„RECESSION HAS AFFECTED TOURISM INDUSTRY GLOBALLY. WHAT MEASURES CAN BE TAKEN BY UK HOTELS?‟

“CASE STUDY: MARRIOTT GROUP OF HOTEL‟S EFFORT TO
ATTRACT MEDICAL TOURISTS”

RAMAMOORTHY PANDIAN STUDENT ID: 09004669 DISSERTATION SUPERVISOR THOMAS REEVES

SUBMITTED IN PART FULFILLMENT OF THE REQUIREMENT FOR THE DEGREE OF MASTER OF BUSINESS ADMINISTRATION

UNIVERSITY OF WALES INSTITUTE, CARDIFF
FEB 2010 1

ACKNOWLEDGEMENT

First and foremost, I would like to thank my supervisor Thomas Reeves for his valuable professional advice and guidance as well as for rendering his kindness, endless patience and continuous encouragement towards my dissertation.

I would like to thank interviewees in the Marriott Group of hotels and its branches, without which this study could not have been reached its conclusion.

A handful of thanks to all the lecturers of my concern for their teaching, without them, I can‟t learn so much knowledge.

This dissertation could not have been completed without continuous support, encouragement, and caring of all my friends and my family members. I would wish them many a thanks too.

Finally, I would like to express my sincere appreciation to those who provided me with great support and encouragement during my studies in UK.

Thanks again to all of them.

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ABSTRACT

The aim is to find out the most possible means that recession would affect the tourism industry globally and also to pay attention towards the various measures taken over by the UK hotels to overcome those tough times and to analyze the same through the case study involving the Marriott group of hotels in entertaining medical tourists.

The constructive, qualitative case study research to conduct in-depth interviews is carried out in order to meet the aim and objectives of this research. Planned interviews are conducted with the managers of the Marriott Group of Hotels across the various branches of the management in UK like Marriott London Country Hall., London Marriott Park Lane., and Marriott Residence Hotel. The objective of this dissertation is short listed as to conclude the findings of the research based upon the interviews conducted and its results.

The dissertation uses a case study approach and data is collected from a handful number of Marriott hotel‟s branches. Further research should extend this work by collecting data from a large number of organizations in the hotel industry. This could result in the generalization of this study‟s findings.

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TABLE OF CONTENTS
CHAPTER 1. Introduction 1.1 The Tourism Industry 1.2 Medical Tourism at UK 1.3 Research proposal 1.4 Aim and Objectives 1.5 Structure of the Dissertation 7 8 10 11 12 PAGE

2. Literature Review 2.1 Introduction 2.2 Recession and its effects 2.2.1 Introduction 2.2.2 Tourism in developed and underdeveloped countries 2.2.3 Categories of tourism 2.2.3.1Domestic tourism 2.2.3.2 Inbound and outbound tourism 2.2.3.3 Range of reasons for travel and tour 2.3 Tourism industry and recession 2.3.1 Global crisis on tourism 2.3.2 GDP growth rate as a factor influencing Tourism 2.3.3 Medical health care growth rate (UK) 2.4 Medical tourism and hospitality 2.4.1 Role of managers in hospitality 2.5 UK hotels against recession 2.6 UK hotels attracting medical tourists 2.6.1 Introduction 4 26 23 24 20 21 22 15 16 16 13 14 13

2.6.2 RevPAR – status measure 2.6.3 Hotel management – Behind the scenes 2.6.4 Significance of Marriott 2.7 Conclusion

27 29 31 31

3. Research Methodology 3.1 Introduction 3.1.1 Tourism industry affected by recession 3.2 Research design 3.2.1 Revealing Marriott strategies and outcomes 3.2.2 Frame work of the case study 3.2.2.1 Interview guide – Managers 3.2.2.2 Interview guide – Medical tourists 3.3 Conclusion 37 39 41 35 32

4. Data analysis 4.1 Data analysis and design 4.1.1 Introduction 4.1.2 Analysis from the response of interviews 4.1.2.1 Impact of recession on tourism 4.1.2.2 UK hotels measures to bring up tourism 4.2 Date analysis – case study (Marriott hotels) 4.2.1 Remedial measures to attract medical tourists 4.2.2 Strategies of Marriott 4.2.3 Evaluation of strategies 49 54 58 43 44 42

5. Conclusions 5.1 Conclusion 5 62

5.2 Goals revisited 5.3 Limitations of the reported research

62 65

6. Recommendations 6.1 Proposed recommendations 6.1.1 Directions for the future work 6.1.2 General recommendations to attract medical tourists 68 69

Appendices List of figures and list of Tables References Bibliography

73 77 78 80

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CHAPTER 1 INTRODUCTION
The motive of this session is to render the observers and readers of this dissertation with knowledge and a clear route map of this dissertation. Mainly, this chapter gives a brief introduction to the tourism industry and provides readers with the proposal of the research topic and its ultimate goals and objectives and also the entire structure of the dissertation work is discussed in the format of chapter schedules.

1.1 THE TOURISM INDUSTRY

Tourism is opted as one of the best social and interesting sector, when considering the pleasure of human. People travel across various countries in the globe for plenty of reasons. Their travel may be considered as a vacation trip comprising of site seeing packages and some desire to choose their work places over abroad and fix carriers. There are also category of people availing business tours involving conferences and help up meetings. Some select peculiar destinations for their medical treatment abroad. Like this the reason behind people traveling and taking a tour across the globe varies depending upon their needs. However all of us would expect a complete, satisfied and a happy tour. Thomas Jefferson (1795), comments on tourism as „Traveling makes a man wiser, but less happy‟. He justifies his comments through the sense of some problems that are faced while visiting other countries. But even then the travel and tourism sector seems to be flourishing and we go along its way to satisfy our needs rather. Obviously the joint venture of tourism and hospitality contributes a greater part to the economy of a nation and uplifts the financial status of a country. Thus it is proved to be an important criteria that is directly associated with the welfare of the country.

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The common expectation which flashes over the mind of the tourists was that the ease of comforts and pleasure. Every soul flying abroad would develop this basic thought to survive better over there, failing in which would make their tour unhappy. Irrespective of their motive of tour, the hospitality means would only make them at the most happy and satisfied. Bill Bryson (2004) says that “What odd thing tourism

is. You fly off to a strange land, eagerly abandoning all the comforts of home, and then expend vast quantities of time and money in a largely futile attempt to recapture the comforts that you wouldn't have lost if you hadn't left home in the first place.” Thus hospitality and tourism put hands together and make the economic lifeline of a country.

1.2 MEDICAL TOURISM AT UK
The medical tourists go abroad for their treatments, taking all issues in to considerations. Medical tourism starts to gain reputation and fame in almost all the developing countries including UK. Medical Tourism provides an affordable and quality healthcare solution to patients around the globe. According to Groucho Marx (1975), Medical Tourism is a realistic solution to the huge expense of high quality 21st Century Medical Care. To achieve competitive advantage, the individual countries should be capable of identifying the competences and should satisfy the customer expectations and thereby balancing the supply and demand needs. Every country has its unique and familiar medical treatments. UK tries to make difference with the other countries by providing proper medical advice and the rate of fall in pounds would relatively help them to entertain the medical tourists. The medical tourists keeps the following five important factors while purchasing health care abroad and this includes Availability of treatment, Quality of treatment or providers, Price or cost of treatment, Aftercare and Privacy. The first major factor is the availability of treatment for which the medical patients need a thorough knowledge of treatments across various countries in the world. Next they 8

need assurance for the quality of treatment provided and then the cost of treatment that would compensate them always. Later the post-treatment follow up care and finally the attitude of privacy provided. With reference to the UK medical tourism report released in June 2009, the ambition of the tourism sector was to represent the current medical tourism reports. It clearly points the impact of global financial crisis on medical tourism and discusses the issues that holds important for health care providers. The results of the report are analyzed and summarized as follows. The recent medical surgeries that happened abroad were very few in percentage regarding cosmetics and plastic surgery. It is a fact that the health care abroad constitutes cosmetic surgery as a major concern. Usually women were the frequent users of medical tourism but on a contradictory aspect, the report result reveals that males have been reported to undertake frequent medical travel when compared to females. Patients going for treatment abroad give importance to be treated with less waiting time rather than saving money. In some cases the patients develop the attitude of fear that the medical standards abroad may not meet up with the international health care standards. On a whole medical tourism is watched to be flourishing in this financial crisis, irrespective of expensive medical treatments.

From the previous study, it is easy to refer the impact of recession on cosmetic surgery. Fancy A makeover, a website for searching information regarding the current cosmetic trends, justifies the aspects that make recession affecting medical tourists. In spite of the fall in financial status of an economy and though the markets started to fall and peoples are quite struggling for existence, they would be giving much importance to fashion and beauty. The real fact is that nowadays, people remain to struggle for survival and hence they are no more beauty conscious and this makes the need of cosmetic surgery fall down deeper to some extent. This was betrayed by James Brown (2009) of Fancy A makeover. However it is statistically proved that the cosmetic surgery for women is still on rise. Men cosmetic surgery seems to have a 9

dull market and it seems to be more concerned about the recession. Thus the demand for men cosmetic surgery is very less and they are provided at dead cheap prices at good standards too. Thus the study report depicts that this will be the right time for men cosmetic surgery and it is easier and obvious to get effective medical treatment without huge waiting time and money expenditure. Brown believes that the economic condition will be in boom very soon and cosmetic surgery will be back to form very soon again.

The emerald group publishing journal (2009) focuses on the tourism industry and provides solutions to meet the challenges observed. The major aspect considered is the effect of climate change for the travel of medical tourists. Richard Teare (1998) commented on the development of worldwide tourism industry. To accomplish this particular task, a team of academics is formed who are integrated with the medical practitioners to analyze the possible solutions to promote tourism. They view the recent trends and developments in medical field and offer the medical tourists to get proper and satisfied treatment to their level of confidence. The Worldwide Hospitability and Tourism Theme (WHATT) are launched to contribute the promotion of tourism industry.

1.3 RESEARCH PROPOSAL
The focus lies upon the general survey of UK hotels and their procedures to combat with the recession and thereby promoting tourism at a level of ease. This case study research deals with the Marriot group of hotels and their effort to attract medical tourism. The current issues and problems facing the medical tourism are analyzed and the measures to overcome those crises are made with specific reference to the Marriot group of hotels. This dissertation involves the collection of data from the Marriot hotels and a survey procedure to study the human behavior tending to tourism sector and medical tourism in specific. The possible means of improving the measures are 10

studied and successfully implemented. In the course of work made in the Marriott group of hotels, it is found that the tourism industry acts as a fluctuating industry in terms of recession. People who avail holiday tour abroad usually do not know anything about recession and its adverse effects and people who know about recession do not know the factors of medical tourism. Although a large numbers of research reports introduce and analyze the rising tourism industry, no research has investigated the measures motivating turn over of hotels at times of recession. However, managers of the hotels need to be enough motivated so that they can devote themselves to the job. This dissertation discusses and relies much with the interview procedures and its results that makes a hotel unique and distinguishes it from the rest of the other hotels at UK.

