Health and Wellness Tourism Industry: Types and Development Potentials in Bali, Indonesia I Gusti Bagus Rai Utama1 , Made Nyandra2 1Hospoyality Management of Dhyana Pura University, Bali, Indonesia 2Public Health of Dhyana Pura University, Bali, Indonesia ABSTRACT *Published Online: 26 July 2021 This study aims to explore health and wellness tourism: types and development potentials in Bali, and is expected to become an alternative attraction for tourism in Bali and Indonesia. This research uses the desk research method with data and information search techniques online, secondary sources, and other sources of scientific publications. While the analysis technique used is descriptive qualitative analysis techniques, analogy, and comparison of several research results and other scientific publications related to health and wellness problems. Particularly in Bali, the tourism market health and wellness can be divided into four segments: (1) medical tourism, (2) wellness and spa, (3) nursing and elderly care, and (4) research services, and diagnostics. In many countries, services health and wellness are an ideal service to promote the role of tourism services exports as a share of GDP. In Bali, the number of spas has grown to more than 160% since 2003. It is identified that around 390 spas are currently operating and the remaining 21 are currently being built. The existence of health and wellness tourism is an opportunity and strength to increase the competitiveness of Bali as an international tourism destination. Keywords: Bali, Tourism, Health and Wellness, herb, spices 1. INTRODUCTION According to Maslow’s theory of needs, where human needs are not just basic needs but more than that, humans also need a sense of security, social recognition, long for an award, want achievement, and ultimately want to do selfactualization. If most humans cannot fulfill their psychological needs, it is all because of compulsion alone, not from a human conscience, meaning that human needs are indeed the desire of all humans in this world. In this segment of psychological needs, leisure activities play an important role [1,2]. Leisure can be divided into five main groups, namely: (1) Existential: They are escapes from the routine of daily life, they join groups for leisure activity seekers that are spiritual in nature. (2) Experimental: They are looking for a lifestyle that is different, very extreme from their daily life. *Corresponding Author: I Gusti Bagus Rai Utama *Cite this Article I Gusti Bagus Rai Utama, Made Nyandra (2021). Health and Wellness Tourism Industry: Types and Development Potentials in Bali, Indonesia. International Journal of Social Science and Education Research Studies, 1(1), 08-12 (3) Experiential: They look for the meaning of their lives in different communities and compare them, seeking an experience from different cultures. (4) Diversionary: Those who run from routine life, looking for physical or mental “refreshment”. (5) Recreational: Those who do leisure activities as part of self-entertainment or relaxation. When viewed from a person’s motivation for doing leisure activities, McIntosh and Murphy group them into four groups, which consist of: (1) Physical Motivation: People who are encouraged to leisure for physical reasons; relaxation, health, comfort, sports, relaxing and so on. (2) Cultural Motivation: They want to remember and get to know lane culture as if they will be in another world in the context of time or era. (3) Social Motivation: They are motivated by social activities such as visiting family in the village “returning home” to visit friends, or even visiting sick people. (4) Fantasy Motivation: Those who try to make something that they have been or are thinking about trying to get away from their daily routine [4,5]. In line with some of the opinions, type of tourism or leisure activity has been packaged into a business opportunity to provide health and wellness services. In this context, tourism health and wellness refers to the activities of a person I Gusti Bagus Rai Utama et al., Health and Wellness Tourism Industry: Types and Development Potentials in Bali, Indonesia 9 Avaliable at: www.ijssers.org traveling to and living in places outside their usual environment for no more than one consecutive year for purpose health and wellness and not related to a job, and not being paid from places visited. It is also associated with trips to health spas or resort destinations where the main objective is to improve physical fitness through physical exercise and therapy, diet control, and medical services relevant to physical maintenance 12. Wellness can be described as a process in which individuals make choices and engage in activities by promoting directing a healthy lifestyle, which in turn has a positive impact on the individual’s health [6]. This study aims to explore health and wellness tourism: types and development potentials in Bali, and is expected to become an alternative attraction for tourism in Bali and Indonesia. 