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Article

Driving Factors of the Health and Wellness Tourism Industry: A Sharing Economy Perspective Evidence from KPK Pakistan

by
Nadeem Ullah
1,
Shagufta Zada
2,3,
Muhammad Amir Siddique
1,
Yike Hu
1,*,
Heesup Han
4,*,
Alejandro Vega-Muñoz
5 and
Guido Salazar-Sepúlveda
6
1
Department of Landscape Architecture, School of Architecture, Tianjin University, Tianjin 300272, China
2
Ideological and Political Education Department, School of Marxism, Northeast Forestry University, Harbin 150040, China
3
Department Business Administration, Ilma University, Karachi 75190, Pakistan
4
School of Hospitality and Tourism Management, Sejong University, Seoul 05006, Korea
5
Public Policy Observatory, Universidad Autónoma de Chile, Santiago 7500912, Chile
6
Departamento de Ingeniería Industrial, Facultad de Ingeniería, Universidad Católica de la Santísima Concepción, Concepción 4090541, Chile
*
Authors to whom correspondence should be addressed.
Sustainability 2021, 13(23), 13344; https://doi.org/10.3390/su132313344
Submission received: 27 October 2021 / Revised: 25 November 2021 / Accepted: 26 November 2021 / Published: 2 December 2021
(This article belongs to the Special Issue Sustainable Entrepreneurship in Tourism and Sport)
Browse Figure
Versions Notes

Abstract

:
In the recent years, the health and wellness tourism industry has become one of the new emerging industries in Pakistan. In terms of the sharing economy, the driving mechanism of the health and wellness tourism industry has undergone significant changes. Based on a combination of theoretical and practical research, the paper explores the dynamic system and mechanism of innovation development of health and wellness in the tourism industry in Pakistan. Firstly, it theoretically constructs the driving factors in four aspects, which include market demand, industrial supply, infrastructure, and external environment. Secondly, taking Khyber Pakhtunkhwa province (KPK) as an example, it uses the entropy method and Grey relational analysis to test the driving factors system. The empirical results show that four aspects jointly influence the innovation of the health and wellness tourism industry in Pakistan. Finally, this study discusses several practical implications for the development of the health and wellness tourism industry of KPK for academics, policymakers, business owners, and scholars, with recommendations for future research.

