Meaning of Service Marketing
A Service is an economic activity that is intangible or not be touched, not be stored, and not be owned. Postal service delivering mail is a Service, and the use of expertise like person visiting a doctor is also a service. A service is consumed at the point of sale and does not result ownership. A product is material or tangible in nature, can be touched, can be stored, and a product can also be owned, but it is not so in case of a service.
Defining Service
Services include all economic activities whose output is not a physical product or construction, is generally consumed at the time it is produced, and added value in forms (such as convenience, amusement, timeless, comfort and health) that are essentially intangible.
Defining Services Marketing:-
Services marketing are a sub field of marketing, which can be split into the two main areas of goods marketing (which includes the marketing of fast moving consumer goods (FMCG) and durables) and services marketing. Services marketing typically refer to both business to consumer (B2C) and business to business (B2B) services, and include marketing of services like telecommunications services, financial services, all types of hospitality services, car rental services, air travel, health care services and professional services. The range of approaches and expressions of a marketing idea developed with the hope that it be effective in conveying the ideas to the diverse population of people who receive it.
Services are economic activities offered by one party to another. Often time-based, performances bring about desired results to recipients, objects, or other assets for which purchasers have responsibility. In exchange for money, time, and effort, service customers expect value from access to goods, labor, professional skills, facilities, networks, and systems; but they do not normally take ownership of any of the physical elements involved. There has been a long academic debate on what makes services different from goods.
Adam Smith’s famous book, The Wealth of Nations, published in Great Britain in 1776, distinguished between the outputs of what he termed “productive” and “unproductive” labor. The former, he stated, produced goods that could be stored after production and subsequently exchanged for money or other items of value. But unproductive labor, however” honorable,..useful, or... necessary” created services that perished at the time of production and therefore didn’t contribute to wealth.
Size of Service Sector
Services sector contributes the most to the Indian GDP. The Sector of Services in India has the biggest share in the country’ GDP, it accounts for more than 50% contribution.
The various sectors under the Services Sector in India are construction, trade , hotels ,transport ,restaurant ,communication and storage ,social and personal services, community ,insurance, financing business services, and real estate.
Services marketing concepts and strategies have developed in response to the tremendous growth of service Industries. Most new employment is provided by services. Strongest growth area for marketing.
Deregulation and Services Marketing
Specific demand for services marketing has come from deregulated industries and professional services.
Deregulatory moves from government have affected service industries such as airlines, banking and telecommunications.
As a result, marketing decision that used to be tightly controlled by government are now partially, and sometimes totally, within the control of individual firm.
Nature of Service
1. Lack of Ownership
One cannot own or store a service as it can be done in case of a product. Service is consumed at the point of sale and does not result ownership. Services are used or hired for a period of time. For example buying a movie ticket the service lasts for two or three hours, but customer want and expect complete entertainment and excellent service for that time period.
2. Intangible
Services are intangible in nature, you cannot touch it, cannot see it, cannot taste it. You cannot touch or hold a service as you can do with a product. For example one cannot touch or hold the services provided by his financial adviser. This makes it difficult to evaluate the quality of service prior to consuming it since there are fewer attributes of quality in comparison to a product.
3. Inseparable
Service is inseparable in nature means to say that it cannot be separated from the service provider. A product when produced can be taken away from its producer whereas a service is produced at or near the point of purchase. For example visiting a restaurant, you order your meal, wait for the meal, meal delivered to you and services provided by waiter/waitress are all part of service production process and is inseparable.
4. Perishable
Service last for specific time period, it cannot be stored as like a product for future use. Service production and utilization goes simultaneously. For example watching a movie in cinema hall, service will only last the duration of the show. Again because of this time constraint consumers demand more.
5. Heterogeneous
It is very difficult to make each service experience identical, for example travelling by plane the service quality may differ from the first time you travelled by that airline to the second, because the air hostess is less or more experienced. Systems and procedures are followed in service production process to minimize this heterogeneity and to provide consistent services all the time.
Services are Different Goods | Services | Resulting Implications | Tangible | Intangible | Services cannot be inventoriedServices cannot be displayed ,communicated | Standardized | Heterogeneous | Each time experience differs Service quality depends on many uncontrollable factors | Production separate from consumption | Simultaneous production and consumption | Customer participate in and effect the transaction Mass production is difficult | NonperishableRight of ownership | PerishableNo ownership | Service cannot be returned, resold or storedCannot be owned |

HISTORY
The term marketing mix was coined in an article written by Neil Borden called “The Concept of the Marketing Mix.” He started teaching the term after he learned about it from an associate, James Culliton, who in 1948 described the role of the marketing manager as a "mixer of ingredients"; one who sometimes follows recipes prepared by others, sometimes prepares his own recipe as he goes along, sometimes adapts a recipe from immediately available ingredients, and at other times invents new ingredients no one else has tried”.
7 Ps of the Service Marketing Mix
The customer service for a service firm cannot be explicitly divided into pre-transaction and post-transaction elements, because production and consumption of a service occurs at the same time. The service provided can prove effective in terms of satisfying the customer, only if the gap between expected service and perceived service is bridged. The wider this gap–the more the number of disappointed customers; and disappointed customers may cause the image of the firm to deteriorate.
1. Product/Service
Most services are intangible because they are performances rather than objects, precise manufacturing specifications concerning uniform quality can rarely be set. Because of this intangibility, the firm may find it difficult to understand how consumers perceive their services. For developing a good customer service, the service marketer should stress on tangible cues and also create a strong organizational image. This can be done by communicating clearly to the customers the features of the service being provided.

