INTERNATIONAL JOURNAL OF ADVANCED RESEARCH International Journal of Advanced Research in Management (IJARM), ISSN 0976 6324 (Print), ISSN

N 0976 6332 (Online), Volume 3, Issue 2, July-December (2012) IN MANAGEMENT (IJARM)

ISSN 0976 - 6324 (Print) ISSN 0976 - 6332 (Online) Volume 3, Issue 2, July-December (2012), pp. 29- 39 IAEME: www.iaeme.com/ijarm.asp Journal Impact Factor (2012): 2.8021 (Calculated by GISI) www.jifactor.com

IJARM
IAEME

THE HOLISTIC APPROACH OF AYURVEDA BASED WELLNESS TOURISM IN KERALA

RAMESH U*, KURIAN JOSEPH** * Research Scholar, Faculty of Management, NIMS University, Jaipur, Rajasthan. e-mail: rameshtrivandrum@rediffmail.com ** Research Guide, NIMS University, Jaipur Rajasthan & Associate Professor, St.Dominics College, Kanjirappally, Kerala ABSTRACT The striking feature of healthcare industry in India is its potential to grow at a much faster rate in the foreseeable future. In this prevailing situation, Health Tourism has emerged as a separate industry with incredible potential. Health/Wellness tourism refers to trips that are taken by tourists with the principal purpose being to improve their health and/or wellbeing. Today, once again, promoting the healthful and health-care benefits of a destination is gaining popularity because tourism marketers need ways to differentiate their products. Kerala can tap this trend by highlighting its unique health care products. The State, almost synonymous with the word 'Ayurveda', is now all set to reap the benefits of the same through Wellness tourism. Kerala has the advantage of worldwide recognition, as it has been included in the list of the ten must-see destinations by the National Geographic Traveler. Wellness, in general, is used to mean a healthy balance of the mind, body and spirit that results in an overall feeling of well-being. The concept of health holiday, now better known as Wellness holiday, is based on the principles of Ayurveda, meditation, yoga, physical exercises and a balanced diet. It is like rejuvenation and clean up process on all levels - physical, mental and emotional. Ayurveda deals elaborately with measures for healthful living during the entire span of life and its various phases. Besides, dealing with principles for maintenance of health, it has also developed a wide range of therapeutic measures to combat illness. In order to cope with the growing demand for wellness, resorts, hospitals, medical practitioners and Government have taken ample measures to promote alternative health care in Kerala. Along with the projects already underway, there is a need to draw up plans for promotions in future. The present paper investigates the reasons why Kerala is now pioneering as an alternative healthcare destination and the main objective is to analyze the reason as to why Kerala is being chosen as a preferred destination for Wellness Tourism. An attempt is made to

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International Journal of Advanced Research in Management (IJARM), ISSN 0976 6324 (Print), ISSN 0976 6332 (Online), Volume 3, Issue 2, July-December (2012) study the market potential and strategies adopted for Kerala to emerge as the most sought after Wellness tourism destination in the Globe. Keywords : Ayurveda, Destination, Health tourism, Wellness.