1. Introduction

International tourism is becoming increasingly vital throughout the world [1]. As per the report of the World Tourism Organization (WTO) in 2018, international tourists spent $1.3 billion per day and in total $462 billion in the year 2001 alone. In most countries, tourism revenue is considered a substitute for export earnings and significantly contributes to their balance of payment [2]. The government can generate revenue and enhance household income by developing this sector and easing austere visa policies for international visitors/tourists. There are many examples where tourism has a very positive impact on the economy, and tourism positively contributes to the economic development of Pakistan [3]. Tourism positively contributes to the local income development of kpk Pakistan [4].
In the new sharing economy era, against the backdrop of implementing a healthy Pakistan strategy and vigorously developing a modern service industry, Pakistan's health and wellness tourism industry has risen rapidly [5,6]. The health care tourism industry is an emerging industrial form formed by the mutual penetration, crossover, and gradual integration of multiple sectors such as the elderly care service industry, tourism, healthcare, leisure, real estate, and cultural industries [7]. It has gradually become a new growth point and source of vitality for my country's national economy [8]. In the new era, a new economic model centered on improving the utilization efficiency of idle resources using an information technology style sharing economy has gradually risen, in addition to its development concept, business logic, and profit model [9,10].
The formula and other aspects have had a significant impact on the traditional health tourism industry and brought new challenges and opportunities as well as new problems to the development of the health tourism industry [11,12]. The motivation and motivation mechanism of the innovative action of the health and wellness tourism industry under the sharing economy is a major theoretical issue for the development of the health and wellness tourism industry in the new economic environment. It is a scientific plan for the development strategy of the health and wellness tourism industry prerequisites and foundations [13,14].
The rise and development of the health tourism industry is affected by many factors [15]. Scholars have conducted extensive research on the motivations of the development of the health tourism industry; these include external driving factors, including world political and economic integration [16,17,18], government support and promotion [19,20], economic and social effects [21,22], network communication technology and information technology revolution [23,24], faster transportation [25] (Rodriguez, 2001), healthy lifestyle of the new generation [26,27,28], population aging and lifestyle changes, the formation of residents' healthy consumption concepts, and tourism consumption demand [29,30,31,32]. Internal driving factors mainly include health tourism resources, such as medical technology and service projects [33], cost and benefit [34], medical equipment [35], and environmental infrastructure [36,37,38].
In summary, health and wellness tourism refers to individuals’ tourism activities undertaken to fulfill physical, emotional, psychological, and intellectual wellness [39,40]. Health and wellness tourism thus offer various opportunities to enhance life satisfaction, happiness with life, health condition, social/emotional wellbeing, and mental health [41]. The research scope of the development motivation of the health tourism industry at Pakistan and abroad continues to extend, and the research content is gradually refined and deepened. With the advent of the era of the sharing economy, the external and internal environment for the development of the health and wellness tourism industry has undergone significant changes. Traditional theories can no longer effectively explain the new theoretical issues that have emerged in developing the health and wellness tourism industry under the new economy. This article is based on the research on the motivations of the innovation and development of the health tourism industry and its driving mechanism in the new environment of the sharing economy, which can fill the gaps in existing research in this regard. Driving factors for the innovation and development of the health tourism industry under the sharing economy and theoretical thoughts combined with the development practice of the health tourism industry under the new economic environment construct a dynamic framework for the innovation and development of the health tourism industry (Figure 1). The framework is composed of four sub-elements: market demand power system, industrial power system, infrastructure power system, and external environmental power that constitute a power system with the same overall system, and the roles of each component are different. The market demand power system is the source of consumption power. The industry supply power system is the source of power. Both influence the direction of innovation and development of the health tourism industry from the market side and the supply side. Infrastructure power material guarantees power, which ensures the orderly operation of the industrial system. Material conditions and the external environmental power system are the inducing power, which supports the innovative development of the health tourism industry from the aspects of politics, economy, culture, technology, and so on.

1.1. Market Demand Power System

Significant changes have taken place in the market demand for health and wellness tourism in the era of the sharing economy [42,43]. The expansion of market demand, the upgrading of market consumption structure, and the transformation of market demand patterns have promoted the health and wellness tourism industry [14,44].

1.1.1. The Scale of Market Demand in the New Era

With the rapid development of Pakistan social economy and continuous improvement, people's dual demand for health and tourism, has promoted the rapid growth of the new market for health and wellness tourism [45,46]. The sharing economy relies on mobile Internet technology, cloud computing, big data, intelligent terminals, and other technical means to improve the efficiency of the use of idle resources and innovate the consumption method of "use instead of ownership" that separates the right to use and ownership, to provide health for tourists [18]. Elderly consumer groups, in particular, obtain comfortable health and agree tourism services at a lower cost, which increases the purchasing power of health and wellness tourists, drives the increase in total purchasing power, and improves the welfare level of the entire health and wellness tourism consumer, thereby stimulating health and wellness—the diverse needs of the tourism market. Second, the sharing economy broadens health tourism consumption by creating idle resources and reusing the market. Relying on the sharing platform to make more efficient use of scattered resources, meeting the personalized and diversified needs of the health tourism market with lower cost and higher efficiency under the sharing economy model, and realizing the long tail effect and scale effect [47] can further expand the scale of the health tourism market.