1.4 AIM AND OBJECTIVES

The ultimate goal of the dissertation research is to deliver the remedy measures to compensate the tourism industry, affected by economic recession. The aim of this dissertation is to do research on the measures carried out by the Marriott Group of Hotels to meet up with critical positions, which are done through procedural interviews. In meeting the aim of this research, the following objectives are set:



To review literature on the recession affecting tourism industry and considering medical tourism in particular for the case study.



To analyze the cause and effect of Recession on the tourism industry and to arrive at the conclusions that would clearly depict the possible measures that a hotel management could avail to attract and entertain tourists at times of recession



To conclude the marketing strategies of the hotel organization to maintain the 11

incoming rate of the tourists at times of recession. Planned interviews are conducted with the managers of the Marriott Group of Hotels: across the various branches of the management at UK like Marriott London Country Hall., London Marriott Park Lane., and Marriott Residence Hotel etc. The objective of this dissertation is short listed as to conclude the findings of our research based upon the interviews conducted and its results.

1.5 STRUCTURE OF THE DISSERTATION

Chapter 1: Provides the research knowledge, defined proposal of the research topic and its aim and objectives.

Chapter 2: Provides the literature review of this research.

Chapter 3: Discusses and justifies the research methodology used to attain the aims and objectives of this dissertation.

Chapter 4: Provides the analysis of the data obtained as the result of the research methodology and its concluding remarks, concerned with the Marriott group of hotels at UK.

Chapter 5: Presents and discusses the conclusions of the dissertation

Chapter 6: Provides a summary of proposed recommendations and directions for future research work.

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CHAPTER 2

THE LITERATURE REVIEW

2.1 INTRODUCTION

The purpose of this chapter is to review the literature available to achieve the objectives of this dissertation. The purpose is also to find out the most possible means that recession would affect the tourism industry globally and to pay attention towards the various measures taken over by the UK hotels to overcome those tough times and to analyze the same through the case study involving the Marriott group of hotels in entertaining medical tourists.

2.2 RECESSION AND ITS EFFECTS ON TOURISM

2.2.1 Introduction

In macroeconomics, recession can be defined as a fall of a country‟s Gross Domestic Product (GDP) or Gross National Product (GNP). The concept of recession can be combined with inflation to generate a phenomenon called as stagflation. The recession may be either long lasting one or a short - lived type which may be defined as economic depression and economic correction respectively. During the period of recession, the confidence in business tends to decrease and in due course this may create challenge to job availability in the economy. Thus recession is referred to as the crisis of trust. The reasons for recessions are mainly due to economic shocks. The 13

pricing decisions of products during the period of recession become tedious and the leadership qualities start to fall. The greatest worldwide recession ever experienced was the depression that occurred during 1920‟s and 1930‟s.

John Kenneth (1960) believes that there is no reasonable distinction between the above three varieties of recession. He referres the events raised due to the recession as „crisis‟ or „panics‟. He believes that suffering by others due to recession will surely have worst economic effects. Ronald Reagan (1970) portrays his comments on recession as “Recession is when a neighbor loses his job. Depression is when you lose yours”. This makes clear that recession is the starting stage for economic depression and thus creates the inflation. A nation becomes economically week due to the effect of recession. According to Wyndham levis (1962), recession is the path that leads to universal destruction. This path is a fatal competitive path. Ryszard Kapuscinicki (1982) speaks out that in case of underdeveloped economic society, poverty occurs which may create a situation of recession. Such a critical position push the people to survive not only by struggling against nature or increased production but also by expending little resources as possible more constantly to provoke an immobility state.

2.2.2 Tourism in developed and underdeveloped nations

The impact of recession varies between developed and underdeveloped countries. Tourism is observed as one of the major sector contributing the economical status of the nation. In case of underdeveloped nations, where the situation of depression sustains, there are fewer chances to afford its citizens to fly in air for an abroad tour. Irrespective of the purpose of the tour they rely much upon the cost as a major concern in spite of the motive. As a result of which the regular people outgoing from the under developed nations considerably decreases and this gradually affects the tourism industry of the other nation. This is observed to be a chain process and 14

mutually affects the tourism industry. This is the reason behind which the recession affects tourism industry globally. The developed countries take immediate actions and steps to overcome this crucial situation and attract the tourists and thereby increasing the regular income of the tourists periodically.

2.2.3 Categories of Tourism

Travel and tourism does not always make the sense of flying abroad for a tour. The purpose of the tour distinguishes them in to three main types. The reason behind the tour might be observed as to visit the attractions abroad, trips to business meetings, local tour within the nation, Visiting Friends and Relatives (VFR). Based upon the motive behind tourism falls in to the following categories say: Domestic, inbound or incoming and outbound or outgoing tourism.

2.2.3.1 Domestic tourism

This is the one in which the people avail short holiday trips within their nation. This might be short day trips and also long day trips. The reasons behind may be of numerous types. Couples may decide to take upon a week end break within their country, sports and game trips across various parts of the country and families visiting their relations in the same country. From the statistical survey it is observed that during the year 2000, British Tourists Authority (BTA) shows that people at UK made 174.5 million trips within in the country which was broken down in to the following spits. 106 million were on their holidays, 23.7 on their business trips, 40.6 for VFR trips and the rest for the other miscellaneous reasons.

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2.2.3.2 Inbound and Outbound tourism

Inbound tourism is the means of international tourism in which the other country people entering for specific purpose. Again the reasons may be depending upon the situation of the traveler such as sports meet, business meet, VFR‟s, medical trip abroad etc. BTA statistics (2000) shows that, over 25.2 overseas visitors spend their holidays at UK by affording about 12.6 billion pounds. The other category namely the outbound is the one in which the people migrate from their home town to other international countries for business or leisure or medical treatment. Under BTA figures for 2000 50.9 million people from London went abroad for their tour.

2.2.3.3 Range of reasons for travel and tour

The range of reasons for traveling abroad may be analyzed or categorized rather in to three major groups as discussed in the following figure. The ranges may be either leisure tour or VFR or business tour.

LEISURE TOURISM

VISITING FRIENDS AND RELATIVES (VFR) TOURISM

BUSINESS TOURISM

Holidays Health and fitness Sports and games Cultural and spiritual Education Social tour

Wedding celebrations Elderly persons visit Social visit with friends Social visit with relatives

Business meetings Conferences Exhibitions Trade fairs Incentive tour

Fig 2.2.3.3 Range of reasons for tour and travel 16

2.3 TOURISM INDUSTRY AND RECESSION

The tourism industry on a global point of view has been hit hard by recession. Various citations and stuffs prove that tourism sector also faces a hard and tough time at times of recession. Tourism industry contributes a major part to the international trade, scheduling about 40 percent of the global trade services and 6 percent of the total world trade. It is considered to be one of the chief sectors that offer a considerable percentile of employment and thus contributing the economy. Ronald Reagan (1970) portrays his comments on recession as “Recession is when a neighbor loses his job. Depression is when you lose yours”. This makes clear that recession is the starting stage for economic depression and thus creates the inflation. A nation becomes economically week due to the effect of recession. According to this aspect, the fall in growth of tourism industry certainly affects the economy of a nation on its worst side.

The number of international tourists could decrease if a nation falls in to a deep recession. In UK After 2007's record 898 million tourist trips, a 6.2% jump over 2006, the World Tourism Organization projects continued but slower growth in 2008. The region "continues to be one of the tourism success stories of the decade so far, despite ongoing tensions and threats," the WTO said. A study by professional services firm Deloitte, commissioned by Visit Britain, reveales that the tourism sector at UK is struggling to cope with the decline of the global economy and increased international competition for holiday-makers. The adverse effect was the rise in unemployment and other issues related to wages. Christopher Rodriguez (2009), chairman of Visit Britain, says that “With proper government attention and support, the visitor economy will

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grow strongly over the next few years. But if market failure is allowed to continue and policy barriers are not addressed, the economic impact could be considerable."

The fall of a country‟s Gross Domestic Product (GDP) or Gross National Product (GNP) has been the central focus for the tourism industry development. The recession may be either long lasting one or a short - lived type which may be defined as economic depression and economic correction respectively. The concept of 'recession' can be combined with 'inflation' to generate a phenomenon called as 'stagflation'. According to John Kenneth (1960), there is no reasonable distinction between the above three varieties of recession. He referred the events raised due to the recession as „crisis‟ or „panics‟, which may pull down the growth of an industry. The report published on 9th November, 2009 at the World Travel Market in London, UK, shows that the tourism industry has performed far worse during the past 12 months than initially expected. The annual Global Trends Report (GTR) for tourism shows that the international tourism industry has been hit hard by the recession.

The UK hotels started to suffer at a greater extent, mainly due to the deviations in employment caused due to recession. UK suffered two major economic recessions, one during 1980‟s and the second ten years later. The implications from various sides indicate that the clear understanding and management of employment change would affect the economy a lot. It was analyzed that recession affects the tourism industry to a greater extent, which in turn pours its effect upon the entire nation. Recent reports show clearly the global attack of Recession upon the tourism industry. Dow Jones (2005) justifies that „UK Recession Is Catalyst for Decade of Business Change‟. Hence it turned out to be a positive attitude. Recession, marked as a crucial state of trading creates a knock-on effect on the economy and puts the budget and competitions to fight with each other. As a result, the market starts to shrink and the 18

business parties would get aware of their investments and the side affects that would spoil their growth.

This stands true for all the business sectors of the economy. Such a situation urges the people to demand more for their money during the period of recession, rather than the expectations. The global economic downturn caused by recession naturally affects the tourism sector of the particular nation and such a downturn would bring down the sales and new jobs and pushes the price rate of products and services up to a greater extent. Hoteliers and restaurateurs are the most affected in such a case. The incoming tourists would slightly hesitate considering the above factors for their stay in case of specific purposes and the Gross Domestic Product (GDP) of a Nation begins to be wiped off slowly. From the fact above we can consider recession as a factor that affects tourism industry. The nations are pushed in to a position that, they have to establish measures to overcome the recession and thereby promoting tourism at a level of ease. Jorge Costa (2004) discusses the challenges faced by the Portuguese tourism sector and their effect on economy. According to him, the employment patterns provided in Portugal are closely related to tourism and the economic status. His portrayal depicts the role of ethics in operational issues like quality management, product differentiation, marketing and productivity. The key principle of achieving tourism by minimizing recession is done by the human resources training and development. This is practically possible through providing proper education and ethics management to develop the Portuguese tourism sector.