OBJECTIVES AND METHODOLOGY The present study enquires into the current infrastructure and the market potential of Ayurveda based wellness tourism offered at Kerala in attracting International medical tourists. A set of questions were employed to interview the Ayurvedic medical practitioners who were working in reputed wellness resorts. A total of 60 respondents were chosen as the survey sample from among the 250 wellness providers (both certified and non-certified) in the State. The districts chosen were Thiruvananthapuram, Kollam, Alappuzha, Kottayam and Idukki. Of these, 17 questionnaires were incomplete as the doctors were not willing to share their real and sincere comments and hence were discarded. Thus, 43 usable questionnaires were finally entered into the research analysis and interpretation stage. Earlier studies carried out in the field were analyzed and it reveals that a striking gap exists in the field of research in this highly potential but understudied area. Related data were collected from the Directorate of Tourism, Govt. of Kerala, Kerala Tourism Development Corporation, Govt. Ayurveda College Thiruvananthapuram, Directorate of Indian Systems of Medicine, reputed and classified wellness resorts in the private sector as well as from the published research reports on health tourism. Simple random sampling has been adopted in interviewing the wellness providers from the selected locations. AYURVEDA BASED WELLNESS TOURISM IN KERALA Tourism is an important economic activity and continues to be the fastest growing sector and hence is typically included among the top three industries in the country. Although India has progressed a lot since the fifties with respect to tourism, the country is still way behind the developed or even the developing countries. India earns one seventh of China, one fourth of Indonesia and less than half of Philippines from tourism in comparison. Kerala is the foremost state in India that realized the potential of Ayurvedic health tourism and has widely marketed it throughout the state. About 10-12 years back, Kerala started with the task of promoting Ayurveda on a larger scale. It is estimated that about 30% of the foreigners coming to Kerala avail themselves to Ayurvedic care and about 40% of the States tourism revenue is generated from the same. Table 1 indicates the top 10 States/Union Territories in India regarding foreign tourists arrivals from 2006 to 2009

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International Journal of Advanced Research in Management (IJARM), ISSN 0976 6324 (Print), ISSN 0976 6332 (Online), Volume 3, Issue 2, July-December (2012) Table 1: Foreign Tourist Arrivals to India- Top 10 States/UT
Sl No 1 2 3 4 5 6 7 8 9 10 State Delhi Maharashtra Uttar Pradesh Tamil Nadu Rajasthan West Bengal Andhra Pradesh Karnataka Kerala Goa 2006 2007 1974836 1995123 1712302 1762005 1328974 1396932 1319501 1338521 1220164 1250056 998029 1024220 669617 69732 505524 555798 428534 468480 380414 416355 Source: India Tourism Statistics 2009 2008 2339287 2056913 1610089 1594680 12677646 1133671 789180 571846 598929 433375 2009 1958272 1969992 1532573 1534787 1073414 1080418 795173 614316 609880 444576

Kerala The mesmerizing land located in the south of India enjoys geographical features that are unique and rich. This state is also the only place in India which practices Ayurveda in its purest form. Ayurveda is the traditional Indian system of medicine that has brought true health, happiness and wellbeing to millions of individuals throughout the ages. This ancient art of healing has been in practice for over 5000years, and was also the mainstream medicine in the ancient times. Derived from its ancient Sanskrit roots ayus (life) and ved (knowledge) and offering a rich, comprehensive outlook to a healthy life, it is the only medical science in this universe which is useful even when one is not ill. Ayurveda is a complete science of health that is being applicable in all stages of life starting from birth, neonates, infants, childhood, youth, old age and even life before and after death. For many people, the image of Ayurveda is limited to the use of herbal or home/kitchen remedies and a traditional way of treatment. But in reality, Ayurveda is a much serious medical science, which strongly emphasizes on the diagnosis, examination, analysis of the disease, diet, medicinal properties, dose, frequency of the medicine and the medium with which it should be consumed. The Medicare in Ayurveda has broadly two parts: one is preservation of health and prevention of diseases and the second, diseases and their treatment. In Ayurvedic terminology, the first is Swasthavritha and the later is Athuravritha. Ayurveda follows a totally different way of treating diseases known as Panchakarma, which means literally Five Therapies which are the subtly harmonizing purification procedures that dissolve metabolic waste products and toxins generated from the environmental ill effects, in a gentle and effective way from the tissues and eliminate them from the body. This treatment is advisable to the diseased as well as the healthy. Ayurveda also has a comprehensive system of massages and body treatments that gives relief from a wide range of illnesses, from migraine and sinus to arthritis and paralysis; that detoxify and cleans the body through controlled emesis, purgation, making the individual sweat; and that makes the body receptive to further treatment. These therapies are more effective in Kerala due to the almost year around humid climate of the state. Ayurveda extends excellent treatments for ailments like Osteo-Arthritis, Rheumatic Arthritis, Tennis Elbow and Carpel Tunnel Syndrome, Spondylosis, Intervertibular disc prolapse, Frozen Shoulder, Insomnia, Migraine, Skin Diseases and of course Weight management. From the past two decades, the necessity for a holistic approach in the treatment of diseases had been an active topic for discussion among the scholars of modern medical sciences. As a system of medicine that completely eliminates the disease from the body without causing any side effects,