1.1.2. Market Consumption Structure

The sharing economy has reduced transaction costs and increased supply through advanced information technology [48]. The need to match efficiency has relatively improved the level of consumption in the market and broadened the scope of consumption, making improving the quality of life a common pursuit of public health tourism consumers, thereby promoting the upgrade of the consumption structure of the health tourism market from sightseeing consumption to experiential consumption [49,50]. Upgrade from material consumption to service consumption [51], upgrade from physiological consumption to spiritual consumption [52]. The proportion of non-basic tourism consumption of leisure and entertainment, physical and mental health, cultural experience, social and emotional communication, and value realization of health tourists have increased. In contrast, the proportion of basic tourism consumption has declined [53]. The consumption structure upgrade of the health care tourism market directly promotes the upgrading of domestic health care tourism products, the deconstruction and reconstruction of the health care tourism industry chain, and the transformation of industrial production and management, which promote the innovative development of the health care tourism industry [54,55].

1.2. Industrial Power Supply System

Tourism development has become a main policy of the government of KPK to create employment and regional economic [56,57,58]. However, tourism has long been observed as having environmental effects [6,20] and results in a full variety of such influences and should be regarded as any other industry, especially in natural or semi-natural environments. Governments, non-governmental organizations (NGOs), local communities, and the commercial sector are all concerned about the obvious need for tourist management and environmental planning [59,60]. To mitigate the negative effects of tourism, a variety of measures are encouraged, including land-use zoning, carrying capacity analysis, limits of acceptable change (LAC), and environmental impact assessments (EIA), but they are mostly used to address issues relating to outdoor recreation, with few relating to catering management.
In the new environment of the sharing economy, the supply of the health care tourism industry has undergone significant changes in external industry competition and internal industrial upgrading, which promotes the innovative development of the health care tourism industry [56,61].

1.2.1. External Industry Competition

The driving force of external industry competition is the market environment of the health and tourism industry under the sharing economy [62,63], competition in the face of alternative competitors [64]. The sharing economy has broken the traditional pattern of industrial competition and promoted adaptive adjustments to the innovation activities of the health and tourism industry, thereby affecting the scope, direction, and degree of industrial innovation [65]. The alternative competitors of the health care tourism industry include health care institutions, the nursing service industry, health food, medical care, etc. [66]. Tourism real estate, education, training, leisure, and entertainment industries in the sharing economy, alternative competitors in the health and tourism industry can use the Internet, big data, cloud computing, and other high-tech means to establish more efficient and economical connection channels with consumers, reduce market entry barriers, and increase market supply. This all promotes industrial competition and innovation. In short, external industrial competitiveness has become an important driving force for creating and developing the health tourism industry [67].

1.2.2. Internal Industrial Upgrading

Pursuing profits is an economic motivation for promoting the innovation of the health and wellness tourism industry [68]. Most profitable big erization and cost minimization are the fundamental driving forces for the internal upgrading of the health and wellness tourism industry. New market opportunities are the source of profit. Under the sharing economy, the market demand for health care tourism is gradually showing a trend of diversification, individualization, decentralization, and nickelization, which puts forward new requirements for the supply mode and efficiency of the health care tourism industry [69]. To open up new markets, companies within the health care tourism industry have gradually increased their investment in operations, marketing, and research and development. They have continuously strengthened their capabilities in product innovation, market boundary expansion, and technological innovation [70]. At the same time, under the sharing economy, health and tourism enterprises integrate idle social resources for integrated management, innovate “asset-light” business models to save operating costs, use shared trading platforms to optimize transaction processes, build collaborative partnerships to keep transaction costs, use information technology means, innovative marketing methods to save market costs, innovative, agile manufacturing systems and shared rental services to respond to the personalized customization needs of health tourists promptly [71]. By reducing costs, health care tourism companies can increase market share and expand reproduction with products with higher price-performance ratios, thereby promoting a benign interaction between production and consumption [72]. Therefore, the internal upgrading power of the health tourism industry under the sharing economy is the leading motivation for continuous innovation.