2. POSITION OF HEALTH AND WELLNESS IN THE TOURISM BUSINESS 2.1 Wellness tourism Wellness industry in the travel industry business idea is a subpart of the travel industry as separated as other the travel industry organizations. Wellness industry is classified as sickness counteraction travel industry and spa/improvement travel industry. Wellness and health travel industry is remembered for ailment counteraction travel industry, which is ordered into wellbeing administrations and wellness administrations [6, 12]. Wellness tourism is understood as a scientific concept that will be explored and developed into new concepts that are more relevant in terms of demand and bidding. When viewed from the supply side, wellness tourism is a product in the form of tourism services that can be developed or created following the conditions of a destination both from a social and environmental perspective [7]. From the demand side, health and wellness tourism has now become a trend in the world community to realize health and gain self-satisfaction. The consumers are health and wellness tourism not limited to foreign tourists but have become a “lifestyle”, especially the urban “consumer” community in the country [8]. 2.2 Difference between medical and Health Tourism Health tourism is travel with motivation health is essentially carried out concerning health, such as medical check-ups, maintenance, such as steam baths, mud baths, hot baths, reflexology, fitness massages, and spas which are currently on the rise in Indonesia, treatment, recovery and so on [9]. Health-tourism and medical-tourism are two different things, where health tourism can be interpreted as health tourism in the form of travel for health care and/or recovery which is essentially carried out by people who are healthy, do not suffer from a disease or people who have just recovered from treatment. Meanwhile, medical tourism tends to be more concerned with medical treatment (cure), surgery and/or other medical actions, which are carried out on sufferers of a disease or health condition disorder 6. Medical tourism is more focused on “surgical procedures” but health tourism. More associated with the concept of a resort which is designed for relaxation, seeking tranquility, and improving body fitness. However, the terms medical and health tourism are considered two things that are not much different according to the opinion of consumers or tourists [10]. 2.3 Types and Forms of products The health and wellness tourism need for health and wellness products will continue to grow and vary depending on social factors and environmental sensitivity. If humans still have a sense of extending self-responsibility, then they will need these services for health and wellness. Health and Wellness products can be categorized into several groups namely;(1) mind mental activity/education, (2) health nutrition/diet, (3) body physical fitness/beauty care, and (4) relaxation rest/meditation [11]. 2.4 Trend of Health and Wellness Tourism Trend increasing the growth and development of health and wellness tourism cannot be doubted. At the global and regional levels, for health and wellness (medical service, leisure, and recreation Spas, medical-surgical clinics, medical wellness centers or spas) tourism is spread almost evenly in several regions such as Europe, America, Asia, and Australia and New Zealand [12]. The need or demand for natural destinations that are capable of being a place for healing has become a trend that is prevalent in almost all regions of the world. Health and wellness tourism can be developed based on materials or assets that have been available on a destination (Existing assets for health and wellness tourism) and or held based on the needs or requests (Use of existing assets). are included in the existing assets of health and wellness tourism for is (1) Natural healing assets, (2) Indigenous healing traditions, (3) medical service, (4) nature, and (5) spiritual traditions. Meanwhile, those included in the use of existing assets are (1) leisure and recreation spas, (2) medical/therapeutic hotel/clinic spas, (3) medical/surgical clinic or hospital, (4) medical wellness center or spas, (5) holistic retreats, and (6) hotel and resort spa [12]. Natural healing assets are spread almost evenly in several regions such as Northern, Western and Central Europe, and Southern Europe. Meanwhile, the American region is spread over two regions, namely Central and South America. Likewise, the African region and the Pacific region are also rich in natural healing assets, while the Middle East and Southeast Asia are not included in the regions rich in natural healing assets except for Far East Asia, this is possible because at the time this research was conducted, the two regions have not explored this as an asset that can be used as a natural healing asset [13]. I Gusti Bagus Rai Utama et al., Health and Wellness Tourism Industry: Types and Development Potentials in Bali, Indonesia 10 Avaliable at: www.ijssers.org The indigenous healing tradition is spread evenly in America, Africa, Southeast Asia and the Far East, and the Pacific region. The European region is considered not to have an indigenous healing tradition, which means that this might happen