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International Journal of Advanced Research in Management (IJARM), ISSN 0976 6324 (Print), ISSN 0976 6332 (Online), Volume 3, Issue 2, July-December (2012) and which ultimately promotes the basic health, Ayurveda stands atop the alternative systems of treatments recognized by the World Health Organization. Many foreign countries have already started Kerala Ayurveda treatment centers and the export of Ayurvedic medicines to international market is increasing in a faster pace day by day. But, to the surprise, foreign tourists are often just as keen to visit the origin of the practice to avail treatments and body purification processes. The basic principles emerging from a holistic outlook, the peculiar and unique techniques of treatments, and the health promoting and non reactive herbal drugs used are the main elements which differentiate Ayurveda from the other prevailing medical systems. The Kerala government realizes that it is of vital importance to offer assurance to its wellness seeking guests and visitors to the state that safety, hygiene, service quality and quality assurance are top priorities. This is to be achieved through the introduction of quality standards, registration, certification and regulation, and legislation. The comprehensive plan also includes guidelines and measures to ensure fair pricing. Beyond a competitive pricing strategy, achieving quality is another key to Kerala's competitiveness. The ability to attain international standards and consistently deliver high quality products and services are critical success factors in the promotion of Kerala products on the global market. Kerala, as part of its marketing strategy, continuously organizes road shows all around the world for the promotion of Ayurveda along with modern medicine. It is vitally important to create confidence in the products Kerala offers. There is much greater awareness and operators have come to realize that delivering quality translates into greater business efficiency, lower operating costs and increased profits. RESEARCH ANALYSIS The first part of the questionnaire dealt with the location of the Wellness centre, qualification of the respective medical practitioner employed and whether the centre possessed any certifications. The percentage distribution of the sample according to selected variables is shown in the table 2 below. Table 2: Percentage distribution of the sample according to selected variables Count Percent Qualification BAMS 37 86.0 of Doctor MD 6 14.0 Nil 17 39.5 7 16.3 Certification Govt. Approved possessed by Green leaf 8 18.6 the centre Olive leaf 9 20.9 ISO 2 4.7 Alappuzha 4 9.3 Idukki 12 27.9 District Kollam 7 16.3 Kottayam 4 9.3 Thriruvananathapuram 16 37.2

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International Journal of Advanced Research in Management (IJARM), ISSN 0976 6324 (Print), ISSN 0976 6332 (Online), Volume 3, Issue 2, July-December (2012) Among the 46 wellness centers, 37 employed Doctors with BAMS as their qualification and 6 centers had Doctors with Post Graduation. Among the 46 wellness centers 9 were certified with olive leaf, 8 with Green leaf, 7 centers were Government approved and 2 possessed ISO certification while 17 lacked any certifications. The district wise distribution was:-Thiruvananthapuram 16, Idukki 12, Kollam 7, Kottayam and Alappuzha with 4 each. Certification by competent authorities were considered as the bench mark deciding factor for the respective Wellness centers and various aspects were analyzed using statistical tools to check the reliability, significance and validity. Destination The destinations chosen for the study were located either in a Beach or River/Lake/Wetland, Forest/Rain forest or Mountain. The comparison of destinations in which the selected Ayurvedic resorts are situated is shown in the table 3 below.
Table 3: Comparison of destination based on certification Destination No Yes Total Percent Count Percent Count Percent 35.3 21 80.8 27 62.8 17.6 5 19.2 8 18.6 17.6 0 0.0 3 7.0 35.3 3 11.5 9 20.9 p# p<0.01 p>0.05 p>0.05 p>0.05

