2014 03-20 secondary-rsch_hnee_final

WelDest project has been funded with support from the European Commission.
Thisreportreflectstheviewsonlyoftheauthor,andtheCommissioncannotbeheld
responsible for any use which may be made of the information contained therein.
Lead by Dipl.-Kfm. Steffen Lange, Ph.D.
University for Sustainable Development, Eberswalde, 2014
WelDest
Literature
Review
Health and
Well-Being in Tourism Destination
527775-LLP-1-2012-1-FI-ERASMUS-ECUE
http://weldest.blogspot.com

WelDest Literature Review 2014
Content
LIST OF TABLES......................................................................................................................................4
LIST OF ILLUSTRATIONS.......................................................................................................................4
1 INTRODUCTION TO HNEE...........................................................................................................6
2 RESEARCH AND DEFINITION......................................................................................................6
2.1 Research objectives and methodology.................................................................................................... 7
2.1.1 Research object I - Current state of existing health andwell-being destinations ................................ 7
2.1.2 Research object II - Current state of literature about health andwell-being destinations .................. 7
2.1.3 Research object III - Possible models to analyze health andwell-being destinations .......................... 8
3 FINDINGS OF SECONDARY RESEARCH......................................................................................9
3.1 Current state of existing health and well-being destinations................................................................... 9
3.2 Current state of literature about health and well-being destinations – literature review...................... 18
3.3 Possible models to analyze health and well-being destinations ............................................................ 19
3.3.1 Tourism models.................................................................................................................................. 19
3.3.1.1 Tourism area model ...................................................................................................................... 20
3.3.1.2 Tourism time model ...................................................................................................................... 22
3.3.1.3 Extended modular model of tourism ............................................................................................ 23
3.3.1.4 Economic tourism model............................................................................................................... 24
3.3.1.5 Framework of touristic mobility.................................................................................................... 27
3.3.1.6 System tourism by Bieger.............................................................................................................. 28
3.3.1.7 Micro-analytical system of tourism............................................................................................... 30
3.3.1.8 Swiss tourism concept................................................................................................................... 32

3.3.1.9 Determinants of DMO success ...................................................................................................... 33
3.3.1.10 Destination competitiveness and sustainability Model ................................................................ 35
3.3.1.11 Main elements of destination competitiveness............................................................................ 35
3.3.1.12 Guide to Tourism Destination Management (UNWTO) ................................................................ 37
3.3.2 Health models .................................................................................................................................... 39
3.3.2.1 Health cluster model ..................................................................................................................... 39
3.3.2.2 Step model to freight division of health economics...................................................................... 40
3.3.2.3 A concept of “Wellbeing Tourism in Finland” ............................................................................... 41
3.3.3 Wellness models ................................................................................................................................ 43
3.3.3.1 Wellness model by Dunn............................................................................................................... 43
3.3.3.2 Model for wellness by Ardell......................................................................................................... 45
3.3.3.3 Model for wellness by Hettler....................................................................................................... 47
3.3.3.4 Model for wellness by Travis......................................................................................................... 48
3.3.4 Service qualitymodels ........................................................................................................................ 50
3.3.4.1 Perceived service quality by Parasuraman et al............................................................................ 50
3.3.4.2 Donabedian Model........................................................................................................................ 51
3.3.4.3 Grönroos Model ............................................................................................................................ 53
3.3.4.4 “Moments of Truth” model........................................................................................................... 54
3.3.4.5 Meyer and Mattmüller model....................................................................................................... 55
3.3.4.6 Parasuraman, Zeithaml and Berry model...................................................................................... 56
3.3.4.7 Dynamic process model by Boulding, Staelin, Kalry and Zeithaml................................................ 59
3.3.4.8 Model of relationship quality by Liljander and Strandvik.............................................................. 60
3.3.5 Models and theory in regional management and destination development .................................... 61
3.3.5.1 Model of action dimensional circles.............................................................................................. 61
3.3.5.2 The export base theory ................................................................................................................. 62
3.3.5.3 Polarisation theories ..................................................................................................................... 63

3.3.5.4 Endogenous development theories /-distinctive regional development...................................... 65
3.3.5.5 Milieu approach (Innovative and creative environment).............................................................. 66
3.3.5.6 Cluster approach ........................................................................................................................... 67
3.3.5.7 New Economic Geography ............................................................................................................ 67
3.3.5.8 Learning Regions ........................................................................................................................... 68
3.3.5.9 Transaction cost theory................................................................................................................. 68
3.3.5.10 Institutional density (New institutions approach)......................................................................... 69
3.3.5.11 Evolution economics ..................................................................................................................... 70
3.3.5.12 Residential Economics................................................................................................................... 71
3.3.5.13 Smart specialization ...................................................................................................................... 72
4 CONCLUSION SECONDARY RESEARCH.................................................................................. 73
5 LIST OF REFERENCES................................................................................................................. 74

List of tables
Table 1: Marketed health and well-being destinations per country. Own illustration. ............ 9
Table 2: Results of research - regional analysis. Own illustration............................................ 17
Table 3: Results of literature review. Own illustration. ........................................................... 19
List of illustrations
Illustration 1: Process of literature review................................................................................. 8
Illustration2:Tourism area model. Freyer 2006, p.43. ............................................................. 20
Illustration 3: Tourism time model. Freyer 2006, p. 44. .......................................................... 22
Illustration4:Extended modular model of tourism. Freyer 2006, p. 47................................... 23
Illustration5: Factors of economic interest, in accordance with Freyer 2006, p. 48. .............. 24
Illustration6: Economics of tourism, Freyer 2006,p. 51........................................................... 25
Illustration 7: Framework of touristic mobility. Grümer 1993, p. 18....................................... 27
Illustration8: System of tourism (static). Bieger 2010, p. 84.................................................... 29
Illustration9: Micro-analytical system of tourism, in accordance with Pompl 1994, p. 6 ....... 30
Illustration 10: Swiss tourism concept. Beratende Kommission des Bundesrates 1979, p.84.32
Illustration 11: Comparison of success determinants for an ideal DMO and destination. T.
Bornhorst et al. / Tourism Management 31 (2010) 572–589.................................................. 34
Illustration 12: Integrated Model of Destination Competitiveness.......................................... 35
Illustration 13: The main elements of destination competitiveness, Dwyer/Kim (2003)......... 36
Illustration 14: Elements of Destination Management,UNWTO (2007).................................. 37
Illustration 15: Step model to freight division of health economics. BMBF 2010, p.42 .......... 40
Illustration16:Recommended concepts of health tourism by the Finnish Tourist Board (FTB by
Liisa Renfors 17.9.2010) ........................................................................................................... 42
Illustration 17: Wellness model by Dunn. Image source:
http://classconnection.s3.amazonaws.com/1084/flashcards/622455/jpg/dunn-wellness-
grid2.jpg.................................................................................................................................... 44
Illustration 18: Model for wellness by Ardell. Image source:
http://well.pacificrimwellness.com/1999_fall/articles/teacher_wellness.html ..................... 46

Illustration 19: Six dimensions of wellness. Image source:
http://c.ymcdn.com/sites/www.nationalwellness.org/resource/resmgr/docs/sixdimensionsf
actsheet.pdf, 1976.................................................................................................................... 47
Illustration 20: Illness-wellness continuum. Image source:
http://www.wellpeople.com/images/Illness_WellnessContinuum.jpg, 1972 ........................ 49
Illustration21: Model of perceived service quality. Gleitsman, Guttzeit, & Roschk 2010, p.9.50
Illustration 22: Model of Donabedian. Image source:
http://www.studydroid.com/imageCards/04/ek/card-4673550-back.jpg.............................. 52
Illustration 23: Grönroos model. Image source: http://water.prevos.net/category/blog/..... 53
Illustration24: Model of servicequality by Meyer and Mattmüller ......................................... 55
Illustration25: Model of service quality by Zeithaml, Parasuraman and Berry. Zeithaml, V.,
Parasuraman, A. & Berry, L. (1992), p. 49................................................................................ 57
Illustration26: Dynamic process model according to Boulding, Staelin, Kalry and Zeithaml .. 59
Illustration 27: Model of action dimensional circles................................................................ 62
Illustration 28: Income cycle of export basis approach, L.Schätzl (1996)................................ 63
Illustration 29: Regional polarisation (own presentation)....................................................... 64
Illustration 30Milieu approach, H.-J. Domhardt et al. (2009).................................................. 66
Illustration 31: New institutions approach (own presentation)............................................... 70
Illustration 32: Dominant development path of evolution economics (own presentation) ... 71

p. 6 weldest.blogspot.com
1 Introduction to HNEE
With about 1,900 students and 70 academic staff, Eberswalde University of Applied Sciences
(HNEE) is the state of Brandenburg's smallest university of applied sciences. By now, 14
programs have been developed which have shaped the university's profile as a place of
genuine commitment to the concept of sustainable management. It is the only university in
Germany that brings together different disciplines that relate to rural areas, i.e. forestry,
landscape management and nature conservation, organic agriculture, wood science and
technology, regional management and tourism. These attractive, unique programs lure
students from all over Germany and abroad to Eberswalde. HNEE has several subtask leads
in the WelDest project, e.g. they are hosting the international networking and benchmarking
event in Berlin (2014) and leading the secondary research. They are actively participating in
dissemination and exploitation in Germany, and in the creation of educational material.
2 Research and Definition
The aim of the secondary research is to get knowledge from the existing researchabout
health and well-being tourism and competencies needed in theareas of e.g. destination
development, regional planning, possible best practices and development tools.
Simultaneously a list of the existing health and well-being destinations, and their approach
to health (e.g. preventive approach, medical approach) in participating countries has been
compiled.This list consists of destinations which already market themselves as health and
well-being tourism destinations. The results will also be used as input for the stakeholder
research. Secondary research is conducted in all partner countries.