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2.3.1 Global crisis on tourism

Private sectors Vs household sectors
GDP rate % growth
15 10 5 0 1970 -5 1980 1990 2000 2010 2020

-10 Year
Series1 Series2

Series 1- Personal house hold sector

series 2- Private financial sectors

Figure 2.3.1 Growth of GDP rate at UK The graph showing the growth of GDP rate at UK for the past few years‟s spots that, the private financial balances was severely observed to be good when compared to that of hospitality and house hold sectors. As a result the tourism industry would get a great fall down. Some companies, manufacturing products continue to run with large surpluses, but industries under the hospitality category would suffer a lot and from the mid of 2008 till the first four months of 2009, UK had a very tough time in case of the tourism industry. The main reason that the private companies remains to be balanced is that the absence of price - wage dependency. As a result of inflation, the price rates go high and this would gradually insist the employees to stress more for higher wages. But the fact is that UK did not encourage this, even against the protest of public sector people. The threat of rising unemployment could not make people achieve in getting chances of raising the wages in case of private sectors. This made them likely to maintain their levels and standards and the GDP rates started to fly high to some extent. This would not suit the house hold sectors and in contrast to the private sectors, the house hold hospitality sectors experienced a great fall in terms of GDP growth rate and naturally the tourism sector becomes worst affected.

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2.3.2 GDP growth rate as a factor influencing tourism industry Citations from the Economic Review ( July 2009 ), shows the great fall of GDP growth started from 2008 and the economy began to shrunk for the four quarters of that year and started its negative growth from the third quarter and prolonged during 2009 too. The growth was very much negative during the first two quarters of 2009 and on a four-quarter basis, by comparing GDP (2009) in relative to the first quarter in 2008, the result was found to be fallen by 4.9 percent and observed to be the highest drop on record. This concludes that the drastic effects upon various sectors including tourism and patients hiring medical treatment abroad. A clear comparison of the other sectors with the hotel tourism sector itself shows the lack of tourism industry in the output and expenditure during 2009. As a whole adding upon all the services provided at UK, it pulls considerably the GDP ratio down. This gives a complete idea of the recent trends in UK economy and the status of GDP growth. public and private sectors

UK sectors contribution to economy 2009
7 5 3 1 -6 -4 -2 0 2 4 Series2 Series1

o u t c o me a n d e x p e n d i t u r e

Series 1- Quarterly accounts

Series 2 – Output and income

Figure 1 Contribution of UK sectors to economy- 2009.

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2.3.3. Medical Health Care Growth Rate (UK)

The growth rate of health care costs was analyzed and was found that UK proved to show an average percentage change in expenditure for health care. Comparing with the other countries UK has spent considerably an average amount for the health care sector among the other non European countries. The conclusions made from the international health policy survey made from 2002 till 2008, it‟s silently observed that London faced only a few problems in case of hotel and tourism industry during those times. It was found to be better when comparing with the other leading countries, where the rate of problems due to cost can be enumerated more and keeps on increasing. Thus the hotels at UK found an easy way to entertain tourists and avail greater profits and benefits. The medical care and follow up care provided at UK hospitals urges the tourists to visit there in spite of higher `costs too. Apart from the normal tourists, the medical tourists rely much upon the medical care structure and its effects. UK hotels stand worthy to compensate the issues and needs raised by the medical tourists

International Health Policy Survey

Failure category

Australia

Canada

New Zealand

London

America

Medical Care Follow-up care Privacy

16 16 44

9 10 35

26 15 47

4 5 21

28 26 40

Table 2.3.3

Rate of cost problems in health care sector 22

2.4 MEDICAL TOURISM AND HOSPITALITY
Tourism and hospitality is the economic lifeline for many parts of a country. The UK hotels started to take contemporary measures to get advantage of the tourists. Tourism at UK was observed to be low during the initial stages of 2009 and the hotels struggled a lot to attract the tourists from the terrorist‟s attack on the capital of London at July. The tourism industry became very sensitive to the world economic events. Marriott UK and Ireland vice-president Robert Gaymer-Jones (2009), said hotels need to start packaging other products with rooms to encourage business travelers to stay longer. He admitted that London has had "a terrible time" since the bombings, with leisure travelers staying away from the capital. Obviously many hotels started launching attractive tour packages with additional features that would please the tourists to make them have a pleasant and peaceful stay. He said business travelers stay an average of 1.9 nights, but could stay longer if hotels started packaging up their rooms with theatre tickets or restaurant reservations.” We must offer business travelers something special to make them stay longer," Gaymer-Jones said.

2.4.1 Role of managers in hospitality sector

When most of the hotels at UK are experiencing bare ends due to global economic recessions, they stand to survive no matter how bad the economy of nation is. According to the General Manager of Isla Verde Courtyard by Marriott, Luis Rivera

(2008), the result of a well-coordinated 325-employee team effort by the beach that not only relies on leisure and convention guests but also in areas of specialization , like medical tourism and destination facilities. UK hotels have been working for more number of years in areas like sports and medical tourism. Of course, they would have

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felt the bad times of the economy, but even then the managers approve that it is good for they could prepare themselves well in advance to face the critical situations. They don‟t sit patiently for the medical tourists or customers to arrive at the desk; rather they would be paying straight attention to the attractive medical tour packages with good hospitality and follow-up care, says Rivera. UK hotels are quite noted for its good quality services that would perfectly balance the supply and demand.

2.5 UK HOTELS AGAINST RECESSION

To withstand the dancing recession, UK hotels are being pushed to a position that they need to put forth thoughts and actions to maintain tourism at its level of ease. All sectors are particular in achieving sufficient outputs in their processes and obviously the tourism sector needs to concentrate more upon the possible measures to attract the tourists and maintain their income. Remedy measures are the most important solutions that are enhanced to bring up the tourism field. Naturally if a Nation's depression is reduced, it considerably pulls down the effect of recession on a particular field, say tourism in our case. John Maynard Keynes (1940), a British economist, is particularly remembered for advocating interventionist government policy, by which a government would use fiscal and monetary measures in attempts to mitigate the adverse effects of economic recessions, depressions, and booms. He stressed much upon the policies to reduce unemployment, which may be the best solution. The global financial crisis is taking its toll on the travel industry, UK - falling expenditure, lack of credit and rising unemployment caused a slump in confidence and demand. Hence it is suggested to control unemployment first and making out the industries to fly high with great output and income. Thus to overcome or fight with the recession the basic knowledge of recession and its adverse effects are much essential in our case.

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David Ducker (1995) describes the management of information sources across the tourism industries in UK. They mainly cover the international sources for domestic and outbound tourism. The various means of transport, purpose of travel and the pieces of accommodation during travel are considered and based upon which the strategies of tourism were developed. Richard Teare (1997) encompasses the top issues assigned by UK hotel managers to improve their tourism industrial growth. He insists more upon the issues regarding environmental scanning. This process becomes broad in scope and future oriented. The environmental scanning activity proposed by UK hotels tries to ignore recession as a chief factor affecting tourism industry. David Gilbert (1997) explains the role of UK hotel managers for the past number of years in finding changes in the hospitability methods of the hotels. They form as a delicate border between the various sectors of hospitability. Gilbert analyzes the scope of these changes and focuses the management behind the scenes. This gradually helps the managers to study the present position of UK hotels and the methods through which the tourism industry can be explored and the customers are satisfied at the best of their consciousness.

Keith Pollard (2002), managing director of institution communication ltd, a web publishing business in health care sector provides regular updates on medical tourism. He manages a UK based company which owns many websites for private healthcare and treatment abroad. It is true that he owns the rapidly growing medical tourism site. His comments on medical tourism stands worthy and put front the current issues and problems facing the medical tourism industry. As a fact if recession affects the tourism industry the hotels begin to suffer. Considering Budapest, a dental tourism hub for patients from UK, Ireland, Germany, Austria, Switzerland and Scandinavia, some bad trends were found. Some of them were the number of patients from abroad has decreased, the amount of spent by the medical tourist were considerably very less and the increase in age of patients. Due to these reasons, Budapest starts losing 25

patients and the tourism industry for medical patients were considerably decreasing in growth. The major reason found for this panic situation was the financial crisis occurred during that time.

Thus recession shows its adverse effect upon the tourism industry and its much harder to avoid recession situations. Possibility of occurrences of recession is more likely to happen. Tommy Shaw (2002) says that “as sure as the spring will follow the winter, prosperity and drastic economic growth will follow recession”. Jeffrey Sacks (2000) believes that during the immediate postwar years, the whole of Europe was in a recession. Hence it helped us step out of a recession. The quotes and the study made above in a literature survey betrays the various levels of risks faced by the tourism industry and their dimensions that rectify he possible problems and their measures to promote tourism industry to a peak.

2.6 UK HOTELS ATTRACTING MEDICAL TOURISTS

2.6.1 Introduction

To help the tourist for a healthy holiday, the UK hotels need to speak out health advice to its clients, by giving them detailed information about the various diseases overseas to make them come out of the troubles. This issue becomes greater because of the falling value of the UK pounds against the other currencies and the tourists decide to travel towards UK and here they wish more to combat foreign diseases and other health risks. The hotels at UK started to implement the techniques therewith to flourish the tourism industry. Bill Maloney (2008)from Association of British Travel Agents (ABTA) reveals the fact that in spite of the economic recession happened, the rise in the number of UK travelers tend to have a 200% increase over the past ten 26

years even at risk situations. At the same time there was a slight drop in tourism at European countries. "The more advice you give, the more likely you are to be sued if that advice is incomplete or incorrect," said the ABTA spokeswoman. "As situations can change very quickly, it would be a bad idea for travel agents to give out specific advice unless they are getting regular updates from websites such as [that of] the Foreign Office." 2.6.2 RevPAR – Status measure As far as the measures taken by UK hotels to withstand with the recession, the most important thing was found to be Revenue per available room (RevPAR) which is regarded by hotel companies, the investment community and other commentators as the most effective yardstick of the balance between hotel room supply and demand. RevPAR is an optimistic method of recognizing the financial performance of the hotel industry, which is calculated by multiplying a hotel's average daily room rate (ADR) by its occupancy rate. The revenue managers of the hotels take main in-charges for this fact and the based upon the RevPAR value, the price fixation for the room rentals can be made out. The fall in RevPAR value clearly will indicate the revenue bench to be attentive and take appropriate measures to overcome the crisis. With reference to Slattery et al (1998), the method of calculating RevPAR suits well at practical situations of recession. Such a critical position pushes the people to survive against the task to provoke an immobility state.

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Figure 2.6.2 (a) UK hotel performances in terms of Rate of change in RevPAR up to june2009

Figure 2.6.2 (b) Rate of change in RevPAR up to june2009 28

2.6.3 Hotel management- Behind the scenes

David Gilbert (1997) explains the role of UK hotel managers for the past number of years in finding changes in the hospitability methods of the hotels. They form as a delicate border between the various sectors of hospitability in a management. Gilbert analyzes the scope of these changes and focuses the management behind the scenes. This gradually helps the managers to study the present position of UK hotels and the methods through which the tourism industry can be explored and the customers are satisfied at the best of their consciousness. The managers of the UK hotels are frequently conducting periodic meetings and discuss about the contrasting measures that would be implemented in action. UK hotels experience the positive shades of the result and the absolute share price performance of the hotels was found to be acceptable during November 2008, depicted in figure.7. Comparative study of the hotels concludes the group offering good share performance and least shares category

With reference to the economic cycle, London, during 2009, Recession has hit the tourism industry at its lowest point and the hotels found it quite more difficult to get through the crisis and panic situation. They have been influenced by factors like fall in rate of occupancy of the rooms and decrease in the percentage change of Revenue per Available Room to some extent. This urged the hotel desk to pull down the rental rate of rooms down to fifty percentages than actually fixed. How ever the hotel business trading was observed to perform well and that the budget sector of the economy would not get worst affected. The weakening pound rate at UK hotels brought the mind of the European and Asian peoples to choose London as their perfect holiday destination.