Count 6 3 3 6

Beach
River, lake, wetland Forest/rainforest Mountain

The statistical test employed was Fishers Exact Test and the comparison is shown in the above table. It indicates that 62.8 % among the wellness centres were located in destinations near beaches, 20.9% in destinations near Mountains, 18.6% in destinations near river/lake/wetland and 3% in destinations near forests. 80.8% of wellness centres located in beaches possessed certifications by competent authorities. The results displayed in the table prove that certification is a significant factor only for Ayurvedic wellness centres located near Beaches. Number of staff employed The total numbers of staff employed in the wellness centres were classified into three groups: less than 10, between 10 and 15, and greater than 15. The comparison of the average number of staff members employed in the selected wellness centres in shown in the table 4 below
Table 4: Comparison of number of staff based on certification No Yes Total 2 Count Percent Count Percent Count Percent 10 58.8 2 7.7 12 27.9 6 35.3 12 46.2 18 41.9 15.43** 1 5.9 12 46.2 13 30.2 11.1 11.2 16.5 5.2 14.3 8.4

Number of staff <10 10 15 >15 Mean SD

0.000

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International Journal of Advanced Research in Management (IJARM), ISSN 0976 6324 (Print), ISSN 0976 6332 (Online), Volume 3, Issue 2, July-December (2012) 41.9% among the total had their respective number of staff between 10 and 15 irrespective of the possessing of certification. Considering the certified centres, 46.2% had staff numbers between 10 and 15 and equally 46.2% had staff numbers greater than 15. 58.8% of the wellness centres without any certification had less than 10 numbers of staff. Analyzing the significance, the number of staff between 10 and 15 only proves to be valid. Open to all Categories A question was asked to the respective official to know whether the services provided at the wellness centre were made available to all categories of tourists. It was noticed that the Ayurveda dispensaries and hospitals owned by the State Government provides treatment and medicare only to the Indian nationals. The table 5 below shows the comparison on whether the services are open to all categories of tourists.
Table 5: Comparison of open to all categories of Tourists based on certification No Yes Total Whether open to all p# categories of Tourists Count Percent Count Percent Count Percent Yes 15 88.2 15 57.7 30 69.8 p<0.05 No 2 11.8 11 42.3 13 30.2

69.8% among the total wellness centres irrespective of the possessing of certification provides medicare services to all categories of medical tourists. When analyzed based on certification, 57.7% of the certified centres were open to all categories and 88.2% of the uncertified centres were open to all categories of tourists. Hence the option Yes was found significant. Patient Accommodations The total number of patients who could be accommodated in the wellness centre to provide consultation and treatment were classified into three groups. Less than 10, between 10 and 15, and greater than 15. Whether the particular centre possessed any certification by the competent authority was considered as the bases for comparison. The comparison and the respective result is shown in the table 6 shown below.
Table 6: Comparison of maximum no: of patients accommodated at a time based on certification Max. no of patients No Yes Total accommodated at a Count Percent p 2 Count Percent Count Percent time <10 10 58.8 3 11.5 13 30.2 10 - 15 6 35.3 21 80.8 27 62.8 11.04** 0.004 >15 1 5.9 2 7.7 3 7.0 Mean SD 12.5 23 11.7 3.6 12 14.5 **: - Significant at 0.01 level

A total of 62.8% of the wellness centres irrespective of the possessing of certification could accommodate between 10 to 15 patients at a time. When analyzed based on certification, 80.8% among the centres could accommodate between 10 and 15 number of patients and 58.8 % among the centres without any certification could accommodate only less than 10 patients at a time. The number of patients between 10 and 15 was found significant at 0.01 levels.