1.3. Infrastructure Power System

Infrastructure is the essential material condition for the orderly operation of health tourism economic activities and one of the driving factors to promote the innovation of the health tourism industry [73]. The cost of production and operation activities for health tourism companies in areas with good infrastructure conditions will be lower than in other regions [74]. At the same time, regions with good infrastructure will have a larger market size and market opportunities, which will have more significant opportunities for health tourism companies [75]. The infrastructure power system includes elements such as medical facilities, transportation facilities, cultural and sports facilities, and commercial service facilities [76,77].

1.4. External Environment Power System

Under the sharing economy, the political, economic, social, cultural, and technological environments of the health and wellness tourism industry have undergone significant changes [46]. The policy superimposition affects economic transformation, and development, social and cultural differences, and scientific and technological innovation have become essential to promote the creation and development of the health and wellness tourism industry’s creation and development [78].

1.4.1. Policy Environment

Entering the era of sharing economy, as Pakistan population increasingly ages as an essential part of the health industry, the health and wellness tourism industry has gradually received more attention [79]. With the attention and support of the central and local governments, the new PTI government has issued a series of preferential policies, such as several opinions on promoting the development of the health service industry and trying to give various preferential policies to the health and wellness tourism industry in terms of investment, approval, taxes, land, management, and talents [61]. The superimposed effect of the policy can not only invest a large amount of fiscal funds to increase social security expenditures and improve people's living standards [80], it can also attract social capital into the health tourism industry, from a suitable market guidance mechanism [81], and becomes an essential motivation for promoting the innovation of the health tourism industry.

1.4.2. Economic Environment

The domestic economic environment presents new characteristics, which affect the direction, method, and efficiency of the innovative development of the health tourism industry. In the new era, the less-developing countries' economies are downward, and Pakistan's economy has entered a unique, developing situation. The economy has shifted from high-speed growth to medium- and high-speed growth, from extensive growth of scale and speed to intensive growth of quality and efficiency, and from being factor investment-driven to innovation-driven. Affected by the economic environment, people's incomes have fallen, unemployment has risen, disposable income has fallen, and market purchasing power has fallen relatively. Therefore, people have begun to re-examine the concept of consumption. More and more people have gradually accepted the sharing of consumption methods to reduce consumption costs and increase sources of income and livelihood [82]. The rapid development of the sharing economy has expanded the scale of demand in the health and health tourism market, increased the level of demand and purchasing power, and stimulated the expansion of reproduction and innovation and upgrading of the health and health tourism industry; the sharing economy model uses the right to use idle resources through the monetization of idle resources [83]. Production and operation have greatly enriched the supply of operating resources for the health and wellness tourism industry, reduced resource use costs and resolved overcapacity, and promoted the development of the health and wellness tourism industry from extensive development of a scale to intensive development of quality, and a "heavy asset" management mode. There was a shift to the "asset-light" business model, and shift from being capital-driven to innovation-driven.

1.4.3. Cultural Environment

Pakistan's aging population is gradually increasing, and population flows are becoming more frequent [83]. In addition to the accelerating pace of modern life, the structure and functions of Pakistani families have undergone tremendous changes [84]. The family structure tends to be miniaturized and empty-nested, and family functions tend to be core, leading to the continuous weakening of family care functions. More and more families seek social services to meet the needs of the elderly. The contradiction between the rapid growth of market demand for health care tourism and the relative shortage of market supply forces the health care tourism industry to urgently need innovation [85]. On the other hand, the changes in consumption concepts in the new environment of the sharing economy have caused health tourism tourists to shift from focusing on product ownership to using rights, from preferring mass consumption to individual consumption, from focusing on material consumption to spiritual and cultural consumption, and from advocating excessive consumption to sustainable green consumption. The change of consumption concept directly causes the consumption behavior and consumption pattern of health tourists to change accordingly, which has become a significant force to promote the innovation of the health tourism industry.