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The hospitality references from the hotels at UK show that they would satisfy their medical tourist customers. Tourism remains as a key to economic appraisal even at the times of recession. The hospitality operators started to provide more value for money than ever before. British Hospitality Association (BHA) chief executive Bob Cotton (2008) warned that the industry needs to do more to make politicians understand the value of tourism and the Government should recognize the importance of tourism as a leading factor which contributes to the economy and to encourage the growth of tourism sector through job fulfillment and modernization.

Figure 2.6.3 Absolute Share Price Performance of UK hotels during November 2008

%

change in Revpar

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2.6.4 Significance of Marriott Every big company at UK began as a small business, and in 1927, the Marriott hotel was a small company. The opportunities given to Marriott made them succeed at a high level and now it stands proudly to continue the tradition by reaching out to a new generation of entrepreneurs. The employees of Marriott hail from many nations and render their services across the various banners of the Marriott group in the world. Marriott is strongly committed to dedicated managers and it started its growth with about nearly 3000 managers who began their carriers. Thus Marriott aims at achieving global diversity across the globe by exploring corners of the world and develop their international operations pursuing varieties of cultural diversity. J.W. Marriott,

Chairman & CEO, Marriott group (2003) says that “We are broadening how we think about global diversity and inclusion, reaching across cultural borders to compete for customers and talent worldwide. In this competitive marketplace, we must continue to embrace the unique talents and experiences of our employees-who speak more than 50 languages in 66 countries and territories-to help us meet the changing needs of our customers.”

2.7 CONCLUSION
Tourism industry contributes a major part to the economic welfare and that‟s why the hotels need to understand the effect of recession over previous years and should take preventive measures to withstand with the recession and the possible ways to attract medical tourists. The contrasting measures taken by Marriott successfully suggest the concluding remark it‟s in the hand of the hotel management to take care of the medical tourists.

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CHAPTER 3 RESEARCH METHODOLOGY

3.1 INTRODUCTION

Research is an original contribution to the existing stock of knowledge making for its advancement. The research methodologies included the various methods of research and the design of the research process. It is an academic activity used in a technical sense. According to Clifford Woody (1959) research comprises defining and redefining problems, formulating hypothesis or suggested solutions; collecting and evaluating data; making deductions and reaching conclusions; and at last carefully testing the conclusions to determine whether they fit the formulated hypothesis.

The primary aim of this chapter is to provide research methodology to achieve objective of this dissertation. The research methodology can be achieved by reviewing relevant textbooks on the subject. The objective of this dissertation was to bring out the contrasting measures that are associated with medical tourism in the Marriott group of hotels. In the current chapter, different steps of research methodology are elaborated. The research philosophy selected for this dissertation is interpretivism; secondly, the constructive approach was employed to conduct research through descriptive case study that was conducted by interview method to collect data. Finally, the data was analyzed and the remarks are concluded.

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3.1.1 Tourism industry affected by recession

The growth of GDP rate at UK for the past few years spotted that, the private financial balances was severely observed to be good when compared to that of hospitality and house hold sectors. As a result the tourism industry experienced a great fall down. Some companies, manufacturing products continued to run with large surpluses, but industries under the hospitality category suffered a lot and from the mid of 2008 till the first four months of 2009, UK had a very tough time in case of the tourism industry. The main reason that the private companies remained to be balanced was that the absence of price - wage dependency. As a result of inflation, the price rates went high and this gradually insisted the employees to stress more for higher wages. But the fact is that UK did not encourage this, even against the protest of public sector people. The threat of rising unemployment made people to achieve in getting chances of raising the wages in case of private sectors. This made them likely to maintain their levels and standards and the GDP rates started to fly high to some extent. Thus it becomes evident that tourism industry stands affected due to

recession.

The impact of recession varies between developed and underdeveloped countries. Tourism is observed as one of the major sector contributing the economical status of the nation. In case of underdeveloped nations, where the situation of depression sustains, there are fewer chances to afford its citizens to fly in air for an abroad tour. Irrespective of the purpose of the tour they rely much upon the cost as a major concern in spite of the motive. As a result of which the regular people outgoing from the under developed nations considerably decreases and this gradually affects the tourism industry of the other nation. This is observed to be a chain process and mutually affects the tourism industry. This is the reason behind which the recession affects tourism industry globally. The developed countries take immediate actions and 33

steps to overcome this crucial situation and attract the tourists and thereby increasing the regular income of the tourists periodically.

3.2 RESEARCH DESIGN

The methodology literature suggests that there exist three research designs: exploratory, descriptive and explanatory. Each one has a individual purpose (Sanders, 2003). According to Sanders (2003), exploratory studies can be quite informal, those on secondary research such as reviewing available literature and/or data, or qualitative approaches such as informal discussions with consumers, and more formal approaches through in-depth interviews, focus groups, projective methods, case studies.

An examination of the research methodology literature suggests two major approaches to conducting research; deductive theory testing and inductive theory building. Deductive approach is to develop a theory and hypothesis (or hypotheses) and design a research strategy to test the hypothesis; Inductive approach is to collect data and develop theory as a result of data analysis. This Dissertation will focus upon the inductive approach, in which the data collection is done first and later analysis and theory formulation is done. Based upon the result formulations conclusions and remarks are made.

The main objective of the explanatory qualitative case study research, being used for this dissertation purpose is to discover ideas and outcomes that would be concluded at the end. It was the most flexible means of qualitative data collection, done through the secondary data collection and planned interviews with the managers of Marriott

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Hotels.

The case study in this dissertation was done with reference to the Marriott

Group of hotels at London.

3.2.1 Revealing Marriott strategies and outcomes

To achieve the main goal of the research, the case study involving Marriott group of hotels was successfully carried out by getting varieties of opinions from different level of managers at Marriott. Also the complete idea about the medical tourism was obtained only when consulting the medical tourists residing at Marriott. These two sources of data are of primary importance in this dissertation which would facilitate in making decisions and concluding remarks at the end of this dissertation. The strategy of In-Depth interviews was carried out to achieve the same above. There are two types of information available to a market researcher: primary data and secondary data. Primary data is original information gathered for a specific purpose. Secondary data refers to information that already exists somewhere and has been collected for some other purpose. Secondary research is usually faster and less expensive to obtain than primary research.

The case study research method tried to solve the task through scientific procedures. The collection of primary data for this research purpose was done through surveys and descriptive researches. The main approaches being used for primary source of data was done through observational methods and interview methods. The survey for the primary data was done through series of interviews to the hotel managers of the Marriott Group. In this dissertation, qualitative case study method is to be employed to conduct in-depth interviews. Interviews in five branches of Marriott group were designed and the opinions of managers are collected. Also the sample survey was planned to be conducted for the patients opting for medical treatment abroad. Their 35

opinions were accumulated in a procedural format, which forms the primary data. Interviews were conducted with managers of five hotels of Marriott group during December 2009.

A survey of Marriot hotels and their procedures adopted to satisfy general and medical tourists are made and thereby implementing measures to attract them almost. The secondary data for the research was collected form the company website, magazines and some journals. Both primary and secondary data were used for the findings of the research. Secondary research was mainly conducted to obtain information on the environmental context surrounding the case-firms. Plenty of sources are consulted from the company own website and relevant magazines and newspapers. Secondary sources are also used for obtaining information on firm specific issues, although their usefulness is rather limited.

3.2.2 Frame work of the Case study

In this dissertation, case study methodology will be employed. Yin (2003) described the case study is but one several ways of doing social science research. On the other hand, He suggests that case study should be defined as a research strategy, an empirical inquiry that investigates a phenomenon within its real-life context. Case study research means single and multiple case studies, can include quantitative evidence, relies on multiple sources of evidence and benefits from the prior development of theoretical propositions. Yin notes that case studies should not be confused with qualitative research and points out that they can be based on any mix of quantitative and qualitative evidence. In addition, Robson (2002) defines case study as a strategy for doing research which involves an empirical investigation of a 36

particular contemporary phenomenon within its real life context using multiple sources of evidence. This strategy will be of particular interest to you if you wish to gain a rich understanding of the context of the research and the processes being enacted.

Crimp (1990) suggested that “depth interview” and “group discussion” are the two most commonly used qualitative research methods. This dissertation will use in-depth interview method to collect data. Its goal is to elicit rich, detailed material that can be used in analysis. Such interviews are best conducted face to face, although in some situations telephone interviewing can be successful. There are so many benefits for using in-depth interview method. The interviewers seek to encourage free and open responses, and there may be a tradeoff between comprehensive coverage of topics and in-depth exploration of a more limited set of questions. In-depth interviews also encourage capturing of respondents‟ perceptions in their own words, a very desirable strategy in qualitative data collection. This allowed the evaluator to present the meaningfulness of the experience from the respondent‟s perspective.

3.2.2.1 Interview Guide – Managers

Interviews in five branches of Marriott group are designed and the opinions of managers were collected.The sample interviews conducted among the various levels of managers in Marriott group of hotels are clearly shown as follows. In this dissertation, all the responses from the interviews is collected and fully transcribed in to some meaningful conclusion. The following questions were used during interviews with managers. The in-depth analysis of every question is used at the time of interview which would help in understanding the core of the concept more clearly.

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Manager interview questions How far the economic recession has affected the tourism industry? What contrasting measures are done at your hotel to combat with the situation of recession? Under statistical survey the rate of occupancy at UK hotels was found to fall around 3.7 points for the first five months of this year. What are the possible means of a hotel to attract and entertain medical tourists? What are the medical tourist's criteria for selecting an hotel for their stay during treatments? Are the hospitals recommended by your group qualified to treat them? How many days will the medical tourists need to stay in the country for treatment? What are the costs for an initial assessment and diagnostics? Who is responsible for treatment going bad if the patient goes around touring after surgery? Are the procedures done at local hospitals good enough or do they 38

In-depth coverage Does it contribute to Economic depression? Did you experience any effect due to the measures?

Has this been your experience?

Do they place any constraint?

How does your hotel try to facilitate them?

Having an IHA rating is not really enough to say that are qualified? Can u site some samples?

Comment your answer please

Do you take immediate actions?

What procedures do you follow?

need to be repeated at the destination facility again? How important is a travel insurance required for medical tourists? What all complications do medical tourists have? Can a web transaction be performed for transfer of money? As heard Marriott hotel‟s follow up care is been excellent. What follow up care do you provide? Table 3.2.2.1: The Interview Questions Form ( Manager) Do you suggest any further How do you compensate those complications? How does it help the tourists? Comment your answer.

improvements?