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International Journal of Advanced Research in Management (IJARM), ISSN 0976 6324 (Print), ISSN 0976 6332 (Online), Volume 3, Issue 2, July-December (2012) Method of Fixation of Price. The method of fixation of prices and costs of medicare services is an issue of great concern. Based on the realities, the same could be classified into two categories. The first one is that the prices are standard and the patient could know it before his/her arrival and availing of the services. The second category says that the prices are fixed after the arrival and availing of services by the patient. The table 7 below shows the comparison and analysis of the same.
Table 7: Comparison of method of fixation of prices based on certification Method of fixation of prices No Count Percent Yes Count Percent Total Count Percent p#

It is standard. Patient know it before arrival

It is fixed after arrival # : Fisher's Exact Test

8 9

47.1 52.9

21 5

80.8 19.2

29 14

67.4 32.6

p<0.05

A total of 67.4% of the resorts fix the prices and costs as standards. The patient who is willing to avail medicare could know the same well in advance. When the data were compared based on certifications, 80.8% among the certified wellness centres have standard pricing strategies while 52.9% of the wellness centres without certification fixes the prices and charges after the arrival and availing of services by the patients. On statistical analysis, the method of standard price fixation proves to be significant when compared based on certifications. Implementation of Treatments and Therapies The design and implementation of therapies at the wellness centres could be grouped into three categories. Mostly the doctors will diagnose the patient and based on the report he shall design the therapies and treatment plans. Sometimes, if a patient with ample knowledge on Ayurveda comes as a patient, he shall inform the doctor in advance regarding his requirements and the doctors and masseurs just follow the same. The third category is that the doctor and the patient will discuss and will mutually discuss and arrive at the treatments plan to be implemented. The comparison of the mode and delivery of treatments based on whether the wellness centre possesses certification and the respective statistical analysis is shown below in table 8.
Table 8: Comparison of mode and delivery of treatments based on certification Mode and delivery of treatments No Count Percent Yes Count Percent Total Count Percent p#

As per the diagnosis report the doctor will schedule

As instructed by the patients Both # : Fisher's Exact Test

1 0 16

5.9 0 94.1

12 0 14

46.2 0 53.8

13 0 30

30.2 0 69.8

p<0.01

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International Journal of Advanced Research in Management (IJARM), ISSN 0976 6324 (Print), ISSN 0976 6332 (Online), Volume 3, Issue 2, July-December (2012) Totally, in around 69.8% of the wellness centres, the treatments are carried out based on the mutual agreement between the doctors and the patients while in 30.2%, the treatments are strictly carried out as per the instructions and plans of the doctors alone. When analyzed based on availability of certifications, 53.8% of the centres implemented the same based on mutual consultation and 94.1% of the wellness centres without any certification implemented treatments based on mutual discussions. Fishers Exact test was carried out to measure the significance. Patients knowledge on Ayurveda Analysis was conducted in order to measure the awareness of the patients availing Ayurveda treatments in the respective wellness centres prior to their arrival to Kerala. The comparison and the respective analysis is shown in the table 9 below.
Table 9: Comparison of patients have adequate knowledge about Ayurveda before arrival based on certification Patients have adequate knowledge about Ayurveda before arrival NA Yes No No Percent 17.6 64.7 17.6 Yes Percent 0.0 84.6 15.4 Total Percent 7.0 76.8 16.3

