais?

In this brief article, I’d like to offer you another perspective on health and wellness tourism business development: that of a practitioner with nearly four decades (1983) of practical experience in health and wellness tourism destination development, business development, and with a proven portfolio of completed, successful client assignments.

This perspective is one you will rarely hear at those panelist-centric events because I will not agree to take time away from client deliverable deadlines to prepare shallow infomercials disguised as educational presentations, fly across the world and attend multi-day events month after month for selfie and “networking” opportunities. As a “working” consultant I cannot afford to do so.  But I do want to share insight and expertise. I owe this to those from whom I have benefitted in the spirit of our industry shibboleth, “See one. Do one. Teach one.” This differs from many of the panelist presenters whose alternative shibboleth is, “ABC: Always Be Closing.”

So, here, with the power of the keyboard, I generously share with you a different more in-depth perspective on the topic of destination development. All it costs you is time to read it if you are so inclined.

How Urban Planning Theory and Practice Intersect with Medical, Dental and Wellness Tourism Development

Destination planning includes a body of scientific concepts, definitions, behavioral relationships, and assumptions that are included in the body of knowledge of urban planning. There are eight procedural theories of planning that remain the principal theories of planning procedure today: the rational-comprehensive approach, the incremental approach, the transactive approach, the communicative approach, the advocacy approach, the equity approach, the radical approach, and the humanist or phenomenological approach.1   

I’ve been incorporating urban and regional planners on my team of experts since the early 1980s because of the value they bring to perspectives in destination development for health and wellness tourism. I also love including student interns whenever possible into this fascinating opportunity to learn hands on about the charetting process that occurs in these assignments.

Making tough choices

With health and wellness tourism destination development, each destination must choose from various forms and address numerous issues that contribute to the destination brand’s unique selling proposition. This is the part that I focus on with the pro tem leadership at the earliest stages of planning a medical or dental or wellness tourism destination “strategy”. 

Hungary (2010) 

In Hungary, for example, I was asked to develop a strategy for a rural provider far away from Budapest, that was in the middle of farmlands, and proximate to a UNESCO cultural heritage site. By adapting an urban renewal pathway to a small town near the hospital, and overcoming transit and other infrastructure hurdles. 

In my study and preparation for destination development, I read Etzioni (1968) who cleverly suggested that organizations plan on two different levels: the tactical and the strategic. He posited that organizations could accomplish this by essentially scanning the environment on multiple levels and then choose different strategies and tactics to address what they found there.  This was exactly the course I followed in that project faced with a productive thermal spring, a castle that had been gutted and remodeled to an almost museum-quality, state of the art cardiac weight loss and rehabilitation treatment center in the middle of nowhere, and a well-connected owner who owned a medical transportation company in addition to the cardiac center. 

Maria Todd facilitates medical tourism destination development charetting session and with medical, quality, and tourism officials and other stakeholders in rural Hungary. (2010)
Lessons learned from Etzioni taught me that a mixed scanning approach allows medical tourism destination planners to work on both the functional and more big-picture oriented levels not just for the hospital as a private sector stakeholder, but also to benefit the town’s economic development and add the health resource to raise the level of clinical delivery for residents as well.

Clusters and Public, Private Partnerships for Health and Wellness Tourism

There are a handful of consultants in the USA who would have you believe that a medical tourism cluster is the answer to everything, as long as the cluster pools money for group marketing and paying congress organizers to bring MICE events to their fair city. They wouldn’t know a properly developed destination if it had a placard on it that said “We’re ready!”  A cluster is not, by any stretch of the imagination, a handful of hospitals, clinics and hotels for premature medical tourism advertising. That blows opportunities for appropriate and valuable first impressions and tends to empty coffers of startup capital.

 For government authorities to agree to participate, fund, and co-manage a public-private partnership (PPP) cluster management services organization, the economic benefit to the community at large must be quantifiable. The benefit must be embedded into the planning, strategy, tactics, branding, product development and marketing of the destination as a health or wellness tourism center of commerce and excellence.  Without that involvement and quantification from the start, the public sector would be castigated – and rightfully so, for using public resources for private commercial benefit of one single supplier. That’s not sustainable over the long term and is generally a non-starter.  Those who have recklessly done so in health tourism destination development have failed and regretted it. 

Their first regret? Paying the inexperienced and unprepared (or nefarious) consultants who led them down that path.  What’s that old Santayana saying? “Those who cannot remember the past are condemned to repeat it.” Some are simply too green. Others have nefarious and self-serving intentions and view government coffers as their target, not results to drive medical tourism business to a destination. Prudence is required to see the difference. 