3.2.2.2 Interview Guide – Medical Tourists

Interviews with the medical tourists at Marriott were also designed and their opinions were also collected. The interview samples conducted among the various medical tourists staying in Marriott group of hotels are clearly shown as follows. All the responses from the interviews will be analyzed and fully transcribed in to some meaningful information. The following questions will be used during interviews

with medical tourists. The in-depth coverage of the individual questions is posed upon the tourists and their valuable suggestions and ideas are taken in to consideration. This will also help in the later part of the research.

Tourists interview questions How do you feel comfortable to decide your stay at Marriott during medical 39

In depth coverage Did you feel any discomforts?

treatment? Are the operators of the hotel that you contact qualified to answer your queries? Are all treatments going to cost the same for young and old? What is the basis for a case being categorized „non complicated‟ or „severely complicated‟? Have any success rates and clinical outcomes of the hotel been discussed with you? What criteria do Marriott adopt for selecting a doctor for your treatments? Are you satisfied by the conversation with the doctor who treated you ? Do you suggest for an initial opinion In what ways the preliminary Comment your answer Can you elaborate your justification Do you think these are necessary? Comment your answer

by the doctors before undergoing documents assist for that? treatment? Are all hospitals suggested by the hotel well equipped to treat all diseases? Does Marriott offers medical packages for tourists having complicated cases? Did you interact with patients who have been successfully treated by the hospital? Does the hotel provide any security and insurance? Did your local insurances have any validity in the hospital in which you 40 In what ways does the insurance help you? Comment your answer If yes what was their feedback? Do you have any experience? Comment your answer.

got treated? Will the local doctors be kept in always to give proper follow - up care? By what means can you distinguish Marriott from the other hotels How about the result? Did you feel comfortable with?

regarding medical tourism? Table 3.2.2.2 The Interview Questions Form (Medical tourist)

3.3 CONCLUSION
Based upon the measurement of quality or kind of the personnel, the development of interest in investigating the reasons for human behavior to react for tourism at UK hotels was successfully studied. This helped for a procedural study of mentality of the peoples by using in depth interviews for the purpose. Many opinion research techniques and other projective techniques are employed in case of our qualitative approach. The research analyzed the various factors that motivate the people to behave with respect to the medical tourism. Based upon this procedural approach, the contrasting measures taken by Marriot hotels are studied to withstand with the recession.

Irrespective of the dancing economic condition prevailing in the country the regular income of the medical tourists is not getting affected by any means. As cited already the people seeking medical treatments abroad would not have enough knowledge about the economic status and the concept of recession, which is not needed for them. They keep on do migrating to countries that would suit their medical cases. The hotels should be in a position to withstand the expectations of the medical tourists and thereby ensuring provision of safe and secured medical care. Hence it is concluded that the rate of medical tourism has only improved and has not declined.

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CHAPTER 4 DATA ANALYSIS

4.1 DATA ANALYSIS AND DESIGN

4.1.1 Introduction

This dissertation provided data analysis through logical reasoning to examine the research question. The descriptive analysis was summarized and presented in a chronological order. The observations and descriptions are derived from the dataset collected from the interviews conducted with both managers and medical tourists. The open ended ideas and suggestions are brought out from the data and corresponding decisions and findings are done. The interviews with the five managers of different hotels of Marriott group offer some difference of opinions, which enriches the data analysis segment. Being a qualitative case study approach, the main goal was observed to predict some meaningful information based on the analysis of data done. The summary of data analysis would flow down to a good conclusion and findings, which would facilitate in giving proper recommendations for the future development of the research. The core of this research revolves around the results collected from the interviews and its possible to monitor some issues that help in answering the research topic. The managers of the various branches of Marriott across different parts of London came up with their valuable thoughts, ideas and suggestions.

According to Eisenhardt (1989), a researcher would not be able to draw up the conclusions for a dissertation unless the data is analyzed, comprehended and brought up in to field notes for the reader to get through well. 42 Burgees (1995) emphasize

separation of the qualitative approach design in to phases with regard to data analysis. Its variation depends upon the type of research design used. In case of case study approach the data analysis phases are limited and the constraint becomes simpler to draw up the conclusion based upon the results of the conducted interviews. According to Easterby-Smith et al (2002), the qualitative methods contribute to the development of new theories and enables the new ideas to emerge from the the conclusions of the research and thereby assisting in the new issues that can be further implemented in the near future. Richards (1995), believes the treatment of data in such a way that they are combined at the last to obtain a common finding, which would help in the recommendation of the research.

4.1.2 Analysis from the response of the interviews conducted

4.1.2.1 Impact of recession on tourism

Considering the primitive factor of the data analysis as the impact of recession on tourism industry, various managers of the Marriott group of hotels reported their ideas, which could be consolidated to bring out a perfect analysis. According to the managers of the Marriott, recession may be considered as a factor that pulls down the economic status of a nation, but the real fact is that it does not affect the tourism industry much when compared to the rest of the sectors other than tourism. But the price rates start flying high and hence the tourism gets affected to some extent. The tourism industry would suffer due to recession in terms of occupancy, income and growth. Such a situation may be referred as a depression.

The impact of recession varies between developed and underdeveloped countries. Tourism is observed as one of the major sector contributing the economical status of the nation. In case of underdeveloped nations, where the situation of depression 43

sustains, there are fewer chances to afford its citizens to fly in air for an abroad tour. Irrespective of the purpose of the tour they rely much upon the cost as a major concern in spite of the motive. As a result of which the regular people outgoing from the under developed nations considerably decreases and this gradually affects the tourism industry of the other nation. This is observed to be a chain process and mutually affects the tourism industry. This is the reason behind which the recession affects tourism industry globally. The developed countries take immediate actions and steps to overcome this crucial situation and attract the tourists and thereby increasing the regular income of the tourists periodically.

4.1.2.2 UK hotels measures to bring up tourism

4.1.2.2.1 Wholesalers in travel industry

From the data collected, the holiday tour packages proposed by the tour operators should be consisting of travel, accommodation and the travel services. The tour operators, here in case of hotels, they act as wholesalers in the travel industry and negotiate the commission received by the travel agencies from the customers. The hotel at UK belongs to wholesaler‟s category of the tour operators, offering exclusive packages rather than the direct sell operators. The other major principles proved for this concern was the attractive procedures. The transport providers of the packages may be of numerous types out of which the hotels in UK were observed to integrate with the ferry tour operator principle. Ferry operators provide vital links between large mass of nations and sell the airline tickets and services to the tour operator or to the customer directly.

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4.1.2.2.2 Transport principles

The choice of the tourists regarding the transportation was observed to be dependent upon the following list of factors namely price, time, and destination, reason behind the tour, departure point and of course their convenience. The hotel at UK highly aims at providing accessible travel mode and makes the holiday makers buy their holidays through their packages. The car hire principles were strongly recommended by most of the tourists, for they need to be independent at the destinations. Most of the hotels at UK attracts the tourists by satisfying them irrespective of their motive of the tour and promote self drive holidays. This was observed to be very much true for the business travelers who need to meet up with their customers at the destinations.

4.1.2.2.3 Self catering accommodation services

The accommodation and the availability of the holiday cottages for the travelers are assured by the tour operators and the major international chains for this concern was proved with some hotels like Marriott hotels, Holiday Inn, Comforts Inns hotels. Most of the hotels at UK render self catering accommodation and serviced accommodation. In case of self catering accommodation, the hotels aim at delivering packages to the tourists such that it offers budget for the package holiday and reduces the over all expenditure of the money, they awe to spend at the destination. The most possible means of achieving this target was observed to be performing marketing globally and effectively by attractive schemes and packages. This also includes the catering services and facilities provided. Visitor attractions may include catering through the cafeteria, self-service food selection area or a restaurant with waitress service. Most of the UK hotels follow this principles to attract the tourists. Most of the hotels at UK provide wider range of catering facilities ranging from fast food outlets such as McDonalds, Wimpy, Pizza Hut and other international food chain companies. 45

4.1.2.2.4 Market research principles

Familiar hotels at UK underwent market research principles to establish attractions at a particular location and its audiences. Some large companies at UK allow the travelers and visitors to tour their factories or manufacturing plants. This is done through legal tie up with the particular tour operator. An example of this is the Cadbury‟s chocolates at UK, the manufacturing base of the Cadbury chocolates, where visitors can see the manufacturing of the chocolates and also entertained with rides and purchase of goods in the factory shop. Irrespective the attractions made, the major goal of the hotels was to appeal as many customers as possible in order to make a profit and invest further in its development and improvement. Marketing is largely undertaken as the major strategy for the attraction of tourists. This criterion is mainly achieved through media advertising through televisions and news papers. The increase in attraction towards the tourists was observed to be done by means of discounts in the holiday packages offered.

4.1.2.2.5 Affiliation with the British Tourist Authority (BTA)

The tourist identifies their choice and locates their destiny which could afford almost all the principles they expect through the media advertisements. The UK hotels presented the visitors and travelers with the record of previous experiences of the previous tourists of their hotel. The data of the purpose of the tour was analyzed by the hotels. This is mainly done to identify trends in the economy that affects not only the tour operators and their principles, but also the economy of the country. UK hotels were well noted for its affiliation with the nation pride job of the British Tourist Authority (BTA). The mission of BTA was found to determine the value of increase in the inbound tourism at UK throughout the year. It is aided by the government 46

policies and regulations. It operates in 27 overseas markets, working in partnership with the developed and developing countries. The government department of culture assists the partnership support of the hotels with the airlines and the local authorities to increase the marketing resources. All the hotels at UK are affiliated to the National Tourism‟s Organisation (NTO), whose main responsibilities are listed as the marketing, research, planning and development, finance administration. Many national tourism bodies like Wales Tourist Board work in close with BTA.

4.1.2.2.6 Tourist Information Center (TIC) and local tourism boards

Hotels at UK have very good contacts with the local tourism board authorities and which would help the visitors in providing information regarding issues. The Tourism Information Center (TIC) played a major role in tourism industry which assists the local authorities in regular investigation of the tourism industry promotes the development in that particular area. The specific knowledge about that area was observed to be well known by the TICs and they put forth measures to attract the tourists. At times of recession the hotels at UK kept constant touch with the TIC which would make them analyze the trends in the industry currently and take appropriate actions regarding the same. The TIC encloses display of leaflets and brochures regarding the local sites and attractions and possibly details about the public transport such as train and bus schedule and also the local accommodation at places at smaller deposit.

4.1.2.2.7 Skilled ability of the coach and guides

The guiding services offered by the UK hotels, especially at times of recession also direct the right path of the run way for the hotel management. The exciting ability of them to organize and manage people over local trips kindles the tourists for a long 47

ride. The communication and knowledge of the tourist coaches is analyzed by the hotel and are selected such a way that they induce the minds of the tourists in moving from places to places with interest and keen observation. They were found to be capable of handling customer complaints and negotiating the negative shades of the tour. They were all found to be well equipped and capable of attracting the tourists from various parts of the world and answering their questions in that particular foreign language and the point to be noted is that they may not be familiar with the local languages. This would encourage the interest of the tourists and make their tour happier.