2.1 Research objectives and methodology
At the first WelDest project meeting in Attergau, the project partners developed a definition
of a H&WB destination, which was the basis for the secondary research. The definition: A
health and well-being destination (H&WB-destination) is an area chosen by
customers/guests (with either preventive or curative motives) as a travel destination to
improve their state of health and/or well-being. The destination includes all necessary
infrastructure such as accommodation, restaurants and other facilities, with a systematically
developed offer for health and well-being. The destination is managed and marketed
professionally as a unit.
2.1.1 Research object I - Current state of existing health andwell-being
destinations
The HNEEteamshould identify destinations which market themselves as health and well-
being destinations in the participating countries. According to the project definition,
theHNEEteam derivedcriteria to verify the state of a H&WB-destination. To ensure the
international approach of the review, the criteria were discussed with the other project
teams. After several changes a template was developed to guarantee the same review
processes in all participating countries. The review in each participating country was done by
the project teams involved. The consolidation and examination of collected data was done
by the HNEE team.
2.1.2 Research object II - Current state of literature about health andwell-
being destinations
The HNEE team should identify existing literature about health and well-being destinations
and about related topics. According to the project definition of aH&WB-destination, the
teamderived a list of keywords for further literature review. As a result,some changeswere
made to the keywordlist,and a final template for literature review in all participating
countries was developed. The research in each participating country was done by the
involved project teams. The consolidation and examination of collected data was done by
the HNEE team.

Illustration 1: Process of literature review.
2.1.3 Research object III - Possible models to analyze health andwell-being
destinations
The HNEE team should identify existing models to analyzehealth and well-being destinations.
According to the project definition of a H&WB-destination theHNEE team researched 5
approaches to find suitable models. The approaches were tourism, health promotion,
wellness, service quality and regional/ destination development. Out of the actual literature
the HNEE team identified suitable models from each approach. Furthermore they pointed
out the individual advantages and disadvantages for analyzing a H&WB-destination
usingeach model.
Literature
Review
1. Research in library
catalogs for
books/articles
2. Research in relevant
databases for
articles/projects
3.Research in Internet for
projects/associations/webs
ites

3 Findings of secondary research
3.1 Current state of existing health and well-being
destinations
With input from five universities across Europe – Germany, Finland, Austria, the United
Kingdom and the Czech Republic – this report examines the current state for health and
well-being in these regions. All partners communicated their findings on
destinationsaccording to the following criteria:
 Marketed itself as H&WB destination
 Has natural resources
 Has tourism infrastructure
 Has a regional management structure
 Has medical and wellness facilities
Searches were conducted on the database that is attached to this document. Based on the
keyword list the project teams identified 131 H&WB-destinations.
Current state of H&WB destinations per country
Country
Investigated
destinations
Identified H&WB
destinations
Austria 10 8
Czech Republic 35 24
Finland 15 11
Germany 60 48
UK 40 40
160 131
Table 1: Marketed health and well-being destinations per country. Own illustration.
To sum up, 160 destinations were researched and 131 destinations could be identified as
H&WB destinations. The most H&WB destinations could be identified in Germany with 48,
followed by the United Kingdom with 40 H&WB destinations.

Results of research - regional analysis
Nr. Country Destination
signed and
marked as a
healthcare
region
natural
resources
tourism
infrastructure
regional
management
structure
medical and
wellness
facilities
result of the
evaluation
health and
wellness
destination
1 Germany Metropolregion Rhein Neckar x x x x x 5 Yes
2 Germany Gesundheitsregion Stuttgart x x x x x 5 Yes
3 Germany Gesundheitsregion Schwaben x x x 0 x 4 Yes
4 Germany Gesundheitsregion Bad Dürrheim x x x x x 5 Yes
5 Germany Gesundheitsregion Bad Mergentheim x x x 0 x 4 Yes
6 Germany Gesundheitsregion Freyung-Grafenau x x x x x 5 Yes
7 Germany
Gesundheitsregion Bad Reichenhall -
Berchtesgadener Land
x x x x x
5
Yes
8 Germany Gesundheitsregion Passauer Land x x x x x 5 Yes
9 Germany
Gesundheitsregion Garmisch-
Partenkirchen
x x x x x
5
Yes
10 Germany Gesundheitsregion Bad Bayreuth x x x x x 5 Yes
11 Germany Gesundheitsregion Bad Griesbach 0 x x 0 x 3 No
12 Germany Gesundheitsregion Allgäu x x x x x 5 Yes
13 Germany Gesundheitsregion Berlin Buch x x x x x 5 Yes
14 Germany
Gesundheitsregion Berlin
Brandenburg
x x x x x
5
Yes
15 Germany Region Templin 0 x x 0 x 3 No
16 Germany Region Eberswalde 0 x x x x 4 Yes
17 Germany Region Wandlitzer Seengebiet 0 x x 0 x 3 No
18 Germany Region Prignitz x x x 0 x 4 Yes
19 Germany
Erlebnis- & Gesundheitsregion
Spreewald
x x x x x
5
Yes

20 Germany Wellnessregion Niederlausitz 0 x x 0 x 3 No
21 Germany Bad Saarow x x x x x 5 Yes
22 Germany Region Luckenwalde 0 x x 0 x 3 No
23 Germany Schwielosee 0 x 0 0 x 2 No
24 Germany Bremen 0 x x x x 4 Yes
25 Germany Gesundheitsregion Hamburg e.V. x x x x x 5 Yes
26 Germany Gesundheitsregion Nordhessen x x x x x 5 Yes
27 Germany Marburg-Biedenkopf 0 x x x x 4 Yes
28 Germany Rhein-Main x x x x x 5 Yes
29 Germany
Gesundheitsregion Mecklenburg-
Vorpommern
x x x x x
5
Yes
30 Germany
Gesundheitsregion Mecklenburgische
Ostseeküste
x x x x x
5
Yes
31 Germany
Gesundheitsregion Fischland Darß-
Zingst
x x x x x
5
Yes
32 Germany Gesundheitsregion Insel Usedom x x x x x 5 Yes
33 Germany Gesundheitsregion Insel Rügen x x x x x 5 Yes
34 Germany
Gesundheitsregion Hannover-
Braunschweig
x x x 0 x
4
Yes
35 Germany Gesundheitsnetzwerk Weser-Ems x x x 0 x 4 Yes
36 Germany
Gesundheitsregion Osnabrücker Land
in Weser-Ems
x x x x x
5
Yes
37 Germany Osnabrück x x x x x 5 Yes
38 Germany Health Region Cologne Bonn x x x x x 5 Yes
39 Germany Gesundheitsregion Göttingen e.V. x x x x x 5 Yes
40 Germany Gesundheitsregion Saar x x x x x 5 Yes
41 Germany Gesundheitsregion Vogtland 0 x x x x 4 Yes
42 Germany Gesundheitsregion Erzgebirge 0 x x x x 4 Yes
43 Germany Gesundheitsregion Sächsisches x x x 0 x 4 Yes

Elbland
44 Germany
Gesundheitsregion Carus Consilium
Sachsen
x x x x x
5
Yes
45 Germany Gesundheitsregion Oberlausitz x x x x x 5 Yes
46 Germany Harz x x x x x 5 Yes
47 Germany Halle Saalekreis x x 0 0 x 3 No
48 Germany Dübener Heide 0 x x x x 4 Yes
49 Germany Gesundheitsregion Magdeburg 0 x x x x 4 Yes
50 Germany Gesundheitsregion Nord x x x 0 x 4 Yes
51 Germany Gesundheitsregion Kreis Segeberg x x x x x 5 Yes
52 Germany Gesundheitswirtschaft Nord x x x x x 5 Yes
53 Germany MedCom Gesundheit Südholstein x x x x x 5 Yes
54 Germany Gesundheitsregion Thüringer Wald x x x x x 5 Yes
55 Germany Gesundheitsregion Saale-Ilm-Elster 0 x x 0 x 3 No
56 Germany Gesundheitsregion Finsterbergen x x x 0 x 4 Yes
57 Germany Gesundheitsregion Weimar x x x x x 5 Yes
58 Germany Gesundheitsregion Masserberg 0 x x 0 x 3 No
59 Germany Gesundheitsregion Bad Sulza 0 x x 0 x 3 No
60 Germany Gesundheitsregion Bad Mergentheim x x x 0 x 4 Yes
61'
Czech
Republic
Poděbrady x x x 0 x
4
Yes
62
Czech
Republic
Lázně Toušeň x x 0 x 0
3
No
63
Czech
Republic
Třeboň x x x x x 5 Yes
64
Czech
Republic
Bechyně 0 x x 0 x 3 No
65
Czech
Republic
Vráž 0 x x 0 x 3 No

66
Czech
Republic
Konstantinovy Lázně x x x x x 5 Yes
67
Czech
Republic
Karlovy Vary x x x x x 5 Yes
68
Czech
Republic
Mariánské Lázně x x x x x 5 Yes
69
Czech
Republic
Františkovy Lázně x x x x x 5 Yes
70
Czech
Republic
Jáchymov x x x 0 x 4 Yes
71
Czech
Republic
Lázně Kynžvart x x 0 0 x 3 No
72
Czech
Republic
Teplice x x 0 x x 4 Yes
73
Czech
Republic
Klášterec nad Ohří x x 0 0 0 2 No
74
Czech
Republic
Dubí x 0 0 0 x 2 No
75
Czech
Republic
Mšené – lázně x x x 0 x 4 Yes
76
Czech
Republic
Lázně Libverda x x x x x 5 Yes
77
Czech
Republic
Lázně Kundratice x x 0 0 x 3 No
78
Czech
Republic
Janské Lázně x x x x x 5 Yes
79
Czech
Republic
Lázně Bělohrad x x x x x 5 Yes
80
Czech
Republic
Velichovky 0 0 x 0 0 1 No