1.4.4. Technological Environment

The technological environment has undergone significant changes. Data, cloud computing, mobile payment, artificial intelligence, and other advanced science and technology continue to penetrate and optimize the products, production and operation methods, markets, supply chains, organizations, and other aspects of the health tourism industry and are in the process of the development of the health tourism industry [86,87] that carried out continuous and repeated small innovations until the accumulation becomes a qualitatively changing disruptive innovation, forming a spiraling development trajectory for the industry [88]. Technological innovation will speed up the development of new health tourism products, shorten the life cycle of existing health tourism products, and accelerate product upgrades [89]. Technological innovation has created a "supplier-sharing platform-consumer" platform economy business model, which has changed the traditional supply-demand relationship [90,91]. At the same time, technological innovation reduces costs by optimizing transaction processes and institutional changes, thereby promoting innovation in the health and wellness tourism industry. The platform economy created by technological innovation enables the health and wellness tourism industry to disintermediate or re-intermediate and establish platform-based transaction relationships. In contrast, the cost and expense of the platform are lower than that of the enterprise, thus effectively reducing transaction costs [92], and technology innovation is realized the instant optimal matching of supply and demand has reduced information asymmetry, and effectively reduced the money and time costs of transactions; the popularity of smartphones and other intelligent terminals, and mobile payment technology, have improved transaction efficiency and security, and effectively reduced the cost of payment [93]. Platform big data and trading institutions have established a trust mechanism for the network economy, which effectively protects both supplier's and consumers' rights and interests and effectively reduces the risk and cost of online market transactions [94].

2. Materials and Methods

Variable Selection and Data Sources

Based on the theoretical analysis of the article to construct the driving factors and indicator system of the innovation and development of the health tourism industry KPK Pakistan under the sharing economy environment (see Table 1), the article uses Pakistan the annual time series data from 2009 to 2018. The relevant index data are from 2009–2018 (Annual Statistical reports, KPK national economic, and social development statistical data) (see Table 2).
As an objective weighting method, the entropy method has more apparent advantages when the number of evaluation objects is more significant, and the index system is more complicated [11]. It is more objective and scientific. According to the step calculation of non-dimensional processing of evaluation indicators and objective weighting by the entropy method [12], the final weight results of each indicator are determined (see Table 3), and the weighted calculations of KPK health tourism in each year from 2009 to 2018 are presented. The level of industrial innovation development is presented in Table 4, and finally Grey relational analysis is used for the factor affecting KPK health tourism.

3. Results

3.1. Objective Weighting Method

The results show that the innovation and development level of the KPK health and wellness tourism industry has grown very rapidly in the past ten years, reflecting the typical innovation-driven development characteristics of the KPK health and wellness tourism industry.

3.2. Grey Relational Analysis

The above analysis shows that the innovative development of the KPK health and wellness tourism industry is affected by many factors. However, the extent of these factors is still unknown, and further analysis is needed. Julong [95] proposed the grey system theory, which compared with traditional statistical methods, is applicable regardless of the sample size or the irregularities of the sample [96]. Therefore, the grey relational analysis method can be used to analyze the degree of influence of different dynamic factors on the innovation and development of the KPK health tourism industry. Regarding the creation and development of the KPK health and wellness tourism industry as a gray system, the total tourism revenue of KPK from 2009 to 2018 is used as the reference sequence, and the comparison sequence of 15 evaluation indicators is shown in Table 2.
Association sequence (see Table 5 and Table 6). Suppose the gray correlation degree of a certain driving factor is greater. In that case, the correlation degree between this factor and KPK tourism income is higher, and the degree of influence on the innovation and development of the health tourism industry is more significant; if the gray correlation degree is smaller, the factor is the lower the degree of correlation with KPK tourism income, the smaller the impact on the innovation and development of the tourism industry of health and wellness. As COVID-19 affects every sector of the economy, the Pakistan tourism industry also suffers from COVID-19 during the period for 2019 to 2021 [97,98].
The evaluation results show that the gray correlation between tourism income and various driving factors in KPK is ranked as follows: number of tourists, total retail sales of consumer goods per capita, GDP per capita, number of patent authorizations, per capita disposable income of permanent residents, and health per 10,000 people; the number of beds, the area of sports venues per capita, the number of public automobile and vehicles per 10,000 people, the number of cultural institutions per 10,000 people, the proportion of medical care in consumption expenditure, the mileage of roads per square kilometer, the number of elderly people, tourism income/tertiary industry; the number of beds in pension institutions, and the growth rate of investment in the tertiary industry (see Table 6).