4.1.2.2.8 Attractive marketing through media

The principles of marketing in the travel and tourism industry vary depending upon the hotels. It was strictly observed that almost all the hotels at UK render their own marketing strategies based upon which their regular income of tourists is decided. Through attractive advertisements through media the hotels could grasp the attention of the visitors and it could be achieved through national newspapers in the UK which was mainly aimed at the individual traveler or the tourism package provider rather than one who makes booking through a travel agency. The attractive packages offered by these individual providers bring the mind of the tourists to avail the tour and enjoy a nice time.

4.1.2.2.9 BTA to improve the imbalance in travel account at recession

From the national statistics of UK the observations were made and the figures clearly show the imbalance on travel account for many years due to recession. But it was 48

depicted that later after 2008, BTA targeted to improve the continuing decline in the balance of the travel account and promoted the hotels of UK to monitor the marketing strategies and thereby adding to the increment of the turn over. The major reason observed for the imbalanced travel account was that the regional tourism at UK tends to be seasonal. They were worst affected by the weather conditions that prevailed there and though the bulk or tourism occurs only at summer the other countries might be suffering from severe climatic conditions and gradually this may pull down the balance. Apart from this the major factor was the period of recession at UK itself, which does not allow the local people to undergo domestic medical treatment due to higher costs and thereby afford to take treatment abroad by spending lesser money. Any ways this situation was not sustaining through out all the years. Later after 2008 the BTA became more vigorous in action and urged the hotels and tourists facilitators to improve their standards in marketing and development. At present the tourism industry is brought up to some extent.

4.2 DATA ANALYSIS – CASE STUDY (MARRIOTT HOTELS)

4.2.1 Remedial measures undertaken by Marriott to attract medical tourists

4.2.1.1 Introduction

The fact that the rate of occupancy in UK hotels during the first five months of 2009 is truly accepted and added that it does not prolong for more time and Marriott

recovered from that position very well soon. It is also found that apart from recession there are some other factors like spread of swine flu fever, which is considered as one of the major causes for the sudden decline in the medical tourism. Many observations were made and found out that apart from recession, health factors also make the tourists to deny their travel abroad for medical treatment. Proportionally the rate of 49

occupancy was found to observe a sudden decline at the beginning of the year and news tells that during the later months of 2009, it started to rise. It is also added that it is in the hands of the managers to increase the profit rate of the hotels irrespective of the time and period.

4.2.1.2 Price rate fixation through RevPAR sheme

The confidence of rendering measures to overcome the crucial situation was pointed out as the revised methods of hospitality and price rate fixation through the Revpar (Revenue per available room) scheme. The other remedial measure to adjust with the situation of recession can be achieved by offering attractive medical tour packages that would make the tourists feel their stay as “A home away from the home”. Easy mobility to places inside city is also considered as a major factor. Another alternate idea is to promote through genuine and attractive advertisements that offers special tour packages and through advanced hospitality techniques. Marriott concentrates much upon the current issues and try to present the tourists with the positives and negatives of their purpose of tour and also suggest best and feasible packages with medical tourism in particular.

4.2.1.3 Indoor facilities and offerings

Next analyzing the possible means that a hotel would attract the medical treatment could be concluded as to satisfy the customer expectations and make them fulfilled in every aspect. Considering medical tourists in particular the criteria those placed by them induces the hotels to update and correct themselves in issues. From the response of the managers of Marriott it is well noticed that the hotels with features like post treatment follow-up care, maintaining good track of medical records over periods would achieve more. The contacts with the destination hospitals are supposed to be 50

genuine that makes them to trust the hotel for perfect stay. Hotels should guarantee the medical insurances for the medical tourists and make their stay comfortable. Proper hygienic and healthy environment and specialized rooms for the medical tourists could be implemented to increase the rate of occupancy in hotels. The destination facilities offered by the hotel must meet with the customers. The proper coordination of the managers and staffs of the hotel also could be considered as an important factor to encourage medical tourists. All these needs are satisfied to meet the comforts of the tourists. Attractive food offerings that suit them well also attract the medical tourists and this is one of the major segment through which it is easier to entertain and attract the medical tourists. With reference to a Duty manager at the Marriott, their department is concerned in offering excellent food varieties and is very particular in offering correct and dieted food and beverage items suitable for the patients.

4.2.1.4 Hospital standards and qualities

A hospital recommended and assisted by IHA (International

Healthcare

Accreditation) qualifies to be well equipped and suited to entertain medical tourists. The services and treatment facilities provided by those hospitals can ensure perfect medical procedures to the patients. The managers of Marriott strictly stick to the point that hotels should be inspected by IHA group to satisfy the medical tourists. It is highly qualified rating to treat the medically ill patients. A hospital with such an accreditation speaks out that it is highly eligible to deal with all types of medical treatments. The number of days of stay in hotel purely depends upon the nature of the treatment offered, but even then some medical tourists would like to stay for some more time to spend over their in site seeing and other aspects. Taking this in to considerations, attractive and highly safe and secured tour packages are implemented.

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4.2.1.5 Cost for the medical treatment

The costs for initial consultation and diagnosis may vary depending upon the surgery or treatment performed. Age factor also does matter in this constraint. The surgeries and treatment for women and young children may be quite costly. How ever the factor that is much stressed upon here is the hotel should be perfect in terms of hospitality and indoor facilities, so that the cost would not matter for the tourists to pay. This would add up the turn over of the hotels, irrespective of the cost of the treatment and the medical tourists residing in the hotel. Depending upon the nature and field of treatment, the cost and the number of days for the stay vary for person. Complicated cases would be of higher costs and the hotels should develop the attitude of grasping the attention of medical tourists even for complicated cases. This can be achieved by maintaining proper hospitality standards.

4.2.1.6 Complications after the surgery

If the treatment goes bad after surgery, then the hotel should be capable of interrogating the case and find out the root cause and take immediate actions. Also the remedial measure is also implemented in positive ways. The local doctors and destination doctors should be invited to get through well with the issue. The hotels should also be aware of the contact between the hospital and the local doctors residing in their hotel. In case of any complications that arise due to the worst surgery or treatment it is advised that the hotels should take the primary responsibility and try to solve the issue instead of creating troubles for both the medical tourist and the destination facility. This would not make situations upset and also adds satisfaction to the tourists. The medical insurances have to be claimed properly in case of the worst case of treatment and the hotels should take care of that responsibility. The health manager of a hotel should be capable of handling the situation with delicacy and 52

decisions are taken such that it does not affect any one. Failure in surgery including minor and major complications some times, lack of resistive power due to climatic conditions, improper food habits during treatment, lack of communication problems are cited as the complications. It is the primary duty of the managers to assist the tourists in overcoming these complications.

4.2.1.7 Travel and medical insurances

The hotels offering medical tour could avail travel and medical insurance for the patients, which would attract them at most. This would certainly help them to overcome the complications they would face. The following factors are suggested to be ensured by the hotels as a preventive measure to entertain the medical tourists. They are proper consultation with doctors, provision of proper communication between the doctors and the patients, aftercare facilities. Some times the racial problems too arise. As cited by one of the chief managers of the Marriott group, the managers could take the responsibility of avoiding racial problems and communicate everything very proper between the tourists and the destinations. Web transaction of money is encouraged for the easy transfer of money across the globe. Marriott feels very proud that the services provided by the local doctors, makes the patients completely feel good after their surgery. Only in some cases the treatments are followed up or repeated by the destination facility. The most important factor that the medical tourists feel to be a complication is that the language and communication differences, especially in case of doctor consultations. The hotels should allot the preference of the language and the allotment of the corresponding doctors to the patients.

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4.2.1.8 Follow-up care ( after treatment )

Ultimately the follow-up care facilities provided by the hotel should attract the medical tourist which would please them to have a pleasant stay. Marriott makes it different from the other hotels by providing the unique feature of „smoke free environment‟ at the places of medical tourists. The treatments followed at Marriott are completely sterilized and the regular follow-up by the attenders are usually carried out. Follow-up care facilities are carried out till the last day they wind up from the hotel and the destination doctors should be called upon if at all any complications occur after the treatment, during their stay at the hotels. Updating the status of improvement, giving immense critical care for serious cases and some other means are the follow up care procedures to be carried out in the hotel desk. Regular undertake for walk or outing for the patients is also considered as an important factor in keeping the medical tourists to be healthy fit always. Based upon the responses of the managers the following observations were concluded.

4.2.2 Strategies of Marriott

4.2.2.1 Introduction

Considering the primary factor for the strategies placed by Marriott, as the comfort for the patients to stay at Marriott, it was evidently proved through their responses that Marriott excelled much better than the other competitive hotels in terms of hospitality and medical treatment. Medical tourists hire for various types of treatment abroad, out of which London is much noted for its cosmetic surgerical treatment. From the observations taken out from the medical tourists who had their stay at London, the following depictions can be written with respect to ease of comfort. The proper undertake of the treatment and its excellent follow-up care provided at Marriott made 54

their stay to be a comfortable stay. Irrespective of the nature of the treatment, including highly complicated medical cases the patients felt their stay to be more comfortable and worth while.

4.2.2.2 Communication link between tourists and hotel operators

The perfect communication between the operators of the hotel and the tourists hiring medical tour packages was observed through out Marriott. On a whole there was a positive feedback reply regarding this issue at Marriott. Some cases which faced failure already, is revised at Marriott under well qualified doctors and no patients suffer the language communication problem in case of consulting doctors and the operators of the hotel. This naturally does not put the medical tourists in to a trouble and makes them easy to complete their work with belief. In case of mistakes in an already done surgery, there were positive results which were brought out after admission in to Marriott. Most of the patients feels the same and would choose Marriott for their pleasant stay and treatment abroad.

4.2.2.3 Intensive under care of medical cases and clinical outcomes

The categorization of a medical case as a complicated one or non-complicated one is done based upon the cause and effect of the medical background. Utmost all the cases including both are well handled in case of Marriott hotel, though some hotels hesitate to undertake some crucial medical cases. Thus it is observed that hotels should develop guts to undertake such complicated cases and thereby promoting the development of medical tourism. Marriott undertakes severely complicated cases including misplacement of a part in wrong positions, highly intensive cases and so on. This creates a good impression of the hotel among the medical tourists. 55

Most of the medical tourists prepare their minds to discuss the clinical outcome and success rates being shown in the hotels. This would gradually make their thoughts to set for their stay at Marriott. The previous medical records of the hotel tourists would surely assist the welfare of the hotel growth. The tourists hiring their stay at a hotel would be expecting the previous medical records to be shared with them. Generally speaking, before an initial consultation with a doctor one would be very eager in knowing about the fame of a doctor. Similarly the medical tourists too expect peculiar fame of hotels for taking their treatment.