81
Czech
Republic
Lázně Bohdaneč x x x 0 x 4 Yes
82
Czech
Republic
Hodonín x x x x x 5 Yes
83
Czech
Republic
Lednice x x x x x 5 Yes
84
Czech
Republic
Jeseník x x x x x 5 Yes
85
Czech
Republic
Lipová - lázně x x x x x 5 Yes
86
Czech
Republic
Velké Losiny x x x x x 5 Yes
87
Czech
Republic
Teplice nad Bečvou x x x x x 5 Yes
88
Czech
Republic
Bludov 0 x 0 x x 3 No
89
Czech
Republic
Slatinice 0 0 0 0 0 0 No
90
Czech
Republic
Luhačovice x x x x x 5 Yes
91
Czech
Republic
Ostrožská Nová Ves x x 0 x x 4 Yes
92
Czech
Republic
Kostelec u Zlína 0 x 0 0 x 2 No
93
Czech
Republic
Karviná - Darkov x x x x x 5 Yes
94
Czech
Republic
Karlova Studánka x x 0 x x 4 Yes
95
Czech
Republic
Klimkovice x x x 0 x 4 Yes

96 Finland Rokua x x x x x 5 Yes
97 Finland Savonlinna Region x x x x x 4 Yes
98 Finland Levi x x x x x 2 No
99 Finland Southern Ostrobthnia x x x x x 4 Yes
100 Finland Naantali 0 x x x x 4 Yes
101 Finland Vierumäki x x x 0 x 4 Yes
102 Finland Tahkovuori x x x 0 x 2 No
103 Finland Kainuu (Kuhmo& Sotkamo) 0 x x 0 x 4 Yes
104 Finland Peurunka x x x 0 x 4 Yes
105 Finland Rovaniemi x x x 0 x 3 No
106 Finland Salla x x x 0 x 3 No
107 Finland Lahti x x x 0 x 4 Yes
108 Finland Imatra and Lappeenranta x x x x x 4 Yes
109 Finland Pohjois-Savo x x x x x 4 Yes
110 Finland Ikaalinen x x x x x 5 Yes
111 Austria Gesundheitsregion Pinzgau (Salzburg) 0 x x 0 0 2 No
112 Austria Laufarena Bad Tatzmannsdorf x x x 0 x 4 Yes
113 Austria Vitalwelt Hausruck x x x 0 x 4 Yes
114 Austria Hohe Tauern Health x x x x 0 4 Yes
115 Austria Thermenland Steiermark x x x x x 5 Yes
116 Austria Bad Aussee x x x x x 5 Yes
117 Austria Vulkanland (Steiermark) x x x x 0 4 Yes
118 Austria Naturpark Zirbitzkogel-Grebenzen 0 x x x 0 3 No
119 Austria Joglland (Steiermark) x x x x 0 4 Yes
120 Austria Xundheitswelt x x x x x 5 Yes
121 UK Dartmoor and Exmoor National Parks 0 x x x x 4 Yes
122 UK
New Forest and South Downs
National Parks
0 x x x x 4 Yes

123 UK The Broads National Park 0 x x x x 4 Yes
124 Uk Peak District National Park 0 x x x x 4 Yes
125 Uk Cairngorms National Park 0 x x x x 4 Yes
126 Uk Northumberland 0 x x x x 4 Yes
127 Uk Lake District 0 x x x x 4 Yes
128 Uk Trossachs National Park 0 x x x x 4 Yes
129 Uk Snowdonia National Park 0 x x x x 4 Yes
130 Uk Brecon Beacons 0 x x x x 4 Yes
131 Uk Pembrokeshire National Park 0 x x x x 4 Yes
132 Uk Cotswolds 0 x x x x 4 Yes
133 UK Powys, Mid Wales 0 x x x x 4 Yes
134 UK Yorkshire 0 x x x x 4 Yes
135 UK Surrey 0 x x x x 4 Yes
136 UK Devon 0 x x x x 4 Yes
137 Uk Cornwall 0 x x x x 4 Yes
138 Uk Poole and Bournemouth 0 x x x x 4 Yes
139 Uk Manchester 0 x x x x 4 Yes
140 Uk Liverpool 0 x x x x 4 Yes
141 Uk Bristol 0 x x x x 4 Yes
142 UK Kent 0 x x x x 4 Yes
143 UK Northern Ireland 0 x x x x 4 Yes
144 Uk Witshire x x x x x 5 Yes
145 Uk Edinburgh 0 x x x x 4 Yes
146 UK Cheshire 0 x x x x 4 Yes
147 UK East Midlands 0 x x x x 4 Yes
148 UK England 0 x x x x 4 Yes
149 UK Bath x x x x x 5 Yes
150 Uk High Peak, including Buxton 0 x x x x 4 Yes

151 UK Scotland 0 x x x x 4 Yes
152 UK
Worcestershire, including Malvern
and Droitwich
0 x x x x 4 Yes
153 Uk Wales 0 x x x x 4 Yes
154 UK Blackpool 0 x x x x 4 Yes
155 UK Brighton 0 x x x x 4 Yes
156 Uk Warwickshire 0 x x x x 4 Yes
157 UK London 0 x x x x 4 Yes
158 Uk East Anglia 0 x x x x 4 Yes
159 UK Hertfordshire 0 x x x x 4 Yes
160 UK Berkshire, including Windsor 0 x x x x 4 Yes
Table 2: Results of research - regional analysis. Own illustration.

3.2 Current state of literature about health and well-being
destinations – literature review
Many authors have made attempts to define health, wellness and wellbeing. An extensive
review of the literature was conducted, involving on-line database keyword
searches,additional searches for other studies, screening of abstracts, assessing the
relevance to thereview and integrating the findings. Almost two hundred journal articles,
books and websites were accessed and examined to give an overview of the existing
literature and to findresearch and typical models to support the WelDest Project.
The literature search process included the following major steps:
 Development of keywordlist (to decide which keywords were suitable for research,
HNEE team conducted a brainstorming session as the first step. The other
participating countries were involved for the second step, with the project teams
approving the list);
 Review of the references sections of articles already in the teams’ possession to
identify potentiallyuseful studies;
 On-line searches of databases for potentially relevant articles;
 Review of government departments and NGO websites and related links
foradditional studies and/or unpublished documents;
 Screening of the abstracts to identify studies for further review; and,
 Canvassing of selected academic experts, organizations and governmentdepartments
for additional studies and/or unpublished documents.
To decide which keywords were suitable for research objective 2, the HNEE team conducted
a brainstorming session as the first step.The second step involved the other participating
countries, with the other project teams approving the list. The search terms originally
developed were refined during the course of the on-linesearches to reflect the terms and
keywords used by various on-line services and authors. Searches were conducted in the
database which is attached to this document. Based on the keyword list the project teams
identfied 188 references. During the study, there were no deviations from the methodology.
Country References Allocation in %
Germany 79 42%
UK 31 16%
Finland 28 15%
Austria 7 4%
Czech Republic 1 1%
Other 42 22%
188 100%

Table 3: Results of literature review. Own illustration.
3.3 Possible models to analyze health and well-being
destinations
3.3.1 Tourism models
Tourism theory describes the overall system of tourism in different models. They differ in
terms of the notion of an overall social system and the advantages and representation of the
specific system.1
Currently there is no single comprehensive worldwide accepted model for
tourism. Various scientific approaches have only been merged. However distinctions are
made in:2
- Economics (supply and demand)
- Sociology (group activities, social order, social values, etc.)
- Ecology (environmental impact)
- Geography (spatially relevant aspects)
- Psychology (personality traits, needs and motives)
- Political Science (national and international regulations in travel)
Other areas of science transfer their methods to tourism:
- Transport Economics  Tourism traffic
- Medical  Tourism medicine
- Planning  Tourism planning, etc.
As a result of this, isolated observation means splitting the tourism science disciplines. For an
comprehensive perspective a completely uniform analysis of tourism is to be made (all 6
areas)3
. The individual patterns of tourism are presented.
1
Vgl. Freyer, W. (2006), p. 36
2
Vgl. Freyer, W. (2006), p. 39
3
Vgl. Freyer, W. (2006), p. 39

3.3.1.1 Tourism area model
The word "tourism" is based on the word "tour", which means round trip or return trip.
Tourist trips are therefore always associated with a return to the starting point. Therefore,
the tourist area model differs in three factors:4
 Home area
 Transport area
 Destination area
Illustration2:Tourism area model. Freyer 2006, p.43.
4
Freyer, W.(2006), p. 42f.

Advantages: The model defines the word destination as a place to which a person is going. A
synonym would be the journey’s end. So the H&WB destination can be seen like this. Guests
choose the area while leaving their home for a certain time, which is defined with the word
trip. Whether in the first two figures or in the third one, which describes a roundtrip, each
shows the destination as a unit.
Disadvantages: Although the model describes the destination very clearly, it includes only
facts about the area and nothing about the time. It remains unmentioned how long guests
stay at the destination and what their motivation to come is. Furthermore it is not clear what
the external and internal influences are,or details about the infrastructure. The H&WB
definition takes “necessary infrastructure” as a given, but the model cannot servefully here.
All in all, it is to say that the tourism area model is not enough to explain the whole H&WB
destination. The description of a destination is a good way to start examining the theme.
However it will need further models to represent all requirements.

3.3.1.2 Tourism time model
The tourism time model is also known as a "springboard model of travel." It is different every
day, and during different times. The tourist is often moving around. The tourism time model
is suitable to map the spatial and cultural experience. Three factors have to be considered:5
- Home or everyday time
- Transport time
- Stay or destination time
Illustration 3: Tourism time model. Freyer 2006, p. 44.
Advantages: This model is as intelligible as the tourism area model, because time, just as
area, is subdivided into three fields and they are clearly distinguished from oneanother. If
people are in the transport or destination time, they have chosen the destination as required
in the H&WB definition.
Disadvantages: The model is limited to the factor time.Some more facts need to be
defined,such as the place where the guest is, and how they interact with the destination. It is
not stated whether or not the destination is managed as a unit and which necessary facilities
are situated there.
5
Vgl. Freyer, W. (2006), p. 42f.