2. Price
Because of the intangible nature of the service–price becomes a pivotal quality indicator in situations where other information is not available. It is essential, therefore that the service firm engage in competitive pricing. Being an important tangible cue, price of the service is an area in which the service marketer can concentrate to get a competitive edge. In the case of pure services, as in the present context, like medical services or legal services price is an important factor because it is a basis for the customer to make a final choice among several competing service organizations.
3. Place
Because services are performances that cannot be stored, service businesses frequently find it difficult to synchronize supply and demand. Also, services cannot be inventoried for the same reason. Consequently the service firms must make simultaneous adjustments in demand and capacity to achieve a closer match between the two. Also, the firm could use multisite locations to make the service more accessible to the users. If the service is located in a remote area, regardless of the other advantages of the service, customers would not be motivated to use the service.
4. Promotion
The service marketer should constantly simulate word-of-mouth communications apart from using regular advertising. If customers in an existing market, for some reason or another have an image of the firm which does not correspond with reality, traditional marketing activities can be expected to be an effective way of communicating the real image to the market. Communication includes informing the customers in a language they can understand. Especially in services post-purchase communication is very important, because retaining existing customers is as important, as or even more important than attracting potential customers.

5. Physical Evidence
Physical Evidence such as infrastructure, interior, decor, environmental design, business card, etc that establishes firm's image and influences customer's expectations. Tangible clues help customer judging the quality of service before service usage or purchase. Before service usage the service is known by the tangible elements that surrounds it. In product marketing quality of product is judged by the product itself. Since services cannot be readily displayed, firms should create a conducive environment that helps the customers to develop a positive perception of the service.
For example, people would not like to wait for a medical service or a legal service, if the atmosphere of the place they are made to wait is unpleasant. Customers can be put off by a mere change in the layout of the service facility or even the absence of clear signboards.
6. Participants
A participant in service environment also provides clues about what the customer should expect. Training the personnel adequately is a major factor influencing the provision of quality service. Hence, providing customer service in a service industry depends not only on recognizing customer desires and establishing appropriate standards, but also on maintaining a workforce of people both willing and able to perform at specified levels.
Most services are highly labor intensive; the behavior of the personnel providing the service and the customers involved in production (due to the inseparable nature of services), have an effect on providing efficient customer service. To achieve customer-oriented personnel, the organization needs to recruit and select the right people, and offer an appropriate package of employment, in order to enhance their skills and encourage them. Because of the constant interaction between the employees involved in the service, and the customers–there is a mutual dependence between the two. If the customers are dissatisfied, employees experience discomfort working with unhappy customers, and customers are unhappy because the employees were not trained in customer satisfaction. The extent of this mutual dependence influences the customer’s perception of the service.
7. Process
The how of service delivery is called the ‘process’ or the ‘functional’ quality. The attitudes and behavior of service personnel influence perceived service performance. These behaviors are usually associated with what is called the ‘process’. For example, when things go wrong in a service encounter, employees frequently attempt to sooth disgruntled customers by apologizing, offering to compensate, and explaining why the service delivery failure occurred. Any of these behaviors may influence customer attributions about the firm’s responsibility for the failure and the likelihood of it occurring again. Previous experience with a service also influences the expectations of the customer. If the customer has had a bad experience with the service on any previous occasion, it will influence his or her future perceptions of the service. It is essential to train the front line employees, whose actions and behavior influence the customer’s opinions of the organization and the actual service provided.

