Attributes for health tourism destination development
According to the literature reviewed in Section 2, some attributes were identified as helpful in the development of health tourism destinations in China. The respondents were asked to rate agreement of the importance of each attribute on a five-point Likert-type scale (from 1 = Strongly Disagree, to 5 = Strongly Agree). Table 1 shows the descriptive statistics of the attributes.
The results reveal that a safe environment is a prime attribute with a mean of 4.61. The “Fresh air and clean water” is the second favorable one for the development of health destination, followed by relaxing environment, tranquil environment, healthy diet, beautiful landscape, natural resources, high-quality therapeutic services/practitioner, accommodations, convenient transportation, cultural resources, and health center, all score above 4. Entertainment facility, geriatric nursing services, Chinese medicine treatment, Chinese Kong-Fu/Taiji, convention center and religious resources rank among the lowest.
ANOVA test was used to analyze the difference between the groups. Result in Table 2 reveals few differences were found according to the importance of the attributes. The differences existed in the convention center and Chinese Kong-Fu/Taiji. Young people below the age of 25 and those who do not have a marriage thought convention center is a useful attribute. Aging people between the age of 56 and 65 would love to have Chinese Kong-Fu or Taiji with a mean score at 4.25, but the people above 65 did not think that would be important.
To identify the underlying development dimensions for destinations, factor analysis was employed for the nineteen items. Principle rotation and varimax rotation were used to clarify the structure of the factors. First, three factor groups with an Eigenvalue greater than 1 were elicited that accounted for 66.723%, then try to add one more group the cumulative percent variance (CPV) raised to 72.03%. In all the factors, there are some dominant variables. Bartlett’s test of sphericity yields a value of 4216.924 with a statistical significance (ρ=0.000). KMO shows a value of 0.921, which indicated the suitability of the data for structure detection. All three factor groups possess Cronbach’s alpha value greater than 0.7, which showed acceptable consistency within the factor group. Table 3 reveals that the factors could be categorized into the four groups: basic services, health services, religious services, and social services.
Method for promotion
Based on the previous study, a set of promotion methods were adapted into the questionnaire (9). The respondents rated agreement level of effectiveness of each attribute on five-point Likert-scale (from 1 = Strongly Disagree, to 5 = Strongly Agree). Table 4 shows the results of the descriptive statistics. The chi-square test (all significant at the level of 0.01) indicated that all the items had influences on promoting. Nationwide/International event (i.e. Olympics), mass media advertising, special destination event (i.e. Marathon, Yoga congregation) and government campaign were rated as the four most effective ways of promoting with mean values above 3.81.
To examine the effective way of promoting to a different market segment, we performed the ANOVA analysis. The ANOVA test showed differences on levels of promotion preferences according to participants’ gender, age, monthly income, and marital status. Further, correlation analysis was performed to find the direction and degree of association. Table 5 presents the corresponding results. Regarding gender, cooperation with a geriatric nursing center and rehabilitation appealed to female more, with a mean score of 3.96 for female and 3.53 for male. Holding nationwide/International events or special destination events works effectively towards young people (with mean scores of 4.15 and 4.09 respectively), but not so convincingly for people over 65 (with mean scores of 2.33). The correlation between education background and promotion methods revealed that higher educated people were more likely to accept online advertising and advertisements on health magazines. To do marketing in the high-income segment is not an easy job. We could only find they have the least interest in government campaign, but no exist way could effectively encourage this group into health tourism. The Marital status also influenced promotion preferences. Event planning would be the best way to attract single, in-love people and even families (married and live with child) to the destinations.
Health tourism experience and expectations
To explore tourists’ experience and expectations, more questions were added, including “I am very familiar with health tourism”,” I have several health travel experiences”, “I am satisfied with my health travel experience”, “Health travel is worthwhile” and “I would like to participate again in health tourism activity”. Respondents were asked to rate each statement based on their agreement level using a five-point Likert scale (from 1 = Strongly disagree, to 5 = Strongly agree). Table 6 shows the frequency statistic and the chi-square test results. Overall, the respondents were lack of participation and understanding of health tourism (with a mean value below 3). Then the ANOVA analysis discloses that most of the population are in lack of health tourism awareness in China, as shown in Table 7. Only the aging people had a bearing on the re-travel intention. People aged between 56 and 55 (mean score of 4.08) had a comparatively higher willingness for participating in health tourism again than other age groups. This age group was considered more likely to be wealthy and leisure with the intention for better life quality.
Dream destinations and property buying
As for the choice of health destinations in the future, 49.32% of respondents chose international destinations, while 50.68% prefer domestic. Table 14 and 15 show the results of the frequency analysis of dream health destinations for Chinese people home and abroad. According to Table 8, the top three healthy tourist destinations in China are expected to be Hainan, Yunnan, and Guangxi. The most popular cities are Sanya, Xiamen, Guilin, and Hangzhou. From these areas, the ideal health tourism should have a right natural style, rich historical humanities, diverse national atmosphere and unique landscape feelings. These scenes, feelings, literary talent can let visitors experience the relaxation and nature of the body and mind. As can be seen from Table 9, the ideal health destinations are Europe, Asia, and the Americas, the most popular of which are Japan, Switzerland, New Zealand and the United States, which may be related to the importance attached to tourism in different countries and the degree of development of tourism resources.
An open-end question was added to analyze what is the difference when the tourists think of the health destinations in the east and west. Table 10 recorded the most representative opinions of from186 responders. We could see that in most tourists’ mind, there are better-developed health tourism industry in the west with better service, facilities, and natural environment. But the expenditure is much higher than in the east. Meanwhile, the concerns of health tourism are different. Spiritual health is very important in east health destinations, while physical health is very important in the west. Also, culture and food are different between east and west. When talking about property purchasing in health destinations, 22.51% of respondents showed their willingness within the price range of 500,000 RMB (about $73500) to 1,000,000 RMB (about $14700).
To understand the health travel pattern, respondents filled out two multiple-choice questions asking the traveling companion, types of traveling. A single-choice question was added requesting the length of stay. Table 10 shows the frequency analysis results. Majority of the respondents would like to travel with friends and families and mates when they do health tourism (61.0%, 77.2%, and 43.3% respectively). The respondents also showed great interest in independent traveling and semi-independent traveling (67.2% and 46.4% respectively); while traveling with professional health institution was viewed as the fourth favorable health travel type (22.8%). In terms of the length of stay, most of the respondents would like to take a health trip of 3-7 days (57.8%), which is pretty high compared to the 21.6% from all tourist sample survey of the government (China National Tourism Administration, 2016). Traveling for two to four weeks was also a favorable option (32.5%), which achieved a significantly high score by comparing 2.4% to the all type of tourist census data.