The tourism time modelwas developedto define the aspect of time and how long guest stay
in a destination. The tourism time model could also be useful in addition to further models.
According to the project the model is not sufficient enough to explain detailed how a H&WB-
destination works or what it is.
3.3.1.3 Extended modular model of tourism
Theextended modular model of tourism explains mainly economic relations in touristic
areas. The model describes the interaction of different factors e.g.the relation between
visitors and institutions or between politics andecology. The aim of the model is to show
how a destination works withregard to interactions.6
Illustration4:Extended modular model of tourism. Freyer 2006, p. 47.
6
Vgl. Freyer, W. (2006), p. 45f.

Advantages:The model shows several internal and external influences on the trip. Moreover
the infrastructure, especially the facilities of a destination, are influenced by political,
economic and other circumstances. People, individuals and natural environment are as
important as the other facts. How a destination is created and which image is established
depends on the influences. A destination which is marketed and managed as a unit may have
in general a relatively high level of consensus and mutual assistance.
Disadvantages: It is remarkable that the model does not include all facts, especially what the
destination which is influenced is. Moreover the guest and their motivation to improve their
health are in no way mentioned, and the factors do not influence each other in the model,
ratherit seems these are closed units.
The extended modular model demonstrates that a destination is influenced by various
factors and that it needs to react tothese. However, the model is not sufficient to illustratea
H&WB definition.
3.3.1.4 Economic tourism model
This model considers all economic activities related to the organization of the whole trip and
the different aspects such as travel preparation (tour operators), travel through (transport,
stay in a foreign country) and return to the origin (post-trip). From the perspective of the
economy the "production" as well as the purchase and sale of various tourism products is
important. The economic aspects are distinguished in economics and business
administration. The following facts are important:7
economic Economically
- Growth and economic
- Development of price levels
- Employment
- Distribution (income and assets)
- Competition
- Taxes and subsidies
- Profit and Revenue
- Pricing
- Job quality
- Costs and expenses
- Sales and Marketing
- Procurement and Purchasing
- Taxation and Finance
Illustration5: Factors of economic interest, in accordance with Freyer 2006, p. 48.
7
Vgl. Freyer, W. (2006), p. 48

Illustration6: Economics of tourism, Freyer 2006,p. 51
a ) The economic model of tourism
The economics between consumers (buyers) and producers (providers) is distinguished. Here
both economic agents come intothe market with each other. The state itself forms the third
factor. The providers are distinguished in the model again,more closelyin reference to the
tourist industry, as well as witha tourist economy edge. The consumers are divided into
travelers, those not traveling, users of vacation packages and individual travelers. All of these

suppliers and demanders are between different markets, since it itself is no longer "the
tourism market" but rather various tourism sub-markets. These markets include, for
example, a partial market for accommodation, a transport services market (flight market,
railway market), etc.8
b) The economicalmodel of tourism
Tourism businesses focus their marketing activities mainly on the supply situation
(competition) and demand requirements e.g. market research and market strategies.
Accordingly, the sub-elements and operational management functions form a central role. In
addition to the business functions (purchasing, production, marketing),there are other
especially service-oriented functional areas of importance in the tourism industry, such as
potential, process, and outcome function.9
Advantages: The economic model of tourism focuses on economic and economical
perspectives. As described in the model, there is an infrastructure, such as the
transportation available and the facilities (like hotels)atthe destination. The destination is
chosen by the guest,whichis described in the economic model. The buyer comes intothe
tourism market to choose the best offer from a wide range of providers; therefore, the
offers need to meet the consumer’s expectations.
Disadvantages: In the model there is no relation to health, medical facilities or the
motivation of a guest to stay for a certain time to improve their state of health. The
importance of a uniform management in the destination is not mentioned here. It is
mentioned that the destination should be tailored even more closely to customer
requirements.
The economic model of tourism describes, in a very detailed way, which economic factors
influence the destination and the market activities. Otherwise the model gives just small
insight into the influences on a destination. Therefore it is not enough to describe the
H&WB destination.
8
Vgl. Freyer, W. (2006), p. 56
9
Vgl. Freyer, W. (2006), pp. 56

3.3.1.5 Framework of touristic mobility
A combination of factors influencetouristic mobility. Sociopolitical means administration and
legal orders. Socioeconomic are factors such as education and income. Sociocultural are
values and norms. Touristic mobility is influenced by:10
 Natural Environment
 Economy
 Politics
 Society
Illustration 7: Framework of touristic mobility. Grümer 1993, p. 18
10
Grümer, K-H. (1993), pp. 17

Advantages:All the included factors are parts of the infrastructure ofa destination. Roads,
facilities, political order, natural environment and the society have an impact on the
development of a destination.
Disadvantages: The model shows only the external influences on the development of
touristic mobility. The internal influences and the interdependence of the factors are not
contained in the model. A reference to health, as well as the motivation of visitors, is also
missing here.
Because of thisone-sided view, the model is not sufficient to explain an H&WB destination.
Although it is about mobility, the model does not include the traveler, his motivation and
where he is going (destination). The model is not sufficient to explain H&WB.
3.3.1.6 System tourism by Bieger
The"system tourism" model by Thomas Bieger shows the interactionwith the
environment.The following are seen as environmental aspects:
- Economics
- Technology
- Society
- Ecology,and
- Politics
These facts can be reduced to economy, natureand society.Policyis an expressionofsocial
intention, while technology is aninterface areawithinsociety, economyand nature.11
11
Bieger, T. (2010), pp. 84

Illustration8: System of tourism (static). Bieger 2010, p. 84.
Advantages:Bieger’s model is similar to the model of touristic mobility, but here the
influencing parts are interconnected. Moreover, it shows that all factors have impacts on
tourism as a system. According to the model, system tourism consists of different
subsystems such as destination, transport, travel agents and demand. Thecomplete
combination of all these systems is “tourism.” So the idea of a unique destination is included.
All the factors work together to meet the demand, and so the subsystems and thus also the
facilities could therefore interact as a unit in this area.
Disadvantages:The model looksonly at the provider’s side. The “system tourism” is just the
destination and the factorsthatinfluence it, but the guests of the destination and their
motivation to come tothis area is missing.
Thomas Bieger’s model of “system tourism” is a good way to explain which facts influence,
and which parts are parts of tourism. The combination of travel agents, transport companies
and local companies is similar to the tourism area model and describes the interactions
between these facilities and infrastructures. The model contains important factors to
describe an H&WB destination, but it is not enough to explain it fully.

3.3.1.7 Micro-analytical system of tourism
The micro-analyticalconcept by Pompl(1995) shows a similar form of tourism to Thomas
Bieger’s model. The core of system tourism consists of tour operators, travel agents and
travelers. It is center of the “system tourism.” The following factors create, with their
interaction and interdependence, the tourism system:
- Suppliers
- Service providers
- Institutions
- Attractions12
Illustration9: Micro-analytical system of tourism, in accordance with Pompl 1994, p. 6
Advantages: The core system includes the traveler as a single part of tourism and defines the
person as self-determined. He chooses the destination for a particular purpose. All the
subsystems meet the buyer’s needs and add the requirements while marketing as a unit.
12
Müller, H. (1999), pp. 16

Disadvantages: In the model it is not shown whether the different factors influence each
other or interact. Furthermore the relation to health care is missing, so it is not clear what
the motivation of the guest (the traveler) is.
The micro-analytical tourism system has similar approaches to the previous two models. The
idea of external influences is recognized, so it is clear which factors influence the system.
Alone it is not suitable to explain a H&WB destination, but the idea of “system tourism” can
be adapted.

3.3.1.8 Swiss tourism concept
The Swiss tourism concept consists of three subsystems which are interdependent:
- Society
- Economy
- Environment
According to the figure, the system is controlled by legal and social norms,tourism
investment and consumer spending. Furthermore the direct and indirect tourism policy has
an impact. 13
Illustration 10: Swiss tourism concept. Beratende Kommission des Bundesrates 1979, p.84.
13
Müller, H. (2007), pp.18

Advantages: The factors in the model interact, which is very important. The society has a big
influence on what happens, and therefore it is clear that the guests of a destination have it
too. The socioeconomic system meets the expectations, otherwise no visitors would come to
the destination.
Disadvantages: It remains unclear how the destination interacts. This means that thereis
nothing written about the way the destination is managed and marketed. Whether the
destination works as a unit, or whether every facility is doing its own business, is not stated.
But in the H&WB definition it is an important aspect. Also missing is the motivation of the
guest coming to the destination and what the single demands are.
The Swiss tourism concept is a good way to underline the importance of society and policy as
impacts on local tourism. It is important to remember this while searching for the most
effective factors for the best model of an H&WB destination.
3.3.1.9 Determinants of DMO success
The model deals with main impact factors of successful destinations and tourism
management (DMO).
It shows variables and builds a model that supports the existence of a relationship between
the success of tourism destinations and DMOs with respect to community relations,
marketing, and economic indicators. Unique to DMO success were supplier relations,
effective management, strategic planning, organizational focus and drive, proper funding,
and quality personnel and community support.14
14
T. Bornhorst et al. (2010) pp. 572

Illustration 11: Comparison of success determinants for an ideal DMO and destination.
T. Bornhorst et al. / Tourism Management 31 (2010) 572–589
Advantages: For the model, many stakeholders were asked about their needs and
expectations in relation to tourism and destination development. The model shows a wide
range of factors that influence tourism. A tourism destination has two primary roles and a
number of important supporting roles. First and foremost, it must seek to enhance the social
and economic well-being of the residents who live within its boundaries. Secondly, to be
classified as a tourism destination, it must provide this enhancement of residents’ well-being
by offering a range of activities and experiences of the kind that we identify as ‘‘tourism’’
experience.