Tourism Marketing
Introduction
Travel and tourism have been considered as an important industry in the service sector. The service sector consists of various kinds of industries such as financial services, health care services, and information sector services. Among these industries, tourism is one of the most important indicators of economic contributions for both developed and developing countries. An economic impact of tourism is significant, since huge amount of foreign inflow come from tourism. Moreover, tourism accounts for the major source of cash incomes, and it has been regarded as a major source of economic growth and employment creation.
Tourism is today emerging as a leading sector in the world and is now considered by some as the number one industry. International tourism in emerging & developing markets has grown at an average rate of 6-8% over the past decade. Demographic, socio-structural and socio-cultural developments have always led to changes in tourist demands, and service providers in tourism are faced with a substantial need to adjust. These constant challenges have expanded and intensified considerably in the first few years of the new millennium.
War and tourism, extreme weather, the ongoing internationalization of tourism and the ageing of society (increasingly prominent in public awareness) have emphatically demonstrated the latent vulnerability of tourism as a boom industry. The survival of the tourism industry depends decisively on recognizing the relevant trends and allowing for them in good time. Development of tourism is a very complex process of interaction among many players, who have the shared responsibility concerning the environmental, social and economic sustainability of this lucrative sector. This process involves the tourism industry, which promotes a sustainable product; the consumer who develops the sustainable consumptions trends; and the public authorities who strive to create the right framework so as to enable the sustainable use of the resources and the creation of a commercial level-playing field among all the different stakeholders.
Tourism has become one of the most crucial sectors in a large number of emerging markets. Emerging markets refer to countries that have rapidly growing economy or that are in a transitional phase between developed and developing status. Emerging markets comprise more than half of the world's population, account for a large share of world output, and have very high growth rates. These emerging countries have a strong effect to the global economy as a whole. In fact, it is forecasted that by 2050 emerging countries especially the BRIC economies Brazil, Russia, India, and China will surpass those developed countries as the United States, Japan, Germany, U.K., France, and Italy. On top of that, tourism in emerging markets is a major source of economic growth and foreign income.
For these markets, the expected economic improvement relied heavily on the amount of tourism inflow.
The tourism industry in emerging markets is forecasted to keep increasing in the next decade. For example, the tourism industry China and India are growing rapidly, leading to a significant increase in both business and leisure travel. In particular, China will jump from fourth to second position above Japan and Germany and is forecasted to increase its travel and tourism demand four times up by 2018, accounting for US$2,465 billion, with an annual growth rate of 8.9%.. However, the tourism industry has been affected by the ongoing global economic crisis.
The World Travel and Tourism Council revealed the results of its Travel and Tourism Competitiveness Report (2009), explaining that the tourism trends will face a more challenging time than ever before due to the impact from an economic uncertainty. The report also predicts a downturn of international tourism particularly in emerging markets. Although the tourism industry in emerging market will face a new challenge, it is believed that the trend will be positive in the long-run if properly managed.
Thus, understanding and accurately forecast demand in the industry is essential in order to proactively survive during this tough time and effectively manage the industry over time.
Types of Tourism in India
All types of tourism in India have registered phenomenal growth in the last decade ever since the Indian government decided to boost revenues from the tourism sector by projecting India as the ultimate tourist spot.
The reason why India has been doing well in all types of tourism in India is that India has always been known for its hospitality, uniqueness, and charm – attributes that have been attracting foreign travelers to India in hordes. The Indian government, in order to boost tourism of various kinds in India, has set up the Ministry of Tourism and Culture. This ministry recently launched a campaign called ‘Incredible India!’ in order to encourage different types of tourism in India. The result was that in 2004, foreign tourists spent around US$ 15.4 billion during their trips to India. Being a country with tremendous diversity, India has a lot to offer in terms of tourism and related activities. The diversity that India is famous for, ensures that there is something to do for all tourists in India, no matter what their interests.
Adventure Tourism
As a kind of tourism in India, adventure tourism has recently grown in India. This involves exploration of remote areas and exotic locales and engaging in various activities. For adventure tourism in India, tourists prefer to go for trekking to places like Ladakh, Sikkim, and Himalaya. Himachal Pradesh and Jammu and Kashmir are popular for the skiing facilities they offer. Whitewater rafting is also catching on in India and tourists flock to places such as Uttranchal, Assam, and Arunachal Pradesh for this adrenalin-packed activity.
Wildlife tourism
India has a rich forest cover which has some beautiful and exotic species of wildlife – some of which that are even endangered and very rare. This has boosted wildlife tourism in India. The places where a foreign tourist can go for wildlife tourism in India are the Sariska Wildlife Sanctuary, Keoladeo Ghana National Park, and Corbett National Park.
Medical Tourism
Tourists from all over the world have been thronging India to avail themselves of cost-effective but superior quality healthcare in terms of surgical procedures and general medical attention. There are several medical institutes in the country that cater to foreign patients and impart top-quality healthcare at a fraction of what it would have cost in developed nations such as USA and UK. It is expected that medical tourism in India will hold a value around US$ 2 billion by 2012. The city of Chennai attracts around 45% of medical tourists from foreign countries.
Pilgrimage Tourism
India is famous for its temples and that is the reason that among the different kinds of tourism in India, pilgrimage tourism is increasing most rapidly. The various places for tourists to visit in India for pilgrimage are Vaishno Devi, Golden temple, Char Dham, and Mathura Vrindavan.
Eco Tourism
Among the types of tourism in India, ecotourism have grown recently. Ecotourism entails the sustainable preservation of a naturally endowed area or region. This is becoming more and more significant for the ecological development of all regions that have tourist value. For ecotourism in India, tourists can go to places such as Kaziranga National Park, Gir National Park, and Kanha National Park.
Cultural Tourism
India is known for its rich cultural heritage and an element of mysticism, which is why tourists come to India to experience it for themselves. The various fairs and festivals that tourists can visit in India are the Pushkar fair, Taj Mahotsav, and Suraj Kund mela.
The types of tourism in India have grown and this has boosted the Indian economy. That it continues to grow efforts must be taken by the Indian government, so that the tourism sector can contribute more substantially to the nation’s GDP.