because most of this region has been touched by modernization which hardly leaves any traditional elements anymore, very different from the Asian, Pacific, and American regions where culture is still very easy to find. indigenous traditional healing such as in India, China, alternative medicine in Indonesia, and the like [14]. Medical services are spread in almost all regions except in the pacific region, this is possible because the pacific region is located quite far from other regions so that internationally the pacific region is not as popular as other regions such as Europe, America, and Asia [15]. Nature is spread evenly throughout the region except in Southeast Asia and central and eastern Europe. specifically, for the Southeast Asia region, it is not considered an area that is popular with natural sources for health and wellness tourism assets [16]. Spiritual Tradition is only found in Southeast Asia and Far East Asia. This is possible because this area is most present in preserving original spiritual cultures or better known as spiritual traditions such for example; healing with yoga exercises based on the flow of Yin and Yang in China, and so on [17]. Surprisingly, the distribution for the use of existing assets spreads to Southeast Asia and Far East Asia for all types such as; leisure and recreation spa, hotel spa therapy and clinic, medical clinic and hospital, medical wellness center and spa, holistic retreats, and hotel and resorts spa. The same is true of southern Europe and the Pacific region [15]. 3. RESEARCH METHODS This research uses the desk research method with data and information search techniques online, secondary sources, and other sources of scientific publications. While the analysis technique used is descriptive qualitative analysis techniques, analogy, and comparison of several research results and other scientific publications related to health and wellness problems. 4. RESEARCH RESULTS AND DISCUSSION 4.1 Health and Wellness in Indonesia So far, the development of health and wellness tourism has not been widely recognized as a very potential business potential in Indonesia, even though Indonesia has enormous potential for both types of assets for the development of health and wellness tourism [18]. In almost every region of Indonesia, you can find health tourism that has been developed; This is understandable considering that Indonesia is an archipelago that is rich in nature and mountains, which are spread over the five largest islands in Indonesia as well as in thousands of other small islands. However, it is a shame that data on the existence of health tourism that has not been developed and is still very nature cannot be known with certainty [9]. For most Indonesians, the use of spices, and herbs such as rice, coconut, ginger, and others to be used as healing and relaxation (rejuvenate holistically) has been a hereditary habit and some have been packaged. has become the industry spa and in the last ten years’ spa and wellness have grown very rapidly in Indonesia, especially in Bali, and this industry has generated high income [19]. So far, health and wellness, especially spa, is more synonymous with beauty and body fitness, but along with the development of creativity and innovation of service providers, with the combination of Spa and herbal therapy in addition to being beautiful, a person also gets many benefits for healing various diseases [20]. Life in urban areas such as Jakarta, Surabaya, and also Denpasar which is full with activities has an impact on the body to become tired. This condition gives rise to a business Spa that offers recovery and fitness so that no matter how hard a person’s activity with a spa, they will get back in shape and ready to go back to doing those busy activities [21]. For modern society, all of these are things that are faced every day. At such times, health therapy and also a means to pamper yourself are a necessity and have even become a trend nowadays, including a subscription to a spa to restore the body from feeling tired, and gradually it has become a lifestyle for the world community [22]. In line with the demands of health and fitness have turned into self-actualization in line with the improvement of human welfare as well as encouraging the creation of a modern lifestyle. The desire to be different from a body that is always fresh and healthy and health and wellness tourism develops along with the demand and the creation of various types of products, along with the health and wellness amid a level of competition between suppliers or service providers [23]. 