Disadvantages: In the model there is no regard to health or medical facilities. The model
focuses primarily on shareholder, marketing and economic aspects. Therefore it is not
enough to describe a H&WB destination.
3.3.1.10 Destination competitiveness and sustainability Model
The model of destination competitiveness shows the correlations between situational
conditions and destination resources. The aim is to figure out the relative strengths and
weaknesses of different tourism destinations and different influences affecting the
competitiveness. The destination competitiveness and sustainability model can be used to
develop strategies for improving competitiveness of a destination. The model is used by
industry and governments to boost the tourism sector.
Illustration 12: Integrated Model of Destination Competitiveness
Advantages: The model shows the given effects on a destination and includes tourism
demand awareness, perception and preferences. Actors can enhance the appeal of the core
resources and attractors, and strengthen the quality and effectiveness of the supporting
factors and resources.
Disadvantages: The model cannot capture a destination’s hard and soft factors. Even though
the model describes the effects of destination competitiveness in a very detailed way, it is
not sufficient enough to be congruent with the H&WB definition. In addition to this
definition, and given the destination resources, there is no relation to health and wellbeing.
3.3.1.11 Main elements of destination competitiveness
The main elements of destination competitiveness which are mentioned in the model are
the following: the ability of the destination to be better that its competitors in delivering

goods and services which should exceed all the guest’s expectations. Price differentials and
the provided service and its quality in comparison to competitors are further elements. The
implementing institutions can be the government or the industry. Influenced by the
environmental framework and the demand, the ability of being competitive can be defined.
“Resources” contain endowed (natural - mountains, cultural - language), created
(infrastructure, entertainment) and supporting (hospitality, accessibility to destination)
resources.
Illustration 13: The main elements of destination competitiveness, Dwyer/Kim (2003)
Advantages: The resources give a destination their specific orientation and build up
attractiveness to visitors. A destination needs good management to provide such services,
and therefore destination management becomes necessary. Working as a unit here means
to have companies interacting with each other and pursuing the same goals. So it becomes
possible for a destination to be competitive. The model shows the interaction between the
several influencing factors and the importance of each one of them.
Disadvantages: Despite the advantages, the model of destination competitiveness is
insufficient for the definition of an H&WB destination. The health aspect is not mentioned
here, therefore the destination’s focus is not clearly defined. Moreover the guest’s
motivation is unknown. In conjunction with the given H&WB definition, the guest’s purpose
for the stay and the market guidance become negligible.

3.3.1.12 Guide to Tourism Destination Management (UNWTO)
The practical guide to tourism destination management, published by UNWTO, describes
measures, aims and reasons for the necessity of destination management in a region. In this
regard the destination described can be a centre or a town up to a whole country. Things like
organization, responsibilities, objectives, strategies and following up are discussed in detail.
Furthermore the special character of tourism as a part of industry gives an idea for the
equality and differences between tourism and other categories of industry.15
Illustration 14: Elements of Destination Management,UNWTO (2007)
Advantages:
The title gives an idea of the main aspect in this guide: an area which is managed and
organized as a unit; it acts and is marketed like this. The success of such a destination
depends on the state of the infrastructure, the demand of guests and the high quality of the
product. It means the destination which offers the guest a whole package of
15
UNWTO (2007), pp. 2

accommodation, service, treatments, etc. could also be marketed with a brand to stay in a
guest’s mind. Determining the USP of the region and the specific target market are essential
for long-lasting success. All in all, the guide focuses on the marketing aspect very strongly
and so it isclear that building up networks and acting in cooperation takes an important role.
Disadvantages:
The guide describes destination management in general. So the reference to health and
wellbeing in a destination is completely missing. Moreover the supplier side is focused on,
which is why the guest’s motivation to come with the intention to improve his state of
healthis not mentioned. The practical guide to tourism destination management is a good
way to get an overview for the influencing factors and their importance in a destination.
Although health is mentioned as one of many types of tourism, for the health aspect (kinds
of accommodation, treatments and service etc.) further sources should be considered.16
16
UNWTO (2007), pp. 8

3.3.2 Health models
In this section, individual models ofthe health sector are presented.
3.3.2.1 Health cluster model
Health Cluster in this section corresponds to a possibility for models in the healthcare
industry. Based on this limitation, a small insight into the structures of health models is
given. Below are the different approaches for clusters which can be applied analogously to
the healthcare industry.17
The cluster can be divided into two different types.
Type A is a variant of cluster support, which is seen as a comprehensive regional
development concept. It is an analysis of future developments, and aims to promote and
improve processes to establish the region’s future.18
Type B considers the existing strengths of the region and develops them further, adhering to
the principle of "strengthening the strengths".19
Advantages: The health cluster approaches show that such a model aims for cooperation
among the facilities and organizations of a region. These should encourage support between
the facilities. A cluster meets the requirement of working as a unit, and therefore it is an
important aspect for the H&WB definition, and it gives access to a wide range of skill sets
and capabilities. A cluster is a good way to offer a well-developed infrastructure, especially in
the health care system.
Disadvantages: It remains unclear in the model, why types A and B exist on their own with
no combination or overlap. It seems to imply that just one way is possible, either to analyze
the future development or to strengthen the current strengths. The idea of a mix of both
types with a concept about current measures and future development is not mentioned.
Furthermore, the reference to tourism and guests is not given. So it is not said whether the
region is directly carried by the visitors.
The health cluster model is suitable to show how facilities can work as a unit in the
destination. Although the model does not include a definition of the destination in detail, it
is included in the term of clustering.
17
Vgl. Groh, O.(2006), p. 48.
18
Vgl. Groh, O.(2006), pp. 48
19
Vgl. Groh, O. (2006), p. 49

3.3.2.2 Step model to freight division of health economics
The healthcare industryincludesthe productionand marketing of goodsand servicesfor the
prevention, treatment, rehabilitation and care.According to thestep model, researchand
development are thebasic level.The first threestages:
- Mainhealth-relatedinputs(Level I)
- Core areaof the healthcare industry(stage II)
- Advanced healthcare industry(level III)20
Illustration 15: Step model to freight division of health economics. BMBF 2010, p.42
Advantages: The German health care system is a complex structure and includes a lot of
rules and standards. The destination with its facilities and infrastructure is relative to the
system. It meets the requirements of guests who come with the motivation to improve their
state of health. Whether the visitor wants to have wellness treatments or medical
treatments is not mentioned. The H&WB destination does not need to focus on one aspect.
20
BMBF (2010), pp. 41

Disadvantages: The model does not include the uniform management of the destination.
Moreover guests, and most times patients,do not in every case take offers completely
voluntarily. Facts, such as disposable income, assets, accessibility, urgency of interventions
etc., influence the choice of patients and guests. These external influences are not
mentioned.
All in all the model shows very clearly the detailed parts of the health care system, but it is
not suitable for a H&WB definition, because it is not a common system in all member states
of the European Union or the members of the WelDest project.
3.3.2.3 A concept of “Wellbeing Tourism in Finland”
The concept describes Finland as a region which is rich in resources, especially a natural and
peaceful, harmonious environment. Factors like service quality and basic infrastructure are
well-developed in Finland, too. The Nordic countries represent a whole product for natural,
relaxing and also active stays and so, guests recognize it as a “brand.” Finland as a single
country needs to highlightspecific aspects, otherwise it will not stand out.
Three regions in Finland were analyzed as suitable wellbeing regions: Jyväskylä, Kainuu
(biggest tourism resort Vuokatti) and Vaasa. Each region has a special focus, e.g. high quality
of know-how in education and technology (Jyväskylä), wide range of sports and indoor /
outdoor activities (Vuokatti) and a distinct offer of regional food (Vaasa).

Illustration16:Recommended concepts of health tourism by the Finnish Tourist Board (FTB by Liisa
Renfors 17.9.2010)
Advantages: Finnish tourism is characterized by nature and its offers. It has a remarkable
range of physical activities and spa offers such as saunas and sauna baths. The tourist’s
motivation to visit one of these areas is often to maintain his health and to prevent illness.
That means guests come on their own and have a strong will to act.
Disadvantages: In regard to the advantage of many opportunities to do sports, there is a
related disadvantage: The Finnish tourism concept lacks a strict understanding of pampering.
Beauty farms, massages and other treatments where the guest is just passive are not
included. The concept creates an active guest with the ambition to move. Moreover the
aspect of stays with a cure and healing motivation are not mentioned. And as a last point, it
is important to emphasize that networking and acting as a unit is not yet current. The
structure is at the moment missing, but very necessary. The internal (networking between
companies in one region and cooperation between institutions) and external (marketing for
a single brand, as a single unit) communication do not function properly.