Detail Study of all Types of Tourism in India
Adventure Tourism in India
Adventure tourism India has increased in recent years due to the efforts taken by the Indian government and the Ministry of Tourism. The scope for adventure tourism in India is endless because the country has a rich diversity in terms of climate and topography.
Various kinds of adventure on water, land, and air can be enjoyed in India. The ministry of tourism and culture has, in recent years, launched a campaign called ‘Incredible India!’ and this has given a tremendous boost to adventure tourism in India.
The various kinds of adventure tourism in India are:
• Rock climbing
• Skiing
• Camel safari
• Para gliding
• Mountaineering
• Rafting in white water
• Trekking
As a kind of adventure tourism in India, rock climbing is relatively new. Due to the presence of climbing rocks in large numbers throughout the country, rock climbing as a kind of adventure tourism in India is taking off in a big way. The various places in India where tourists can go for rock climbing are Badami, Kanheri Caves, Manori Rocks, and Kabbal. Skiing in India as a kind of adventure tourism has become popular in the last decade. The country has a large number of hill stations which have excellent skiing facilities. This has given rise to skiing adventure tourism in India. The places in India where tourists can go for skiing are Manali, Shimla, Nainital, and Mussoorie.
Whitewater rafting in India is a relative newcomer in the domain of adventure tourism in India. This has been increasing due to the presence of a number of rivers, water falls, and rapids. The places where a tourist can go for whitewater rafting in India are Ganga, Alaknanda, and Bhagirathi rivers. Trekking as a part of adventure tourism India has grown recently. Many tourists are coming to India in order to go trekking in the various rugged mountains present in India.
Camel safari in India has also become very popular due to the initiatives taken by the tourist boards of some Indian states. The most famous destinations in India for camel safaris are Bikaner, Jodhpur, and Jaisalmer. Paragliding in India has developed recently and paragliding facilities are available in a lot of places in India.
Mountaineering in India is also quite popular in the arena of adventure tourism. Tourists can go to Garhwal, Himachal Pradesh, and Jammu and Kashmir for indulging in mountaineering.
Adventure tourism India has registered a formidable growth in recent years. For this growth to continue, efforts must be taken by the government of India so that India ranks alongside international destinations for adventure tourism.

Cultural Tourism in India
Cultural tourism in India is the predominant factor behind India’s meteoric rise in the tourism segment in recent years, because from time immemorial, India has been considered the land of ancient history, heritage, and culture.
The government of India has set up the Ministry of Tourism and Culture to boost cultural tourism in India. The ministry in recent years has launched the ‘Incredible India!’ campaign and this has led to the growth of culture tourism in India.
India has had many rulers over the centuries and all of them made an impact on India's culture. One can see the influence of various cultures in dance, music, festivities, architecture, traditional customs, food, and languages. It is due to the influence of all these various cultures that the heritage and culture of India is exhaustive and vibrant. This richness in culture goes a long way in projecting India as the ultimate cultural tourism destination given boost to tourism in culture in India.
The most popular states in India for cultural tourism are:
• Rajasthan
• Tamil Nadu
• Uttar Pradesh
• Uttaranchal
Among the various states for cultural tourism in India, Rajasthan is the most popular. The reason for this is that Rajasthan is famous for its rich cultural heritage. The state is renowned for many magnificent palaces and forts which showcase the rich cultural heritage of Rajasthan. The various folk songs and music also reflect the cultural heritage of Rajasthan. A large number of festivals and fairs are held in Rajasthan such as the camel festival, Marwar festival, and Pushkar festival. All these attract many tourists to Rajasthan for they get to see the rich culture of the state.
Tamil Nadu is also famous for cultural tourism in India, for it shows the Dravidian tradition and culture. It has many temples which mirror the rich cultural heritage of India. Uttar Pradesh has a lot of tourist places which also testify to the rich culture of the country. The most famous monument is the Taj Mahal in Agra. Cities like Varanasi, Allahabad, Vrindavan, and Ayodhya in Uttar Pradesh also attract a large number of tourists for they encapsulate beautiful vignettes of India.
Uttaranchal is also famous for cultural tourism India. This state has the Himalaya mountains which are called the abode of the Gods. Many ancient temples are found in the Kumaon and Garhwal regions of the state.
Cultural tourism India has witnessed a lot of growth in recent years. For this growth to continue, the government of India needs to take further pro-active steps and measures.