It helps to have been in health tourism business development for nearly four decades. I can point to many of the failures and explain why  they failed. Those who have yet to grow project portfolio experience and lessons learned that you are listening to in their infomercials are probably not even aware of the trial and error strategies and kickstarts in medical tourism that have failed horribly and still have no real consistent and sustainable traction. This is also what contributes to the ousting of publicly appointed authorities working in tourism, economic development, and the other “pillars” of medical tourism destination development and elected officials, as seen below in my diagram from a client report in 2005:

Questions for discovery and analysis prior to setting strategy

In my consultations with destination stakeholders from the public and private sector, some of the questions I ask and seek inputs into instead of projecting what “I think” they should “do” are as follows:

  1. How will anticipated health tourism visitor growth impact planning for land use, urban design, natural resources, transportation, and infrastructure?
  2. What have you done already to: predict local and regional population growth that will have to co-exist with the tourists?
  3. How do zoning and geographic mapping and analysis of green spaces, water supply, identified transportation patterns for the mobility challenged visitor, CPTED crime prevention, walkability, food supply and commercial catering demands, allocation of existing public and private healthcare and social services, and the impact of land use figure in?
  4. Who will balance and advocate for local public interest as it relates to private sector (or public sector or both) health access, health delivery, pricing, and affording technologies, international accreditations and the incremental direct costs of marketing, branding, and advertising as a medical or wellness tourism destination?
  5. How and when and by what documented means will urban planning and the other eight pillars timely communicate concerns, observations and guidance to developers and stakeholders?

Why I respect urban and regional planners when it comes to destination development

In my professional opinion, these learned professionals save me time and effort and allow for precision and consistency in the strategic planning and tactical campaigns that deal with a wide array of issues such as  sustainability, existing and potential pollution, transport including potential congestion, crime, land values, economic development, social equity, zoning codes, and other legislation. The city or region has already paid them. Why should they pay me an additional fee to reinvent these wheels or study these things independently to develop strategies and tactics. Put me in the room with them and let me get the research and answers I need from these respected professionals. If I need to do it myself, it means I either don’t respect them as professionals or I am trolling for more hours to bill for. Neither is the mark of an experienced consultant with an existing client roster and work on the bench.

Consulting style: Transactive planning

Instead of considering public participation as a method that would be used in addition to the normal training planning process, participation is the central goal. I use this method because it gains buy in from all stakeholders from the beginning.
I have had other “consultants” in Europe, those who don’t know the difference between “consulting” and “freelance contracting” tell me “just tell them to do such and thus.” No thanks. That’s not “consulting”. That’s projecting. In developing the health or wellness tourism destination, their approach risks large inequalities in the political system and in the bargaining process between groups that result in large numbers of people unorganized and unrepresented in the process. The public sector is charged with the responsibility to represent all people and businesses in the area, not just those who will benefit financially from the project and resources available to complete it.
To my way of thinking, prescription without diagnosis is malpractice. With transactive planning, a thing for which I didn’t know had a term to describe it, the public and stakeholders are encouraged to take on an active role in the policy-setting process, while the consultant assumes the role of coordinator and distributor of information and a feedback source.  Transactive planning focuses on interpersonal dialogue that develops ideas, which will be turned into action.  One of the central goals is mutual learning where the consultant gets more information on the community and citizens and the health tourism building block assets to become more educated about destination development issues.
When I use transactive planning, I incorporate the bargaining model, which,  as the result of give and take on the part of a number of interests who are all involved in the health and wellness tourism destination development process. The bargaining model is the best way to conduct planning within the bounds of legal and political institutions.

Davidoff, in his influential 1965 paper, “Advocacy and Pluralism in Planning” acknowledged the political nature of planning and argued that actions to develop public projects such as a medical tourism destination are not value-neutral and encouraged minority and underrepresented voices to be part of planning decisions.2  

This political obstacle has killed more medical tourism destination development projects for me than any other reason in Thailand, Greece, Nigeria, Colombia, Spain, Puerto Rico, Mexico, and other projects. Understanding how to work with vertical developers is another lesson that comes from experience. It is interesting to study the variety of health and wellness tourism development projects that have been the results of large and small-scale developers who purchased land, designed the health services district and constructed the development from scratch all in the time of one political administration. Crossing over an election is actually one of my red flags when conducting due diligence on a project I might accept. 

I hope that this article provokes you to learn more, ask more, and study more before simply contracting with a panelist you met at a medical tourism event who has mentioned destination development and clustering as a strategy and tactic. If you’ve seen one cluster, you’ve seen one cluster. Study the strengths and weaknesses and ask yourself first if it sounds feasible versus is the cluster itself and the destination ready for development as a health and wellness tourism cluster. And if you can’t determine this on your own, hire the consultant with expertise and a busy client load for a very small, preliminary assessment project to give you an unbiased opinion and read on your situation. Promise NOTHING in the form of future continued engagement. This will protect you and your stakeholders from plunking down hard to rebuild startup capital in too large a commitment up front. Small incremental steps allow you to conclude with the deliverable and pivot to a better suited expert when necessary as a natural evolutionary process of your project. 




1. Whittmore, Andrew (2 February 2015). “How Planners Use Planning Theory”. Planetizen. Retrieved 06 January 2020. citing Whittemore, Andrew H. (2014). “Practitioners Theorize, Too Reaffirming Planning Theory in a Survey of Practitioners’ Theories”. Journal of Planning Education and Research. 35 (1): 76–85. doi:10.1177/0739456X14563144.

2.  “Advocacy and Community Planning: Past, Present, and Future”. Planners Network. Retrieved 12 May, 2014.


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