3.3.3 Wellness models
Scientists, physicians, educators and organizations have dealt with the development of
various spa models to explain the "idea of wellness" in its whole extent. In the following, the
various spa models are illustrated.21
3.3.3.1 Wellness model by Dunn
Dunn describedwellness asa methodologicalframeworkto maximizeindividualpotential
availableunder the givencircumstances.22
In Dunn’s opinion patients are not dependent on
the doctor’s decision, but also make their own.Dunn called this "High Level Wellness". This
corresponds to an active lifestyle that allows people the greatest possible utilization of its
productive potential.23
Wellness is not the absence of disease, illness, and stress but the presence of:
 purpose in life,
 active involvement in satisfying work and play,
 joyful relationships,
 a healthy body and living environment, and
 presence of happiness
21
Vgl. Berg (2008), p. 12
22
Deutscher Wellness Verband (o.A.)
23
Vgl. Berg (2008), p. 13

Illustration 17: Wellness model by Dunn. Image source:
http://classconnection.s3.amazonaws.com/1084/flashcards/622455/jpg/dunn-wellness-grid2.jpg
Advantages: Compared with the predefined explanation of an H&WB destination, Dunn
confers self-management skills on the patient. The patient is responsible for his own health
and chooses wellness as the way to reach a higher level “of functioning” (Dunn, 1961[3]).
There is the patient’s motivation in the focus to improve health.
Disadvantages: The model approachesthe destination from one single perspective - the
consumer’s. As mentioned in the definition, the area of the destination is important.
Moreover, the necessary infrastructure such as accommodation and other facilities are not
considered and so it is not clear, whether the destination is marketed as a “unit”. Dunn
refers only to patients, not even to guests. It can therefore be concluded that people who
come to the destination do so with the intention of improving their health. But according to
the definition it is also possible to improve the state of wellbeing and so he limits it.
Even though Dunn’s model portray’s the patient as a self-determined one, it is not complex
enough to meet all the requirements given by the H&WB definition.

3.3.3.2 Model for wellness by Ardell
Dr. Donald Ardell and Travis extended Dunn’s model by building on prevention and personal
responsibility. Ardell’s model is based on the following elements:24
- Conscious diet
- Stress management
- Environmental awareness
- Physical fitness
- Self-responsibility
12 years after the Dunn model, Ardell has his own model which adapts to changing
environmental conditions and other conditions. The elements of the model are
complementary:25
- Self-responsibility and medical prophylaxis
- Find meaning in life
- Stress Management and boredom
- Nutrition and fitness
- Norms and social rules
24
Vgl. Berg (2008), p. 13
25
Vgl. Berg (2008), p. 13

Illustration 18: Model for wellness by Ardell.
Image source: http://well.pacificrimwellness.com/1999_fall/articles/teacher_wellness.html
Advantages: Guests are self-determined and cometothe destination to improve their state
of health or wellbeing. Another factor which appears similarly ismotivation. Ardell built up a
complex system which mentions physical, social, creative, coping and essential aspects. But
also the infrastructure of an H&WB destination should address the needs of guests to create
a large customer base. To reach them, the Infrastructure should meet guest’s expectations.
Disadvantages: As noted in Dunn’s model, the idea of an area which is marketed as a “unit”,
is not detected. Joint selling of the products and services offered in the destination is not
mentioned. In addition, Ardell refers only to guests. However, people could visit the
destination to improve their health as patients. Under this condition a certain infrastructure
would be necessary.
As mentioned in the last model, the Wellness Model of Ardell is not sufficient enough to
meet all the ideas of the H&WB definition. On the one hand the internal influences are
described in detail such as physical and coping aspects. But on the other hand, external
influences of the destination on the patients and guests are not completely considered.

3.3.3.3 Model for wellness by Hettler
Bill Hettler describes the balance and equilibrium in the forefront of his theories. In this case
all components must have the same meaning to be attached to create a balance. The
selected components are:26
- Physical fitness and nutrition
- Emotional intelligence
- Social relationships and environmental awareness
- Mental fitness
- Spiritual awareness and life philosophy
- The joy of career
Illustration 19: Six dimensions of wellness. Image source:
http://c.ymcdn.com/sites/www.nationalwellness.org/resource/resmgr/docs/sixdimensionsfactsheet.
pdf, 1976
Advantages: In Hettler’s model guests strive to reach balance in life. It might be reasonably
assumed that people are self-determined and come with a specific motivation. If the
26
Vgl. Berg (2008) p 14

destination is chosen, it will have a suitable infrastructure. The area will be focused on
consumer needs.
Disadvantages: What is not mentioned, however, is what the infrastructure should include
in detail. The idea of an area, which is managed by one institution to create a complex
destination of offers and services, may give an inkling. It includes manners and conditions of
the whole life, but it is not mentioned where the balance should be reached. It is not clear if
a stay in an H&WB destination becomes necessary and how a balanced lifestyle can be
created. The destination as an area which bundles together all the terms of infrastructure
and organization is not mentioned.
In conclusion, Hettler’s model is shown from the customer’s point of view in a very detailed
and structured way. The motivation is shown in achieving balance and equilibrium.
3.3.3.4 Model for wellness by Travis
John W. Travis describes the state of health as an ongoing process that is influenced by a
variety of situations (Illness / Wellness Continuum). Thewellnessthat Travis refers to is a
constant health of the harmony of body, mind and soul. At the neutral point of the Illness /
Wellness Continuum, neither health nor disease symptoms are visible. The left side of the
model leads from "malaise" to the "death". This corresponds to the range of the traditional
health care system. The goal is to relieve the symptoms, but without the promise of
complete health. The right side of the model considers the flow from "malaise" to a "better
life". The model is intended to show that wellness can be attached to any point on the
continuum.27
The wellness model by Travis includes the following twelve elements:
- Self-responsibility and love
- Proper breathing
- Sensitivity of the senses
- Healthy eating
- Appropriate exercise
- Allow expressions of feelings and
27
Vgl. Berg (2008) p 14

- Mental activities
- The joy of work and play
- The meaning of one's life
- Spiritual awareness
Illustration 20: Illness-wellness continuum. Image source:
http://www.wellpeople.com/images/Illness_WellnessContinuum.jpg, 1972
Advantages: Guests’ motivation directs them to the H&WB destination, so they choose the
area by themselves. People become aware that they want to improve their state of health
and so the destination should meet that. The infrastructure should be available for different
customer needs, otherwise people look for another destination. The idea of rethinking
illness and wellness, and that it means an ongoing process of health policies, is occupying
ever more space in the minds of the people. That idea is shown in Travis’ model.
Disadvantages: The model’s approaches focus on the idea of the state of health which starts
in people’s minds. It still remains unclear what the destination needs to offer in detail,
which institutions and facilities should be present and who will lead the area. According to
the definition of a H&WB destination, it should be marketed as a “unit”, but that is not
required by Travis’ model.
Even though the model describes the state of health in a very detailed way, it is not
sufficient enough to be congruent with a H&WB definition. In addition to this definition, a
second one would be essential which defines the destination and its function in relation to
health and wellbeing.

3.3.4 Service qualitymodels
Inservice it is crucial that the quality of the first attempt meets the expectations of
customers, or better still, outperforms them. Since the service is supplied together with the
customer, quality deficiencies are also immediately apparent. Although mistakes can often
be rectified, the customer is usually highly influenced by his first impression.
3.3.4.1 Perceived service quality by Parasuraman et al.
The model is based on the principle of the conformation-disconfirmation paradigm from
customer satisfaction research. The paradigm reognizes perceived service quality as the
difference between expectations and the results of a service.
Due toexperiences, word of mouthand individual needs, the consumer expects several kinds
of service.Thiswill be compared withthe perceivedservice.Thus,the perceivedservicequalityis
created. The perceived service and the expected service are made up of features like
reliability of service and the environment.
- Service : reliable, reactive, secure, empathetic
- External material environment
- Customer : experiences, word of mouth, needs28
Illustration21: Model of perceived service quality. Gleitsman, Guttzeit, & Roschk 2010, p.9.
Advantages: The model describes the service quality and how customers perceive it. From
this, it can be deduced that the destination has to operate as a single unit, because
28
Gleitsman, Guttzeit, & Roschk (2010), pp. 7

customersrecognize the service as a product of all activities and services in the destination.
So it’s necessary for the H&WB destination to build up a unit and operate in this way.
Otherwise the different facilities and their provided services will inhibit each other, because
of unequal demands and standards of service.
Disadvantages : The model describes the service quality and how it is formed, but it makes
no references to health and healthcare. Therefore the model is not complex enough to
define an H&WB destination. People expect several kinds of service, but it is not said what
their motivation to visit the area is.
The model about Perceived service quality by Parasuraman et al. is a good way to explain
why it is so important for a destination to operate as a unit. A single management can create
a uniform market appearance and define the state of service quality. Through measures, e.g.
regular progress controls, consultations and regular training sessions, a destination can
develop as a “unit”.
3.3.4.2 Donabedian Model
Donabedian developed one of the first service-specific quality models, in which the three
components – quality strucure, process and outcome are differentiated. The term
"structure" is understood by Donabedian as the permanent resources of a service provider,
such as employee skills, the technical equipment of the company, etc. The term "process"
denotes all activities that take place during the actual service provision. "Outcome" means
the result of the performance finally started. Based on the three components, the quality of
a performance can be estimated.29
- System factor : structure of health system
- Processes of care : consultancy, examination, treatment
- Health outcomes : state, symptoms, mortality, costs
29
Vgl. Auer,C. (2004) pp. 87

Illustration 22: Model of Donabedian. Image source:
http://www.studydroid.com/imageCards/04/ek/card-4673550-back.jpg
Advantages: The Donabedian model includes, firstly, the aspect of health care. Here is a
clear link to the health care system, the work of medical and wellness facilities and the
health as a product. Components are included in the infrastructure, e.g. hotels. A destination
which offers a number of facilities like thisappears as a unit.
Disadvantages: Otherwise the model just deals with service and service quality, but not with
the description of where the service is provided. In what kind of area the service is going to
be offered and in which dimensions is not stated. In addition to that, a second factor,
motivation, is missing when comparing it with the H&WB definition. It simply represents
people who come to improve their state of health as patients, but whether wellness
activities are motivation too, is not touchedupon.
To sum up theDonabedian model, is to say that this one is a simple but effective way to
show how service quality especially in health care can be described. In the three
components, aspects of the H&WB definition can be recognized. The model characterizes
the kind of care, which interactions are done and how the patient feels after treatment.
Suitable factors of the definition are necessary infrastructure such as hotels, sports and
medical facilities. Doctors and other qualified staff need to be on site for interactions like
consultancy and treatments. The quality of the outcome and the provided service are crucial
to the success of the destination. The Donabedian model is not enough on its own to explain
the H&WB definition, but in addition to a suitable definition of a destination, it may be
satisfactory.