Eco Tourism India
Ecotourism India has developed recently, for the concept itself is a relatively new one. Ecotourism entails traveling to places that are renowned for their natural beauty and social culture, while making sure not to damage the ecological balance.
Ecotourism pertains to a conscious and responsible effort to preserve the diversity of a naturally endowed region and sustaining its beauty and local culture. Indians have been known since ages to worship and conserve nature. So the growth of ecotourism in India is but natural. Also, the government of India has set up the Ministry of Tourism and Culture to promote ecotourism in India alongside other types of tourism.
Ecotourism in India has grown significantly in recent years in India since the country has a diverse geography which led to the development of many tourists destinations. These various destinations not only de-stress the tourists but also rejuvenate them. There are various ways in which tourists can enjoy nature in India. And this has given ecotourism in India a major boost.
Places such as Kerala, Lakshadweep Islands, the Himalayan region, north-east India, and Andaman and Nicobar Islands are some destinations in India where tourists can participate in ecotourism-related activities. In Kerala, Thenmala is a planned ecotourism spot and is the first of its kind in India. Great care has gone into the care and preservation of Thenmala so that it caters to nature lovers and eco- tourists.
Eco-tourists have been thronging India in large numbers for it has a rich source of flora and fauna. A great number of endangered and rare species are also to be found in the various national parks in India. The major national parks in India for ecotourism are:
• Corbett National Park in Uttar Pradesh
• Bandhavgarh National Park in Madhya Pradesh
• Kanha National Park in Madhya Pradesh
• Gir National Park and Sanctuary in Gujarat
• Ranthambore National Park in Rajasthan
Ecotourism India has increased in the last few years. The government of India and Ministry of Tourism need to make concerted efforts to ensure that ecotourism in India is able to keep pace with ecotourism destinations across the world and making sustainable tourism a priority.

Heritage Tourism India
Heritage tourism India has registered an immense growth in the last few years, ever since additional initiatives were taken by the government of India to boost India’s image as a destination for heritage tourism.
India has always been famous for its rich heritage and ancient culture. So the onset of heritage tourism in India was long anticipated. India’s glorious past and cultural diversity make a potent blend which attracts millions of tourists each year to its heritage tourist attractions. The government of India and the Ministry of Tourism and Culture encourage heritage tourism in India by offering several benefits to the Indian states that are particularly famous for attracting tourists.
India's rich heritage is amply reflected in the various temples, palaces, monuments, and forts that can be found everywhere in the country. This has led to the increase in India's heritage tourism.
The most popular heritage tourism destinations in India are:
• Taj Mahal in Agra
• Mandawa castle in Rajasthan
• Mahabalipuram in Tamil Nadu
• Madurai in Tamil Nadu
• Lucknow in Uttar Pradesh
• Delhi, the Indian capital
The maximum number of tourists who come to India visit the Taj Mahal for it is one of the 7 wonders of the world. It is made of marble which has intricate inlay work done in an exquisite and meticulous style. The Mandawa castle in Rajasthan, built in 1775 reflects India's rich heritage and attracts thousands of tourists each year to Rajasthan which seems especially popular for its antique paintings, jade jewelry, palaces, and costumes. Mahabalipuram has sculptural and architectural sites which are considered the greatest in India. Mahabalipuram has cave temples that have been carved from granite blocks and belong to the 7th century. This is the primary reason why many heritage tourists in India visit this place.
The tourism of heritage in India has also increased due to the interest of many foreigners in the temples of India. Madurai is known as the ‘temple city’ due to the presence of a large number of temples in the city. And for this reason, many tourists go and visit the place each year. The most important temple in Madurai is the Meenakshi temple.
Heritage tourism India has also been popularized because a lot of tourists go to Delhi which is not only the capital of India but also has many heritage sites. The most famous heritage sites in Delhi are the Red fort, Jama Masjid, Humayun's tomb, and Tughlaqabad fort.
Heritage tourism India has grown in recent years but there is scope for further development which can be attained only through combined efforts of the government of India and the tourism boards.

Depth Study on Medical Tourism
Introduction
Medical Tourism is a term that describes overseas travel for medical, cosmetic or dental health care. Medical outsourcing, health tourism, medical travel or health travel are all terms used to describe this phenomenon. In medical tourism, citizens of highly developed nations bypass services offered in their own communities and travel to less developed areas of the world for medical care. Medical tourism is fundamentally different from the traditional model of international medical travel where patients generally journey from less developed nations to major medical centers in highly developed countries for medical treatment that is unavailable in their own communities. Depending upon the need, the medical trips are to surgery centers overseas for medical or plastic surgery, or to overseas hospitals and clinics for advanced medical diagnostics, recuperation care or dental care.
The medical tourist usually chooses to have the surgery or procedure done overseas to:
(i) save on medical costs;
(ii) avoid long wait for medical services in their home country;
(iii) get better quality medical care or diagnostic services ; (iv) even protect their privacy;
For some medical tourists, combining a vacation with the medical procedure is the attraction. For most, though, vacationing and leisure tourism is secondary.
Most the medical tourists are from the US, Europe, Canada, Japan, and the Middle East. The future of medical tourism looks very bright with some countries registering about 30% annual growth in tourism related to healthcare. Medical tourism is surely a part of the next level of globalization.

The Increasing Popularity of Medical Tourism:
Although there are no verifiable statistics regarding the magnitude of medical tourism, the available information suggests that a substantial number of patients travel to developing nations for healthcare. In 2004, 1.2 million patients traveled to India for healthcare. One source projects that 6 million Americans will go offshore for medical services in 2010. It is estimated that medical tourism to Asia could generate as much as $4.4 billion by 2012, with approximately half of this revenue going to India.