Count 3 11 3

Count 0 22 4

Count

3 33 7

5.21

0.157

In total, around 76.8 % of the patients availing medicare in both certified and non certified wellness centres possessed adequate knowledge about Ayurveda and other alternative wellness therapies prevailing and practiced at Kerala. When analyzed based on certification, around 84.6% of the patients residing at certified centres possessed prior and adequate knowledge on Ayurveda and around 64 .7% of the patients at non certified centres too had prior awareness. The analysis and significance of the answers based on chi square test is displayed in the above table. FINDINGS AND SUGGESTIONS Kerala, the state almost synonymous with the word 'Ayurveda', is now all set to reap the benefits of Ayurveda through health tourism. The reason for this is the popularity of Ayurvedic treatments and the manner in which Kerala is marketing Ayurveda in medical tourism. International patients seeking medical services across borders or globally look at more than just cost comparisons in their search for the right physician and right facility to address their specific needs. The top priorities include 1. Credentials recognized international accreditations & certifications. 2. Experience board certified doctors, training, years of experience. 3. Patient References patient testimonials, before & after pictures. 4. Specific Treatment Methods uniqueness of center & procedures offered. 5. Comprehensive Solution provide complete solution to a treatment. 6. Reputation locally as well as internationally e.g., publications, research papers. 7. Language effectively communicate in patients preferred language. 8. Geographic Location local conveniences, transportation services, attractions.
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International Journal of Advanced Research in Management (IJARM), ISSN 0976 6324 (Print), ISSN 0976 6332 (Online), Volume 3, Issue 2, July-December (2012) 9. Cost clear price list, services included in the package, pricing options. 10. Benchmark Data any comparative information that will convince patients. The promotion of Ayurveda in health tourism started in 1994 and the Kerala Tourism Development Corporation (KTDC) started Ayurvedic health centers in its premium properties like Hotel Samudra, Kovalam, during the same period. KTDC has tied up with the most reputed Ayurveda treatment providers and hence the authority of doctors and the quality of the medicines used are not compromised. While all the hotels and resorts in Kerala have now started including Ayurveda in their services, there are some resorts, which are exclusive for Ayurvedic treatments. With a view to facilitate the wellness tourism industry to achieve the targets and to give a greater momentum for this growth, the Ministry of Tourism, Government of Kerala, in association with the Department of Indian Systems of Medicine (ISM) has identified an urgent need to evaluate the safety and service standards of the prevailing and newly establishing Ayurveda centers and classify them accordingly. Standards have been set in terms of Personnel Qualified physicians and masseurs having sufficient degree and training from recognized Ayurveda institutions, Quality of medicines and Health programmes Prior approval by the advisory committee for the levels of treatments, clear exhibition of the treatment programmes offered and usage of medicines manufactured by approved firms with proper labeling, Equipments Standards are fixed for the size and make of massage tables, facilities for medicated hot water , sterilization, electric/ gas stove and the hygiene , Facilities - in terms of number of treatment rooms with prescribed size , proper ventilation and attached bathrooms, quality and finishing of floors and walls, consultation room with proper equipments, separate rest rooms, locality , ambience and the cleanliness of surroundings. Ayurvedic centers fulfilling all the mentioned essential conditions are awarded a certification named Olive Leaf. Apart from the same, Government has also set some optional conditions in terms of the construction and architectural features of the building, adequate parking space, facilities for steam bath, separate hall for yoga and meditation, herbal garden attached to the center and the picturesque location. The Ayurveda centers also fulfilling these optional conditions will awarded Green Leaf. The Department of Tourism does not take responsibility of any centre, which is not classified in either of the above categories. Table 10 shows the distribution of Government classified Ayurvedic health centers in Kerala. Table 10: Distribution of Classified Ayurvedic Health Centers in Kerala District Govt. Approved Ayurvedic Centers Thiruvananthapuram 24 ( Green Leaf:15, Olive Leaf: 9) Kollam 9 ( Green Leaf:5, Olive Leaf: 4) Pathanamthitta 2 ( Green Leaf:0, Olive Leaf: 2) Allapuzha 6 ( Green Leaf:6, Olive Leaf: 0) Kottayam 11 ( Green Leaf:9 Olive Leaf: 4) Idukki 6 ( Green Leaf:5, Olive Leaf: 1) Ernakulam 19 ( Green Leaf:8, Olive Leaf: 11) Thrissur 12 ( Green Leaf:5, Olive Leaf: 7) Palakkad 3 ( Green Leaf:1, Olive Leaf: 2) Kozhikod 6 ( Green Leaf:5, Olive Leaf: 1) Wayanad 2 ( Green Leaf:1, Olive Leaf: 1) Kannur 2 ( Green Leaf:0, Olive Leaf: 2) Total 104 ( Green Leaf:59, Olive Leaf: 45) Source : Kerala Tourism Statistics