3.3.4.3 Grönroos Model
In his model, Grönroos highlights the mainly subjective perception and evaluation of the
quality produced. This is the result of all of the criteria, which before the demand, during or
after the production process are perceptible.30
A company's imageactsas a filterin the performance of the
customer,betweentheexperiencedservice qualityand the twoquality dimensions. Influenced
by service obtained inthe past, ithas an impact on expectationsin the current time.
- Technical and functional dimension form the basis of comparison (expected and
received service)
- Technical dimension: "what" does the consumer receive
- Functional dimension: "how" does he receive it
Illustration 23: Grönroos model. Image source: http://water.prevos.net/category/blog/
Advantages: In the Grönroos model, the service quality is described on the basis of
experiences, expectations and perceived service. As a consequence, the customerevaluates
the whole area as a unit. If the customer had a bad experience with a provider, or if the
service of an institution was unsatisfactory, it would reflect on the whole destination. To be
marketed as a unit is apredefined aspect of a H&WB destination.
30
Vgl. Zolloondz(2006), pp. 211

Disadvantages: The model has no relation to healthcare. It could be used for any other
definition in the service sector and therefore it is not completely suitable for the H&WB
destination. In addition, the guest’s motivation, and which kind of facilities are in the “single
area” is not mentioned.
The Grönroos model shows the importanceof a destination operating as a unit. But in
comparison to the Parasuraman et al. model, theybear a strong resemblance. The difference
is small and only in the way the image was built. Grönroos sees the image as just the result
of two dimensions, what the customer receives and how he receives it. For Parasuraman
other aspects like reliability count too. In conclusion, the Grönroos model is not enough to
meet the requirements of the H&WB definition.
3.3.4.4 “Moments of Truth” model
The concept of "Moments of Truth" developedby Carlzon,found that particular contact with
customers plays a special role in service companies’ employees. Their daily behavior quite
significantly impacted the impression of the customer regarding quality. He speaks of
opportunities - in the moment they have the chanceto take advantage of an opportunity and
leave a very good impression, or to offer a poor performance.31
Advantages: There is emphasis on the necessity of having a good infrastructure, especially
qualified staff.
Disadvantages: There is nothing about health, and nothing about motivation.
31
Vgl. Gardini, M.(2009),p. 234

3.3.4.5 Meyer and Mattmüller model
Meyer / Mattmüller developed a comprehensive quality model which has adescription of the
development of quality in the course of the whole service process to the target. It integrates
aspects of Donabedian and Grönroos and highlights in particular the effects of quality on the
demander.32
- Based on potential, process and outcome
- Potential quality divided into vendor and buyer
Illustration24: Model of servicequality by Meyer and Mattmüller
Advantages: The focus on service and how it builds is more detailed than in the models
before. Here it is clear that the buyer and vendor develop the kind and quality of service .The
ideathat service is also built up during the process means that an ongoing first class service is
necessary. To develop a destination, it needs to work as a “unit” and provide the same
quality standards in all facilities.This idea is included in the H&WB definition and therefore
seen here as an advantage.
32
Vgl. Preißl, K. (2004), p. 25

Disadvantages: As with the following models, the Meyer and Mattmüller model also does
notinclude which kind of area and destination isasked for. Furthermore, the model does not
mention what the motivation of the guests is. Whether there is an individual feeling to
improve one’s state of health, or the need to doit, is not included.
The Meyer and Mattmüller model is based on the quality model by Grönroos with its two
dimensions, technical and functional. Meyer and Mattmüller have realized that the
customer’s behavior is as important as the vendor’s. The model on its own is not enough,
substantially, to be the same asthe H&WB definition.33
3.3.4.6 Parasuraman, Zeithaml and Berry model
While the above models are theoretical, Parasuraman / Zeithaml / Berry chose an empirical
approach to the study of service quality. The five dimensions of service quality are based on
customer interviews from various industries and extracted by factor analysis. They are:
- "Tangibles" for the convenience of the material environment and material
surrogates. This includes the totality of the physical environment of a service,
including the premises of the institution and the external appearance of personnel;
- "Reliability" as a promise of reliability respectively. Compliance is the ability of
employees to perform the promised services, reliably and accurately
- "Responsiveness" as openness, readiness and willingness to perform.The provider
includes the use of open-mindedness and willingness of their employees to help the
customers solve a problem quickly;
- "Assurance" as a performance expertise extends to the fields of knowledge,
competence, courtesy, kindness, respect, trust and security;
- "Empathy" means the willingness to respond individually to each customer.
33
Vgl. Ates, Z. & Büttgen, M. (2009), pp. 18

Illustration25: Model of service quality by Zeithaml, Parasuraman and Berry. Zeithaml, V.,
Parasuraman, A. & Berry, L. (1992), p. 49.
Advantages: The model defines very clearly, where gaps in the communication process can
be a problem. The relation between customer and provider becomes more transparent.
Knowing these gaps can help avoid a lot of mistakes in communication and offering services.
The destination seems to operate as a unit if service works. The companies and institutions
enrich the infrastructure while providing the expected service.
Disadvantages: It remains unclear, which kind of destination is suitable for the H&WB
definition. Moreover it is not stated which motivation causes the guests to visit the
destination or if they choose the destination voluntarily.

The model is not suitable for destinations. It describes the development of service in each
branch and therefore it is not enough for the H&WB definition. The model of gaps in
communication and service can be very helpful to build up an efficient service quality
system. With good management and regular controls, a high level service quality could build
up a professional image of the destination.

3.3.4.7 Dynamic process model by Boulding, Staelin, Kalry and Zeithaml
Boulding / Staelin / Kalry / Zeithaml demonstrate in their model how expectations and
perceptions change over time and cause different behavior compared to the service
company. According to this model, the perceived quality is affected by three factors:
- the will-expectancy (verisimilitude, what will happen with this provider),
- set expectations (the reasonable, for example in the industry, what should happen)
- performance delivered straight during contact with the company
Illustration26: Dynamic process model according to Boulding, Staelin, Kalry and Zeithaml
Advantages: The decision making process is shown in a detailed way with actions between
the provider and the customer. All institutions and parts of the infrastructure need to work
as a unit. Otherwise mistakes occur and at any time somethingcan go wrong. The model
shows that the expected service will be compared with the perceived service,

leadingtobehavioralintention. That means taking up service is influenced by the current
situation. The permanent risk that a customer cancels a service confirms the necessity of a
high service quality.
Disadvantages: The aspect of health care is not mentioned. It remains unclear whether the
people visit the destination to improve their health. The model explains how service quality
develops, but there is no right way how to interact. Even though the model describes the
idea of provided service, it is already incomplete for using it in a destination.
The model is very comprehensive in relation to service quality. But it is not enough to explain
a H&WB destination with its patients and guests, who come with a particular purpose.
3.3.4.8 Model of relationship quality by Liljander and Strandvik
Liljander / Strandvik assume that positive service quality and customer satisfaction lead to
greater customer loyalty, and thus are an important determinants of the success of
acompany. They look at individual episodes, and their effect on the overall relationship.
Then for each contact there is a comparison of the service provided to a comparison
standard.
- High quality
- Satisfaction
- Loyalty increases
- Comparison and permanent weighing
Advantages: The decision making process takes place throughout the entire trip. The
approach of Liljander / Strandvik is that highly qualified service satisfies the customer. As a
consequence, satisfied customers feel high loyalty and these people have lower price
sensitivity.Keeping old customerstakes priority over exclusively winning new ones. The
model defines the way thatdestinations should work. Focusing on satisfying long lasting
customers, and less on gaining new ones, can bring successful influences in the management
of a destination.
Disadvantages: The model is kept to a minimum. No relation to a health care system or
destination is remarked upon. Offering good service quality is emphasized, but in no way is it
explained how organizations, institutions or even destinations should interact.

Together with the previous models about the service quality,built on the provider’s and the
customer’s behavior, the Liljander / Strandvik model could be a good way to define the
framework for good service quality. Although the service model includes loyalty as the first
aspect, this alone is not enough to explain the concept fully. The H&WB definition needs
more, like facts about infrastructure, and the guest’s motivation.
3.3.5 Models and theory in regional management and destination
development
For regional management there exist few suitable models. The objects and needs of the
regions are highly differentiated. The basis of regional management models are business
models and economic models. (See also economic and tourism models). In the field of
regional management the SWOT analysis toolis suitable.However, it is not a model.
3.3.5.1 Model of action dimensional circles
The model shows the benefits of small-scale models of management and political
assertiveness in the region. Although large-scale approaches to larger subspace, planning
associations or district level institutions usually have a higher penetration power outward to
their regional acceptance, however, it is less pronounced. Transboundary approaches can
obviously combine a relatively high regional acceptance and a high load capacity at best.