SWOT of Indian Medical Tourism
Strengths
• Low cost of medical treatment - Prime India Medical Tourism Driver
• Experienced & talented pool of Medical Professionals.
• English is the most preferred language of communication in hospitals and medical centers
• Strong Private Hospital Infrastructure
• Government support in terms of incentives and long term stay in India
• Familiarity of Western Patients with Indian Doctors.
Weaknesses
• India is lagging behind in the competitive market due to the lack of adequate budgetary support for promotion and marketing as compared to some of the competing destinations, including those in India’s neighborhood.
• Taxation norms related to tourism industry, imposition of service tax and fringe benefit tax.
Opportunities:
• Increasing number of health insurance plans will extend their networks to include selected health care institutions around the world and will provide incentives to encourage beneficiaries to use off shore facilities for expensive surgical procedures.
• Modern well equipped hospitals in some areas of India serve the role of regional referral centre for patients from poor neighboring countries providing low cost services.
• To provide for brighter prospects for the industry, the hospitals can also acquire international accreditation, integrate traditional and clinical treatments and offer end-to-end value added services by tying up with tour operators, airline carriers and hotel companies. Hospitals can also allow foreign patients to pay through credit and ensure proper support services to foreign patients after they return to their native countries.
• Government of India can also reinforce its support through quick visa processing, improved flight connectivity and infrastructure development.
Challenges:
• Selection of the best possible destination for the specific service poses a challenge to the medical tourist.
• Safety of the patients or tourists visiting India.
• Cultural and Psychological barriers of the hosts towards outsiders.
• Government restrictions imposed on tourists.
Recommendations
• Initiative should be taken in creating a unique brand for Indian tourism which is vibrant and based on sustainable development.
• Setting up hotels on the surplus land available in the vicinity of Airport Authority of India or near International Airports within the prescribed norms.
• Developing effective marketing plans and strategies for sustainable development.
• Market research should be conducted in the areas of tourism services and products, their pricing, security issues, safety and quality etc.
• Usage of the various technological tools, including the internet, for advertising for greater and wider impact.
• Further, encourage ecommerce portals to extend effective marketing support to small and medium enterprises and also offer competitive packages.
• Publicity and materials used for promotional aspects should be made tax free.
• Tourism training should be imparted at the institutional level to create the awareness of new niche areas of tourism. Medical Tourism Destinations:
The medical tourism marketplace consists of a growing number of countries competing for patients by offering a wide variety of medical, surgical, and dental services. Many of these destinations boast modern facilities with advanced technology and appealing accommodations. A number of countries in Central and South America have developed strong reputations for cosmetic and plastic surgery, bariatric procedures, and dental care. India, Malaysia, Singapore, and Thailand are well-established medical tourism destinations that have become popular for patients seeking cardiac surgery and orthopaedic surgery. Medical services in India are particularly affordable, with prices as low as 10% of those in the United States. Several highly developed nations including Belgium, Canada, Germany, Israel, and Italy are attracting foreign patients under the banner of medical tourism, offering sophisticated modern care with careful attention to patient preference, service, and satisfaction.
List of Medical Tourism Destinations (countries) :
Asia/Middle East – China, India, Israel, Malaysia, Singapore, South Korea,
Philippines, Taiwan, Turkey, United Arab Emirates
The Americas – Argentina, Brazil, Canada, Colombia, Mexico, United States
Europe – Belgium, Czech Republic, Germany, Hungary, Italy, Poland, Portugal, Romania, Russia, Spain
Africa – South Africa, Tunisia
Other – Australia, Barbados, Cuba, Jamaica