4.2.2.4 Selection of doctors for the treatment

The criteria that hotels should adopt for selecting doctors to attract the medical tourists can be short listed in to a few. The major factor for this concern is the selection of appropriate doctors for the patients such that there is no communication problem between them. The doctors selected must be from well qualified destination hospitals with IHA rating. The hotels must also ensure highly secured treatment with the destination facility. Most of the feedback got from the patients shows that they feel satisfied with the consulted doctors. This does not happen to be true in all hotels, but possible in case of Marriott. This dissertation focuses upon the various measures that are supposed to be undertaken by the hotels at UK to attract medical tourists.

Doctors need to give an initial opinion before getting in to the medical treatment. The preliminary documents are supposed to be completely verified before attending a patient. This ensures the patient‟s security and safety. The future actions in the treatment would be discussed with the patients so that they could make some strategic 56

decisions upon the treatment further. This is duly agreed by all the medical tourists visited and also urges the other hotels to follow the same with qualified doctors at their destinations. In case of a tourist who underwent cosmetic surgery was given many severe reports about the result of the treatment and later decided to undertake the treatment. The result is a positive one, any ways the patient felt happier about the doctor‟s initial opinion, which is the key for decision making.

4.2.2.5 Quality of the hospitals

Most of the hospitals suggested and recommended by Marriott group are well equipped and the tourists too agree with the same. Most of the successful medical treatments undertaken by Marriott include cosmetic surgery, plastic surgery and dental operations. Regarding these three major surgeries Marriott stands at its excellence. The hotel should be capable for offering medical packages even for complicated cases. This would sure bring more fame for the hotel management and creates a good impression on the hotel. Marriott stands excellent in case of all types of cosmetic surgeries. The doctors recommended by the hotel excel in case of the above three surgerical treatments. Similarly the hotels should create a separate fame for them based upon the treatments followed.

Open conversation and meeting up of the patients who underwent treatment already, would help the medical tourists in encouraging the surgerical process they undergo. This would give them a comparative idea about the other hotels and obtain a good outcome of the surgery performed. Similarly the other aspects that the tourists keep in their mind include the medical insurances and security provided. Marriott excels in all the above criteria and plays as a key model for the other developing hotels.

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4.2.2.6 Follow-up care procedures

Ultimately regarding the follow-up care provided, the medical tourist expects much more on this than any other criteria. It is only this which would make them have a pleasant stay after the treatment process. The post treatment follow-up care is supposed to be strictly followed by the hotels to ensure medical tourism. The factors that distinguish Marriott from the other hotels may be in terms of hospitality and follow-up care procedures. Though all the hotels undertake the similar policies and services, Marriott excels in all these aspects through the proper coordination of the managers and staffs of the company. This would be a matter of encouragement for the other developing hotels and this research helps in further development of the same in future. The analysis of data collected from the response of the medical tourists can be consolidated as below to draw up the conclusions.

4.2.3 Evaluation of the strategies

From the analysis of data done above, this research gives a clear picture of the motive of the dissertation. The objective has been clearly set as to review the literature behind the research area and to analyze the data collected as an outcome of the case study explanatory research work. From the data analysis point of view with regards to both the managers and the medical tourists it is been inferred that the measures that are undertaken by the hotels to attract medical tourism, has to be supervised and successfully implemented by the various levels of managers. The marketing strategy of a hotel or a health care company does matter to attract medical tourists. The marketing has to be mostly preferred to be done in developing countries rather than under developed countries. Marriott excels its marketing techniques in developing countries which could afford people to fly abroad for medical treatment even at times 58

of recession. To withstand with the recession, hotels can employ techniques like RevPAR shemes, attractive medical tour packages afforded at low costs and exciting marketing strategies etc. The UK economy shrank for the first time in 16 years between July and September 2008 confirming that the nation is on the zone of recession. It is great to see that, even in difficult times Marriott continue to invest in new openings, refreshments, constantly enriching the guest experience and establish quality marketing techniques.

The following inferences were made before and after recession observed at UK.

Before recession:

 Excellent care and hospitality  Diversity set through all the levels  Support round-the-clock and event management efforts  Provision of „healthy‟ environment that would make the medical tourists to have a pleasant stay.

After recession:

At times of recession that happened between July and September 2008, Marriott adopted several policies and methods to overcome the crucial situation and withstand their name in the tourism industry, which may be listed as follows:

 Attractive tour packages with concessions, offered along with their flight tickets at the source point. A legal tie up with the air travel companies would facilitate this aspect and grasps the attention of flight passengers to select their

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package which would comprise of the fight ticket, optimistic stay at hotels and tour package within London.  More effective marketing strategies, when compared to periods of non-recession. This would ensure the constant maintenance of the income of patients to their destinations irrespective of the gloom of recession. Marriott does wise marketing in developed countries and try to afford cheaper prices for tourists hiring from under developed nations, which has been hot hard by recession.  Strict follow up of the Revenue per Available Room scheme, under which the room rent is fixed based upon the rate of occupancy. Contrary to the first feature, the tourists availing stay at Marriott excluding the packages offered then their room rent is finalized depending upon the rate of occupancy at that day.  Application of creative approaches like “Cyber Lounge” to help the employee‟s better meet work and personal needs. Associates can network and access online information and resources in this specially created social zone which is a huge win for the hotel and its client.  Reconstruction or alteration of the existing rooms to bring in to a new format with additional features that would attract the tourists. This would sure bring the tourists to stay and make them feel to reside for some more time.  Provision of genuine medical insurances and health care awareness programs to ensure the medical tourists to meet their expectations. Marriott has got good tie ups with standard hospitals at UK, rated by IHA.  To provide exercise to guests, and hotel employees, the essence of health club to community membership was implemented.

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From the above evaluations the following depictions were made and analyzed in the form of a comparative graph discussed before and after the periods of recession

BEFORE RECESSION
105% Rate of occupancy Follow-up care and hospitality Increase in Monthly turn over Undertaking medical insurances Increase in tour packages FACTORS 1

RATE OF INCREASE

100% 95% 90% 85% 80% 75%

AFTER RECESSION
105% Rate of occupancy Follow-up care and hospitality Increase in Monthly turn over Undertaking medical insurances Increase in tour packages 1 FACTORS

RATE OF INCREASE

100% 95% 90% 85% 80% 75%

Fig 4.2.3 Growth of Marriott – before and after recession

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CHAPTER 5

CONCLUSION
5.1 CONCLUSION

Recession affects tourism industry globally and constructive measures are taken by the UK hotels to overcome the complications raised due to recession. Recession affects tourism industry of both developed and underdeveloped nations in the globe. The state of recession pulls down the economic status of a nation and here with the people of that particular nation suffers due to low wages and rise in price of goods and products. Also difficulties are found in traveling to other countries for tour purpose and their mind sets in the cost factor rather than pleasure. Under this situation the hotels of the country which need to promote tourism industry especially at recession, are supposed to pose measures to attract the tourists such that they get no way affected by any means. Hence tourism is observed to be one of the major sectors contributing the economy of the nation; it is the hotels which should take necessary implementations to attract tourists.

5.2 GOALS REVISITED

Goal 1: To review literature regarding recession affecting tourism industry

Recession affects the tourism industry globally and the literature reveals that UK hotels undertake measures to make them to withstand with the dancing recession. This 62

is mainly achieved by excellent marketing strategies which are proved to be success in many nations. The conclusions drawn from the dissertation would be encouraging that it would be an added attribute measure to entertain medical tourists. This support the researchers to seek more interest in the topic and gain proper knowledge about the various means that recession could affect the tourism industry and the possible means to overcome them. This also would get a chance for the developing hotel managements to undertake some necessary steps to gain fame and reputation in near future. Domestic tours also are concerned for internal recession effects and offers are proposed for that too.

The literature shows that a hotel which monitors its activities and proposes relevant actions to maintain the occupancy rate and continues to attract the tourists, even when the tourism industry is being pulled down could keep on moving in the market. This can be achieved by doing marketing in developed countries which could afford people to go abroad for holiday tour. In contrast hotels which do not pay proper attention towards the same would not experience the best time and should be aware of the measures to be taken.

Goal 2: To analyze the cause and effect of Recession on the tourism industry and to arrive at the conclusions that would clearly depict the possible measures that a hotel management could avail to attract and entertain tourists at times of recession

It is observed that regarding travel and tourism, recession may be considered as to pose either positive or negative shades. This purely seems to be dependent upon the country one is put in and the ways that the country follows to attract tourists from new 63

and emerging countries, which has been hit hard by recession. The nature of the organization also does matters for this issue. Certain countries and tour providers that have targeted the holiday makers and tourists emerging from less developed countries are seeing a slight decline in the income of people because as the economic recession hits these less developed countries, tourism hiring people may decide to sacrifice quality for affordability. These people are making their decisions to go touring in their home country itself in order to save money even though the quality may not be as high. In these less developed countries every dollar counts and tourist people are being extremely conservative in their spending. As a result they are automatically pushed in to a situation that they could not afford much amount to go for a holiday trip abroad. This would be a major factor that recession could affect tourism industry globally.

The most exclusive factor or measure for a hotel to attract the tourists is by performing excellent marketing strategies, failing in which the rate of tourist people would decrease. In spite of the tourism industry being little down in its growth, a hotel should be keeping on promoting its ideas and marketing implementations and thereby attracting tourists from all nations. Marriott also tries to market at affordable prices exclusively for under developed countries. In spite of high recession there and huge price rate there, some people decide their trip at Marriott for their leisure trip.

It is suggested for the hotel to follow the scheme of revenue per available room, with reference to the rate of occupancy. This would naturally make them move well in terms on turn over. Marriott follows the above two principles and the same was found true through the results of the interviews conducted. It is suggested that all hotels could follow the same to achieve high.

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Goal 3: To conclude the marketing strategies of the hotel organization to maintain the incoming rate of the tourists at times of recession.

It is not wise for any familiar hotel or health care provider to advertise or establish marketing efforts in less developed countries. These less developed countries would not entertain its people to travel in air for health care treatment. Marriott suggests perfect marketing strategies across many developed nations, which could afford the people to travel abroad for medical care. This would certainly make them healthy enough to compete with their competitors and come out with flying colors. Considering this marketing strategy in mind Marriott does effective marketing through attractive medical tour packages at the source air station itself. Lack of marketing for any hotel organization would ensure the failure in the rate of income of medical tourists. It is highly recommended to market about medical tourism in developing countries facing recession like United States, Canada and Russia.

5.3 LIMITATIONS OF THE REPORTED RESEARCH

The case study deals with the Marriott group of hotels in entertaining medical tourists. The dissertation reveals the possible measures taken by Marriott for attracting medical tourists in particular. The limitation of the dissertation is restricted within the medical tourism sector and the possible means that Marriott adopts in ensuring health care for them is concluded.