4.2 Health and Wellness Tourism Bali As a tourist destination, the existence of health and wellness tourism in Bali has been recognized worldwide as one of the best spa destinations. The Jakarta Post (2009), reported that Bali, Indonesia received an award as “Best Destination SPA in Asia” by Asia SPA and Wellness, at the Asia Spa and wellness festival Gold Awards at the Landmark Hotel, Bangkok. At this event, there were 28 Spa and Wellness Centers that received an award of 212 nominations in Asia, where the assessment is done by looking at the indicators atmosphere(ambiance), equipment and design, qualification and skills of the therapist, the menu of treatment and quality of service(service), in addition to in 2009, Bali was also awarded as the “World’s Best Spa Destination”. This award was given by Berlin-based fitness magazine Senses and was accepted at the annual International Tourism Bourse(ITB) in I Gusti Bagus Rai Utama et al., Health and Wellness Tourism Industry: Types and Development Potentials in Bali, Indonesia 11 Avaliable at: www.ijssers.org Berlin [24]. To maintain and develop healthy and wellness tourism not only limited to products spa, but it also requires an appropriate and accurate strategy to create product creations and innovations. The Caribbean Export Development Agency proposes a form of strategy for developing tourism health and wellness in the Caribbean. Not much different, considering that the Caribbean and Bali islands have many similarities in tourism development, the adoption of this concept for the development of tourism health and wellness in Bali can also be done. 10 aspects need to be done in the development strategy, the ten strategies are described below. (1) Determination of the Position of health and Wellness tourism Bali’s in the Global Market. (2) Determination of the Position of tourism health and Wellness in Bali in the Regional Market. (3) Identification of the Products and/or Services Offered. (4) Identifying the Target market. (5) Overcoming Potential Barriers. (6) Knowing What Bali’s Competitors are. (7) Distinguishing Bali from Competitors. (8) Aligning health and wellness industry Goals with an Opportunity Strategy. (9) Taking Partner Opportunities. (10) Implementing a Promotion Strategy [25]. Particularly in Bali, the tourism market health and wellness can be divided into four segments: (1) medical tourism, (2) wellness and spa, (3) nursing and elderly care, and (4) research services. and diagnostics. Services health and wellness in many countries an ideal service to promote the role of tourism services exports as a share of GDP. In Bali, the number of spas has grown to more than 160% since 2003. It is identified that around 390 spas are currently operating and the remaining 21 are currently being built 26. This high development has opened up momentum for the health and wellness business in Bali, although on the external side this business will compete with a very competitive international trade environment, this health and wellness business is still a real opportunity to take advantage, to create prospects for sustainable economic growth. This will be an opportunity for Bali as a destination for health and wellness in the future [27]. Foreign direct investment and the formation of foreign companies in Bali in the context of the tourism industry health and wellness in recent years, especially spa development has increased 160% compared to 2003. Of the 160%, 52% are located in hotels, resorts, and retreats (Destination Spas), the remaining 42% are Day Spas [26]. The high interest in investing in the spa sector shows that the tourism industry’s health and wellness in Bali are seen as promising in business [27]. 5. CONCLUSIONS AND RECOMMENDATIONS In Indonesia and the ASEAN region, Bali is known to have a fairly well-established tourism infrastructure. The development of tourism is a health and wellness consequence of the development of infrastructure, tourist demand, the hotel industry, and a well-developed business environment. However, this comparative advantage does not guarantee that Bali will be able to face global competition which has been determined by the wishes of tourists. Therefore, the function of tourism management health and wellness should be reevaluated, especially how the most appropriate strategy can be carried out for the development of tourism health and wellness in Bali, which involves not only the government but Bali tourism stakeholders. From this evaluation, it is hoped that answers will be obtained about: the position of health and wellness tourism Bali’s in the global market, the position of tourism health and wellness Bali’s in the regional market, the type and variety of products and/or services offered, target markets, knowing potential obstacles, knowing competitors. Bali, Bali’s differences with competitors, Bali’s industry goals health and wellness with the right opportunity strategy, making partnerships with foreign parties, and implementing the right promotion strategy. 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Biographical note: Dr. I Gusti Bagus Rai Utama, S.E., M.MA., M.A., is Assistant Professor in Tourism at Dhyana Pura University, Bali, Indonesia. He completed his Doctorate Degree in Tourism Studies and Master’s degree of Agribusiness (M.MA) from Udayana University, and Master of Arts in Leisure and Tourism Studies (M.A) from CHN Professional University, Leeuwarden, Netherlands (now NHL Stenden), and Bachelor of Arts (S.E) in Development Economic from Mahasaraswati University, Bali, respectively, with research, focus on Economic Tourism, Agritourism, Destination Management, and Senior Tourism.