The Marketing Mix for Tourism Industry. They are,
1. Product Elements
2. Process
3. Place and Time
4. Productivity and Quality
5. Promotion & Education
6. People
7. Price & other user costs
8. Physical Evidence
8Ps in Detail
PRODUCT ELEMENTS
In planning its market offering, the marketer needs to think through five levels of product. Each level adds to the customer value, and the five constitute a customer value hierarchy.
The levels of the product that the travel and tourism industry offers to its customers are as follows:
1) Core product
The core product offered by Travel and Tourism industry is the destination. It is core because the main aim of the tourist is the destination where he has to reach or go.
2) Basic product
The basic products offered by Travel and Tourism industry are ticket booking, transport, sightseeing, hotel booking.
3) Expected product
These are the products that the customer expects the organization to offer. These are impeccable services, seat availability on needed time as it is critical to business travelers, accurate information, quick check in for the senior manger of the company, authentic information, information about various packages, different routes leading to a particular destination.
4) Augmented product
These are the products that are offered by the companies to distinguish itself from others. These products become expected products in the future. Those are flat beds in business class, Wi-Fi connection in hotels, customized meals on board, tele checking 8hrs booking in hotels, hotels providing laptops on request, internet access as complimentary for the corporate packages.
5) Potential products
These are the future products that the companies will offer to its customers. These can be underwater tourism, hovercraft for traveling. Also Virgin Atlantic airlines are thinking of adding a casino and a shopping mall in the airline.
PROCESS
The process in Tourism include,
(a) trip planning and anticipation,
(b) travel to the site/area,
(c) recollection,
(d) trip planning packages.
The trip planning packages include, maps, attractions enroute and on site, information regarding lodging, food, quality souvenirs and mementoes.
It is the way of undertaking transaction supplying information and providing services on a way, which is acceptable to the consumer and the effective to the organization. Now to make this definition of process true, it is necessary for the organization which provides services to recognize the critical moments in the entire process which makes the service acceptable or not acceptable to the customer depending on the zone of tolerance and effective or not effective to the organization.
PLACE and TIME-LOCATION and ACCESSIBILITY
The place and time in tourism is providing directions and maps, providing estimates of travel time and distances from different market areas, recommending direct and scenic travel routes, identifying attractions and support facilities along different travel routes, and informing potential customers of alternative travel methods to the area such as airlines and railroads.
Most tour operators sell their services through travel agents, however some deal directly with the consumers and eliminate middlemen.
For example, Thomas Cook has its own branches situated throughout the country so they are easily accessible. The customer, in the travel and tourism industry, has to go to the service provider. Hence strategic locations are very important for Thomas Cook. Other companies may also utilize more than one method of distribution.
Transport also plays a major role in the tourism industry. It makes the destinations accessible to people from around the world. Also, in the case of tangible products in tourism such as souvenirs and cuisine, transportation becomes a major logistical component.
PRODUCTIVITY and QUALITY
This is similar to other service industries. The quality is assessed by time taken for a service, the promptness of the service, reliability and so on.
PROMOTION and EDUCATION
The service marketer should constantly simulate word-of-mouth communications apart from using regular advertising. If customers in an existing market, for some reason or another have an image of the firm which does not correspond with reality, traditional marketing activities can be expected to be an effective way of communicating the real image to the market. Communication includes informing the customers in a language they can understand. Specially in services post-purchase communication is very important, because retaining existing customers is as important, or even more important than attracting potential customers.
Like other services, the promotion should address, the accurate and timely information helping to decide whether to visit target audience, the image to be created for the organization, objectives, budget, timing of campaign, media to be selected, and evaluation methods.
PEOPLE
People is the centre for Tourism. It is more a human intensive sector. For hospitality and guest relations it is very important to focus on people. It also plays a vital role in quality control, personal selling, and employee morale.
PRICE & and OTHER USER COST
In pricing decisions, the product or the service mix of the tourist organization is important. They have to set prices in line with the quality of services to be made available to the customers and the type of customers they are targeting. Pricing decisions are influenced by internal factors like pricing policy of the company, and external factors like the destination itself. They are required to think in favor of discounting price. These may include discounts for cash payments, seasonal discounts, trade discounts etc. But while offering the discounts, it is not to be forgotten that it may also create image problem since some of the value sensitive tourists may doubt the quality.
Because of the intangible nature of the service–price becomes a pivotal quality indicator in situations where other information is not available. It is essential, therefore that the service firm engages in competitive pricing. Being an important tangible cue, price of the service is an area in which the service marketer can concentrate to get a competitive edge. In the case of pure services, as in the present context, like medical services or legal services price is an important factor because it is a basis for the customer to make a final choice among several competing service organizations. PHYSICAL EVIDENCE
Physical Evidence such as infrastructure, interior, decor, environmental design, business card, etc that establishes firm's image and influences customer's expectations. Tangible clues help customer judging the quality of service before service usage or purchase. Before service usage the service is known by the tangible elements that surrounds it. In product marketing quality of product is judged by the product itself.
Physical evidence, as already discussed under the services marketing mix, like the environmental decor and design significantly influence the customer’s expectations of the service. Since services cannot be readily displayed, firms should create a conducive environment that help the customers to develop a positive perception of the service. For example, people would not like to wait for a medical service or a legal service, if the atmosphere of the place they are made to wait is unpleasant. Customers can be put off by a mere change in the layout of the service facility or even the absence of clear signboards main unresolved.

The Continuing Evolution of Medical Tourism:
The medical tourism industry is fueled and driven by patients who feel discomfort by the healthcare system in their home country. These informed patients shop outside the organized medical system to find services that are affordable, timely, or simply available. The flight of American patients to foreign destinations for lifesaving operations is a symptom of an affordability problem that is symbolically important and must be addressed by physician leaders. These leaders must recognize that patients, like all consumers, will search for providers who offer them maximal value, and medical tourism is an explicit declaration about what patients value most. Physicians and hospitals in medical tourism destinations recognize that they must provide high-quality care to develop a sustainable competitive advantage in the international marketplace. It is increasingly apparent that medical tourism is changing the healthcare landscape in industrialized and developing countries around the world, and there is every reason to believe that this trend will continue to evolve.