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The health care providers must analyze the mentality of the medical tourists and their expectations in undergoing medical treatment abroad. More patients choose to utilize medical tourism as a way to save on overall healthcare costs. There has been observed a shift in the demand for various medical procedures. People who wish to take treatments like cosmetic and plastic surgeries would think about the amount to be spent for the treatment. Any ways people keep on migrating to other countries for medical treatments like orthopedics, cardiac and transplants. How ever these

procedures are called the core procedures which the tourist set their mentality to get through those treatments irrespective of the economic situations. Marriott keeps in track about the change in mentality of the medical tourists about the medical treatments and does marketing appropriately.

Hotels should excel from the other hotels in terms of the competitive marketing efforts. Medical tourism has been developed by many nations over the world and the income of patients would be maintained well only through the marketing strategies in the existing medical tourism industry. Marriott proves to be a top destination for providing health care by its high quality of care provided by them and the local hospitals suggested by them. “Brand reputation” is the best form of maintaining the fame of any hotel for health care facilities. The chief marketing strategy is that to keep a “brand” one must be constantly enforcing it. As new comers emerge in medical tourism, Marriott markets more aggressively and started getting the contracts with insurance companies, employers and medical tourism facilitators. Due to the

massive growth of the medical tour industry and the fact that so many hospitals, clinics and doctors are promoting themselves, industry players must constantly market themselves and create and maintain their “brand recognition” or they will simply lose their market share of medical tourism patients.

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The tourism industry participants should always support to avoid misinformation and verify that all facts to be at the best of their ability and also to show good track of records over years always. Marriott does not spread any misleading information as to the future of medical tourism, where patients are traveling from and where they are traveling to, and what countries patients will be coming from in the future. In fact, some health care companies and hotels exaggerate media reports to benefit their own country over others. This is observed as just to gain an edge and should not be taken seriously. From the response of the medical tourists it is very clear that Marriott always go along the good track without any fake information or suggestions. This distinguishes them from the other developing hotels and health care providers at UK.

Thus recession though affecting globally, the health care providers and developing hotels could attract medical tourist through high quality marketing in the increasing competitive world. The information posed by them should be more genuine enough to make the patients to ensure their stay in the hotel. Apart from these strategies the follow up care facilities and post treatment take off could also attract them utmost.

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CHAPTER 6 RECOMMENDATIONS
6.1 PROPOSED RECOMMENDATIONS

6.1.1 Directions for future work

Even though Marriott adopts some policies and methods to keep up its name, here are some valuable suggestions that could be brought up to add their fame.



The inclusion of audio packages in various languages could be made available for the tourists when they take their visit. This could also be accompanied by the automatic walking guide instruments which facilitates the people to seek their interesting destination places. This factor would also promote the independency of the holiday comers and make them feel easier with the local people there. This would considerably reduce the cost of employing guides for the tour and though the tourists might feel that they would loose personal touch with the tour provider, most of the tourists prefer this case of walking guides.



The overseas hotels or tourism facilitator / provider may provide the tourist with a pre-paid cell phone and also through the laptop or a computer provided by the hotels they can send emails or talk to people using an internet phone services such as skype. However this was observed to be more common in almost all the tourism facilitators. It is suggested for the familiar hotels and hospitals even to offer the tourists free international long distant calling

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services. This would be included in their tour packages. Prepaid calling cards may also be provided for the tourist people residing there by applying some conditions.



Attractive offers like advance reservations for the next holiday trip may be met up with the tourists who stay in a hotel. Such plans could be added up with bonus trips within the country at low prices. This could also be accompanied with free medical consultation facilities with the doctors over there.

6.1.2 General Recommendations for UK hotels regarding medical tourism

The employees of all the hotels must be capable of handling guest instructions based upon their language, so that they are entitled to health care. This should not be a barrier for the tourist to handle with. This issue of hospitality is of huge importance that the patients residing their, should feel ease of comfort in their stay. Proper interaction between the patients, the local employees and the managers is supposed to be a major factor based on which the medical tourists make effective decisions for their treatments.

Reputed hotel organizations may be recommended to market in under developed nations too, but placing some constraints. Medical packages could be afforded at considerably low prices such that it does not affect both the tourists and organization by any means. It is also observed that for a reputed and highly familiar hotels or health care providers this would not be a big issue and they could even make a try to entertain tourists from under developed nations, hit hard by recession. But this may be considered to be embarrassing or unpredictable for a developing organization. How 69

ever, as a strategy in marketing familiar hotels could implement this especially during the times of recession.

The medical tourism destinations and health care providers must be simply better suited for touring than others. They should make themselves to be different in terms of the infrastructure, services and experience to provide the medical tourists with an enjoyable and safe trip. In case of a medical tourism patient who has undergone a relatively mild medical procedure such as a laparoscopic hernia repair or an eyelid lift, the hotels could engage in some light sightseeing tours after a few days of rest. Irrespective of the nature of the medical procedure, the destination hotels should consult the physician for his permission before engaging in any activities after surgery.

Hotels and international hospitals should offer the medical tourists a choice of various menu options including Western, vegetarian, and more exotic local fare. If the patients dislike or are allergic to certain types of food, then the local hospital manager or the medical tourism facilitator must make sure that they are able to make proper arrangements. This would also be the means to satisfy them and their food needs. The food provided should be at affordable prices and highly hygienic and healthy.

Hospitals at popular medical tourism destinations are trying out to attract medical tourism patients, and so the medical tourists would expect nicer rooms than what usually available at home. In general, they may be probably get the opportunity to choose from several room-types (with different price ranges) including: shared rooms, spacious private rooms, suites, and in some cases luxury suites. These things can also 70

be enclosed within the tour packages. All room types can be accompanied by the provision of computerized personal nurse call system to ensure safety and security.

Some international hospitals may even have an area dedicated to international patients, where they will be cared for by an English speaking nursing staff experienced in attending to medical tourism patients. But this is not quite common in all the destination hotels. This has to be made common among all the hotels. At most all the international hospitals are expected to have access to a pharmacy or a convenience shop where you can purchase toiletries and other personal items such as shampoo, soap, toothpaste. This would be considered as a common criterion for the medical tourists.

Depending on the particular hospital or the surgery package underwent, the tourists will either spend most of your recovery time at the hospital, or more likely, gets transferred to a hotel or a recovery facility for the remainder of the stay. This only makes the sense as a night stay in the hospital may cost two or three times more than one at a hotel or recovery retreat. Studies also suggest that longer hospital stays increase your risk of infection or contracting an illness. So the medical tourism facilitators can make the patients stay in their hotels after the surgery and getting proper suggestions from the doctors, provided perfect after care procedures are followed with the local doctors in the hotel.

The international health care providers and hotels should follow-up with the medical tourists periodically to make sure that they are doing well after the surgery even after retuning to their home town. They should also provide the patients with a contact for any queries or questions or concerns. This may be someone from the hospital‟s internationals office or even the overseas physician consulted with. The health care 71

providers should be in constant touch with the patients even after reaching their home, which would give proper solutions for any risks in the near future. Many hotels and health care providers do not ensure this and fails to maintain a good track of records. This would also give them high confidence and support after surgery and also a means to promote the particular health care provider across the globe and gain fame and reputation.

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APPENDIX 1
QUESTIONS AND SCHEDULE FOR INTERVIEW- MANAGERS Interviews with managers of Marriott group of hotels:
Questions: 1. How far the economic recession has affected the tourism industry? 2. What contrasting measures are done at your hotel to combat with the situation of recession? 3. Under statistical survey the rate of occupancy at UK hotels was found to fall around 3.7 points for the first five months of this year. Has this been your experience? 4. What are the possible means of a hotel to attract and entertain medical tourists? 5. What are the medical tourist's criteria for selecting an hotel for their stay during treatments? 6. Are the hospitals recommended by your group qualified to treat them? 7. How many days will the medical tourists need to stay in the country for treatment? 8. What are the costs for an initial assessment and diagnostics? 9. Who is responsible for treatment going bad if the patient goes around touring after surgery? 10. Are the procedures done at local hospitals good enough or do they need to be repeated at the destination facility again? 11. How important is a travel insurance required for medical tourists? 12. What all complications do medical tourists have? 13. Can a web transaction be performed for transfer of money? 14. As heard Marriott hotel‟s follow up care is been excellent. What follow up care do you provide?

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Schedule:

Interviewees Michael Hewson, Front Office Manager, Chris Dunn, Talent Manager, Theresa Maw, General Manager, Philip Johnson, Health Care Manager, James Edgerton, duty manager,

Address of the hotel Marriott London Country Hall

Marriott hotels international ltd

London Marriott Park Lane

Marriott residence hotel

Marriott Grosvenor Square

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APPENDIX 2
QUESTIONS AND SCHEDULE FOR INTERVIEW-TOURISTS Interviews with Medical tourists of Marriott:
Questions: 1. How do you feel comfortable to decide your stay at Marriott during medical treatment? 2. Are the operators of the hotel that you contact qualified to answer your queries? 3. Are all treatments going to cost the same for young and old? What is the basis for a case being categorized „non complicated‟ or „severely complicated‟? 4. Have any success rates and clinical outcomes of the hotel been discussed with you? Do you think these are necessary? 5. 6. 7. What criteria do Marriott adopt for selecting a doctor for your treatments? Are you satisfied by the conversation with the doctor who treated you? Do you suggest for an initial opinion by the doctors before undergoing treatment? In what ways the preliminary documents assist for that? 8. Are all hospitals suggested by the hotel well equipped to treat all diseases? Comment your answer. 9. 10. Does Marriott offers medical packages for tourists having complicated cases? Did you interact with patients who have been successfully treated by the hospital and if yes what was their feedback? 11. Does the hotel provide any security and insurance? In what ways does the insurance help you? 12. Did your local insurances had any validity in the hospital in which you got treated?

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13.

Will the local doctors be kept in always to give proper follow - up care? Did you feel comfortable with?

14.

By what means can you distinguish Marriott from the other hotels regarding medical tourism?

Schedule:

Interviewees Ms.Diamond, Germany. Philippe Pétain, France . Saadedin, Australia

Hotel stayed London Marriot Hotel Country Hall. . London Marriot Hotel Country Hall Marriott residence hotel.

Kadri-Faruk, Germany Jocelyn, Philippines

Marriott Grosvenor Square Marriott residence hotel

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APPENDIX 3
List of Figures and Tables

List of Figures
Figure No. 2.2.3.3 2.3.1 2.3.2 2.6.2 (a) Descriptions of Figures Range of reasons for tour and travel Growth of GDP rate at UK Contribution of UK sectors to economy during 2009 UK hotel performances in terms of rate of change in RevPAR up to June 2009 2.6.2 (b) 2.6.3 Rate of change in RevPAR up to June 2009 Absolute share price performance of UK hotels during NOV 2008 4.2.3 Growth of Marriott – before and after recession 61 28 30 Page No. 16 20 21 28

List of Tables
Table No. 2.3.3 3.2.2.1 3.2.2.2 Descriptions of Tables Rate of cost problems in health care sector Interview questions form ( Managers ) Interview questions form ( Medical tourists ) Page No. 22 38 39

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