Illustration 27: Model of action dimensional circles
Advantages: The model shows the conflict between effectiveness of regional development
concepts and enforceability. The H&WB definitionrequires a uniform development strategy
for the whole region. An increasing geographical expansion reduces the acceptance among
stakeholders.
Disadvantages: The model describes only the territorial aspect of regional management. The
model does not deal with infrastructure, health, medical and tourism aspects.The model of
action dimensional circles shows the conflict between regional acceptance and sustainability
of regional management. With a larger radius and increasing numbers of stakeholders, the
effective implementation and acceptance decreases.
3.3.5.2 The export base theory
As the name of the export base theory suggests, it is based on the central assumption that
the development or economic growth of a region depends on the export sector (and thus,
the extra-regional demand). The export base approaches were developed in the 1950s.
Income cycle of export basis approach

Illustration 28: Income cycle of export basis approach, L.Schätzl (1996)
Regarding the generation of income in a region, there is a distinction between "basic
activities" and "nonbasic activities". The former refers to the export activity and the latter
describes the income from activities within the regional market. The basic sector is the
economic base of a region on which the development of the nonbasic sector depends. For
regional development this means that competitive frameworks for regional exports are
created and promoted. The export base theory considers only the demand side, specifically
case export demand as the only criterion of regional growth. In addition to this disregard of
other factors, the export demand is also considered as exogenous.34
3.3.5.3 Polarisation theories
Joseph A. Schumpeter (1959) has laid the foundations for polarisation theories. Schumpeter
defines in his theory of "creative destruction" innovations as impulses of growth. The
impulse- like character of innovation leads to wavelike growth. Innovations destroy physical
capital and human capital in the short term, but in the long-term leads to higher growth. A
distinction is made between sectoral and regional polarisation. In our case regional
34
L. Schätzl (1996)

polarisation is important. With "Regional Polarisation", polarisation theories try to explain
the regionally uneven progressive growth.
Regional polarisation
Illustration 29: Regional polarisation (own presentation)
Regional polarisation: The regional polarisation applies Schumpeter’s theory in a regional
context. It explains how successful economic activity attracts droves of entrepreneurs. The
spatial effects play a major role. This means that depending on the region, different sectors
are variously pronounced with the consequence that the growth is sectorally and regionally
unbalanced. Myrdal differentiates between two possible effects of regional polarisation
between a high-growth region and neighboring regions: backwash effects and spread
effects. The backwash effects describe the effects of withdrawal (withdrawal of labor,
productive capital, resources), while the spread effects (for example,the diffusion of
knowledge) describe the positive effects of the growth region. This means for regional
politics that at a transition to new standards or technologies, specific losses must be
accepted. The focus should always be directed toward long-term goals and growth
opportunities. The spread effects of a high-growth region can be encouraged through the
promotion and strengthening of networks and collaboration.35
35
B. Buser(2005)

3.3.5.4 Endogenous development theories /-distinctive regional
development
Theories of endogenous development (1960) see regional economic growth justified by
intra-regional potential. They form the basis for socio-economic development of a region.
Development should be something self-specific. A comprehensive theory of endogenous
regional development does not exist; there are more various partial-sets and guiding
principles that have to be understood. The basic assumption of the endogenous theories is
that regional development is determined by the endogenous (regional) development
potential. The latter is defined as the totality of the development opportunities of a region in
time, and spatially demarcated areas of effect. The intra-regional potentialis activated by
overcoming existing bottlenecks (scarcity of factors of production), use of region-specific
skills and talents, or by the initiation of intra-regional circuits. Endogenous development
theories apply in addition to prevailing theoretical and regional political doctrines.36
36
L. Schätzl(1996)

3.3.5.5 Milieu approach (Innovative and creative environment)
The basic assumption of the milieu approach (1980) is that the production and use of
knowledge are the basis for the growth of a region. Knowledge increases the
competitiveness and innovative capacity of a region and the production factor knowledge is
thereby given to half of the general value. There are numerous studies demonstrating
knowledge as a determinant of economic growth. For regional politics, this means that
regional growth depends on knowledge, and thus on human capital. If it is assumed that
knowledge is mobile, a region benefits also from the human capital of the neighboring
regions. For the innovators and creators environment, it is assumed that for a knowledge
network, the spatial proximity and thus the density of knowledge is important. Concrete
regional measures of this are the establishment of universities, strengthening of technology
transfer - networking and the generation of knowledge.37
Milieu approach
Illustration 30Milieu approach, H.-J. Domhardt et al. (2009)
37
H.-J. Domhardt et al. (2009)

3.3.5.6 Cluster approach
The cluster approach (1990-2000) is based on the theory of competition by Michael Porter. A
cluster is formed when multiple actors work together in an economy along a value chain and
thereby located in close proximity to each other. Networking in regions is often present. The
competitive theory of Porter states that the enforcement of production systems (in a specific
industry) is determined in a region by the following four factors: factor conditions
(availability/exchange of labor), demand conditions, industry environment and competitive
behavior of regional actors. In conjunction, these four determinants stimulate growth and
development. For regional development, this means that in principle every region can gain a
competitive advantage with their own industry equipment. Regions could use the cluster
approach without requiring conditions like a low population or poor infrastructure
equipment for competitive advantages in all industries.By specializing in certain clusters,
these regions should try to achieve growth. In promoting the regional economy the cluster
approach implies that it is selected between value-added and low-value-adding industries.38
3.3.5.7 New Economic Geography
The New Economic Geography (1990) explains trade between industries (intra - industry),
the formation of agglomerations and the increase in specialization in production. The main
representative of this theory is Paul Krugman. In the New Economic Geography the
assumption of a perfect market is dropped, and several equilibria are possible. In addition,
spatial components are included in the model. The New Economic Geography distinguishes
between so-called centripetal and centrifugal forces. The former are, for example, mobile
factors of production, which lead to the centralization of production and thus to the
formation of agglomerations. Centrifugalforces for example are immobile factors of
production such as land. These immobile production factors lead to trade and barter and
there is no formation of agglomerations. For the regional economy, this means that the
elimination of trade barriers is not equally beneficial for all regions. It can cause
agglomeration and thereby income differences, which potentially increase over a long
period. In immobile factors of production, the elimination of trade barriers can lead to
welfare gains for the concerned region. Regional politics require an exact study of
thestructure of regional economies.39
38
M. Perlik&P. Messerli
39

3.3.5.8 Learning Regions
The Learning Regions approach (1990) applies the operating scientific model of the learning
organization in the region. The Learning Regions approach refers to the knowledge of a
region developed through constant learning. "Learning regions are considered spatial units
in which knowledge is bound locally and in which continuous learning processes between
regional actors emerge from the spatial knowledge bond that enhances the regional
knowledge base"40
. The central point is that a learning region's concept aligns with
networking and processes of strategic market focus. A region is not as well structured and
organized as a company and so it requires strong impulses and intensive management.41
3.3.5.9 Transaction cost theory
The transaction cost theory (main representative: Ronald Coase) states that production
levels can be outsourced at low transaction costs and thus specialization and growth are the
result. Transaction costs are the costs incurred by negotiation (on prices, delivery, etc.) on
outsourced products. The extended transaction cost theory suggests that in addition to the
collectable business relations (negotiations on prices, etc.) although the relationships of
regional actors that are not directly detectable play an important role.For each region, the
majority of these relations are often informally designed, and transaction costs are therefore
not accurately known. In this context, reference is also made to untradable
interdependencies or non-tradable portion action costs;by this, he is referring to so-called
network relationships. This brings benefits to the regional actors. This also means that in
regions the outsourcing of production stages (in the broadest sense) is facilitated through
the promotion of networks.42
40
H.-J. Domhard et al. (2009)
41
Hertig, Hans-Ruedi (2002)
42

3.3.5.10 Institutional density (New institutions approach)
The new institutional approach states that regional growth is also explained by the quality of
their network relationships. The latter depends to a large extent on institutional bodies and
associations (institutional thickness). The improvement of this new approach is the
importance of the non-economic actors (institutions). In regional politics this implies an
increasing attention on the institutions and the promotion of „institutional thickness“.43
New institutions approach
New institutions approach
43

Illustration 31: New institutions approach (own presentation)
3.3.5.11 Evolution economics
Evolution Economics (2002) explains that in a market the best quality and best priced
products do not automatically prevail. Rather, certain innovations spread quickly and then
manifest as standard. Due to the costs that would arise in the conversion or modification of
such standards (see Schumpeter's theory of creative destruction), for other innovations (or
technology standards) it is more difficult to assert or enforce themselves in the market. The
consequence is that certain products in the market prevail, followed by a certain
development path (from which the development occurs). On the one hand there is a range
of development opportunities, and on the other hand this is limited by the initial conditions.
Applied to regional development, this means that a region will continue to develop even
atproduction is only half successful. An example is specialization in tourism. It is important
that those in "long-established" specialization fields review the regions, and that strategy
changes are central in long-term effects.44
44

Dominant development path of evolution economics
Illustration 32: Dominant development path of evolution economics (own presentation)
3.3.5.12 Residential Economics
The economist Laurent Davezies (2008)45
shows that in France, the rural areas are becoming
increasingly attractive due to the local income of commuters, pensioners, tourists, second
home owners and newcomers. The residential economy is based on the assumption that the
income of the "inactive (or elsewhere employed), temporary or permanent residents
enriches the local economy in all circumstances, regardless of their actual production
capacity"46
. Thus, the residential economy has moved away from the value proposition of
the classical theories of growth. Production locations are not forced locations at which
people spend their income. The awareness and willingness to pay for high standards of living
and quality of lifeas well as so-called proximity services (sports, leisure, housing services)
rises. According to the residential economy, production is not the driving force of the
regional development process. Davezies designated two key aspects to the residential
economy: firstly, the influence on the regional external source income (and its use), and
secondly, the regional supply of goods and services. On one side, the productivitysector
(production of goods and services) is examined. This is the source of the tax revenue of the
state. On the other side, residential sectors (mainly rural areas) want to have the income of
highly mobile economic actors. This includes, for example, pensioners, tourists and
commuters. A portion of the income of these actors is consumed locally. In this case, the
45
H. Egli (2009), p. 80
46
H. Egli (2009)
dominant development path
(with dominant technology/strategy)

2014 03-20 secondary-rsch_hnee_final

2014 03-20 secondary-rsch_hnee_final

Recommended

Recommended

More Related Content

Viewers also liked

Viewers also liked (20)

Similar to 2014 03-20 secondary-rsch_hnee_final

Similar to 2014 03-20 secondary-rsch_hnee_final (20)

More from WelDest Project (Erasmus LLP)

More from WelDest Project (Erasmus LLP) (9)

Recently uploaded

Recently uploaded (20)

2014 03-20 secondary-rsch_hnee_final