Quality and Safety in Medical Tourism:
Faced with the choice of many medical institutions in diverse countries, medical tourists may find it very difficult to identify well-known & reputed physicians and modern hospitals that consistently provide high-quality care.
Concerns have been voiced regarding the risk of complications resulting from travel and vacation activities in the postoperative period. The management of postoperative complications that occur after a patient returns from an offshore medical facility, and the consequent costs of this care, are difficult issues that re Marketing mix for Tourism Industry

.Process of Medical Tourism:
Following are steps that will help the customers to have a happy and satisfying medical tourism experience. It will give an idea to the customers that how they can facilitate medical trip.
Step 1 (a) Initiating contact with the Tourism Company:
Following are the Medical Tourism provider Companies which may be a helpful resource for patients in making appropriate choices. They have won the National Tourism Awards 2010-2011 by the Government of India Ministry of Tourism.
The Kuoni Travel ((India) Pvt Ltd
(SWT) World Tours (India) Pvt Ltd, Delhi
M/s. Thomas Cook (India) Ltd, Mumbai
M/s. Creative Travel Pvt. Ltd., New Delhi
M/s. Abercrombie & Kent India Pvt. Ltd., New Delhi
M/s. Trail Blazer Tours India Pvt. Ltd., Noida
M/s. Orient Express Pvt. Ltd., New Delhi
(b) Informing the needs required
(c) Understanding various options available
(d) Deciding on medical travel
Step 2:
(a) Deciding on a treatment & a travel plan
(b) Preparing for the trip
Step 3:
(a) Arrive at the host country
(b) Undergo medical services
(c) Recuperate
(d) Decide on a holiday & return home
Medical Tourism Services:
Some famous Tourism company has researched & put together a list of services that medical tourist are keen on using.
(1) Passports Services
(2) Visas Services
(3) Cheap International Travel Insurance
(4) Supply of Medical Equipment
(5) International Cell Phone on Lease
(6) Digitizing Medical Documents
(7) Secured Medical Loans
(8) Unsecured Medical Loans
(9) Wish Speedy Recovery with Flowers
The mission of these tourism company is to have a satisfied & a happy medical tourist.

Economic Benefit for Travelers Seeking Medical Care
India benefits from all sections of tourism; however, in 2009, India's medical tourism earned $2.2 billion of revenue annually, according to a FICCI- Evalueserve study. It is estimated that 1 million medical tourists will receive treatment in 2012. Medically insured patients from all over the world come to India to get medical surgeries, dental care or holistic and Ayurvedic treatments. Medical tourism in India provides immediate treatment for low-cost prices at world-class hospitals. Most treatments cost one-fourth the price compared with Western prices. For instance, in 2009, open heart surgery cost $6000 in India compared with over $19,000 in the United States. Travel expenses are needed, but overall expenses are still cheaper than surgery in the home country. Wellness tourism, which consists of travelers coming to India for yoga, meditation, naturopathy, spa treatments and Ayurvedic remedies, is a demanding industry and most well known in the state of Kerala. Delhi, Mumbai, Kerala and Tamil Nadu are the leading destinations for medical tourism
Benefits of Medical Tourism:
(1)As the technology, doctor training and standards of healthcare in developing countries has vastly improved in recent years, more and more people are looking at medical tourism as an attractive solution to their health problems.
(2) Medical tourists come from all over the world, but most are citizens of Western nations such as the United States, Britain, Europe, the Middle East and Japan. The most obvious benefit for medical tourists is the dramatic savings in cost.
(3) Another major benefit is the speed at which some surgical procedures can be completed. The waiting period for a hip replacement in Britain, for example, can be up to a year or more. A patient can fly to India, Thailand, Malaysia or the Philippines and have the procedure done almost immediately. Since most of the doctors and surgeons in medical tourism destinations have been well-trained internationally, patients can expect quality healthcare at the reputable institutions.
(4) Insurance is another factor in the decision to choose a foreign country for a medical procedure. Some orthopaedic operations, especially knee and hip replacements, are often not covered by health insurance.
(5) A final benefit is the pleasure of adding some travel and adventure to your medical needs. For many medical tourists, a trip to Thailand or India will be a first. A big component of the medical tourism industry is the relaxing vacation period following the medical procedure.
In Thailand, patients can lounge on one of the country’s many beautiful beaches during their recovery, while India offers some amazing spa resorts where luxury and pampering is the focus. Up-and-coming South Africa even promotes wildlife safaris as part of its medical tourism packages.

Conclusion
In long run, medical tourism can become one of the niche areas for revenue generation as there is an increasing trend in the number of visitors coming to India for various treatments. Varsity of health care products in diversified areas renders multiple choices to the foreign tourists which can be one of the factors for capturing the larger market.

Bibliography
Books:
Articles:
Anamalai Tiger Reserve reopens for tourism, article written by K A Shaji, TNN Nov 28, 2012,
Medical translators to aid foreign patients article written by Aniruddha Ghosal, TNN Jan 24, 2013,
Websites:
www.businesscases.com www.niidtech.com www.ehow.com www.wikipedia.org www.business.mapsofindindia.com
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