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International Journal of Advanced Research in Management (IJARM), ISSN 0976 6324 (Print), ISSN 0976 6332 (Online), Volume 3, Issue 2, July-December (2012) With the destination firmly established as the 'Wellness Capital of Asia', achieving world-class status is next on the national agenda. Kerala is the foremost state in India that realized the potential of Ayurvedic health tourism and has widely marketed it throughout the state. About 1012 years back, Kerala started with the task of promoting Ayurveda on a larger scale. It is estimated that about 30% of the foreigners coming to Kerala avail themselves to Ayurvedic care and about 40% of the States tourism revenue is generated from the same. The Kerala government realizes that it is of vital importance to offer assurance to spa guests and visitors to the state that safety, hygiene, service quality and quality assurance are top priorities. This is to be achieved through the introduction of quality standards, registration, certification and regulation, and legislation. The comprehensive plan also includes guidelines and measures to ensure fair pricing. Beyond a competitive pricing strategy, achieving quality is another key to Kerala's competitiveness. The ability to attain international standards and consistently deliver high quality products and services are critical success factors in the promotion of Kerala products on the global market. Kerala, as part of its marketing strategy, continuously organizes road shows all around the world for the promotion of Ayurveda along with modern medicine. It is vitally important to create confidence in the products Kerala offers. There is much greater awareness and operators have come to realize that delivering quality translates into greater business efficiency, lower operating costs and increased profits. CONCLUSION The Indian tourism industry has outperformed the global tourism scenario in terms of growth, revenue and the volume of international tourist visits. A recent trend has shown that people from developed countries are seeking treatment from the health professionals from developing countries. The destination in wellness tourism is often an alternative space in which one can engage in self analysis without the stresses and distractions of home as well as work place. In the long run, Wellness tourism can become the niche for foreign revenue generation as there is an increasing trend in the number of visitors to Kerala as wellness seekers. The study reveals that the most favourable factor for Kerala to emerge as the Global Wellness Hub is its authenticity and rich Ayurvedic heritage with multifaceted attractions. Marketing Kerala as a safe quality wellness destination depends on effective distribution channels, hospital-defined market niche strategies, as well as data collection on the sources of information used to select Kerala as the preferred medical destination. REFERENCES 1. Angel, Marrica, (2004), The truth about drug companies. New York review of books, LI (12) :52-58 2. Cooper, K. (1982). The Aerobics Program for Total Well-Being. New York: Bantam. 3. Corbin, Pangrazi, & Franks, (2000), Definitions: Health fitness and physical activities, Presidents council on physical fitness and sports research digest,3(9), 1-8. 4. Dunn, H.L, (1965), High level wellness, Arlington 1997. 5. Kulkarni, A, (2008), Become healthy happy and balanced with Ayurveda, Medical Tourism, issue 2, 38-39. 6. Melanie Smith, Catherine Kelly, (2006), Tourism Recreation Research, Vol 31 (1), 1-4

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International Journal of Advanced Research in Management (IJARM), ISSN 0976 6324 (Print), ISSN 0976 6332 (Online), Volume 3, Issue 2, July-December (2012) 7. Mohammed, Ilyas, T, (2008) Medical Tourism: India the Right Destination, Southern Economist, 37-39. 8. Mohanlal,P.K, (2008), The Holistic Approach of Ayurveda, Ayurveda &Health Tourism, vol:3, issue:1,22-26 9. .U.S. Department of Health and Human Services. (2000). Healthypeople2010: Understanding and improving health, 2nd edition in two volumes. Washington, DC: Government Printing Office. 10. Varier, P.R., Dr. (1986) The management of the problem of ageing, according to the Ayurvedic system of medicine, Vasudeva Vilasam Ayurveda pharmacy, Centenary Souvenir, Trivandrum, Kerala 11. World Health Organization. (1947). Constitution of the World Health Organization. Chronicle of the World Health Organization 1, 29-43.

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