4. Discussion

According to Zada, Zada [4], tourism creates employment opportunities and contributes to Pakistan's local economic development. However, fewer studies in this context look at Pakistan. As a result, we investigated the research gap and found a positive impact on the development of health and wellness in the tourism industry in KPK Pakistan. To further strengthen the tourism in kpk in the new era, the innovative development of the KPK health tourism industry needs to implement the following development strategies. First, create a good external environment. The emerging strategic pillar industry of the service industry will further promote the integrated development of sharing economy, Internet economy, service economy, and health tourism terms of the economic environment of KPK. Regarding the social and cultural environment, KPK should strengthen the promotion and education of the concept of health and wellness tourism consumption and the concept of shared consumption to guide market consumption. Our findings link with the research of Kanwal, Rasheed [61], who found that tourism infrastructure positively relate social and environmental development. In terms of the technological environment, KPK should expand and deepen the scope and depth of high-tech applications such as mobile Internet, big data, and artificial intelligence in the health and tourism industry as Ivanov and Webster's study discussed similar aspects. In terms of the policy environment, KPK should improve the policy system for the innovation and the development of the health and wellness tourism industry, increase support for essential health and wellness tourism enterprises, and give more preferential treatment and critical support to health and wellness tourism companies in terms of investment, approval, and taxation. Qualified health and wellness tourism companies should be listed. Voigt and Laing [83] discuss this developmental aspect in their book for developed country Australia.
The second is to tap the potential of market demand, KPK should further expand the youth sports tourism market, the middle-aged health care tourism market, and the elderly pension tourism market and further develop the scale of the health tourism market. KPK should promote the sharing economy model of health tourism, increase the relative purchasing power of tourists by reducing costs, and innovate profit-sharing promotion methods to encourage tourists to purchase high-quality health tourism products and services to optimize the market consumption structure. For the youth sports tourism market, health tourism companies can cooperate with schools, public sports venues, etc. to build research and study tourism bases to win government policy support or financial support; For the middle-aged health tourism market, health tourism companies can cooperate with nursing homes (institutions) and medical institutions cooperate to operate to save site construction and fixed asset investment. In the recent literature review Streimikiene, Svagzdiene [99] highlighted these factors and suggested the strengthening of competitiveness of sustainable tourism. For the elderly care tourism market, health care tourism companies can collaborate with nursing homes (institutions) and related companies to innovate tourism elderly care products, innovative hospitals, elderly tourism, scenic spots, hotels and resorts, senior tourism, towns senior tourism, tourism real estate senior tourism, and other diversified product formats. Hjalager [67] discussed these factors in his study.
The third is to optimize the industrial supply system. KPK should cultivate a health tourism industry ecosystem that adapts to the characteristics of the sharing economy, and form a multi-dimensional industry supply network system centered on the core industry of health tourism and supported by related industries and derivative industries. According to Selen and Ogulin [100], it is also important to optimize the internal connection mechanism of the industry supply network system. To achieve a win-win situation through sharing and to improve the overall productivity and efficiency of the industrial network. In the light of the sustainable development of UNWTO [101], KPK should focus on constructing a health and health tourism sharing economic platform and establishing cross-industry, cross-regional, and cross-ownership health and health tourism enterprise groups, tourism clusters, tourism complexes, and alliances, relying on the sharing economy platform to establish a sharing and win-win benefit distribution mechanism. Use the Internet technology of the sharing economy platform to realize information transparency and open transactions among alliance members, coordinate the division of labor and cooperation among members and share benefits under the unified platform rules; for members who violate the rules, disciplinary measures are used to restrain them from creating an excellent industrial ecological environment [31].
The fourth is to improve infrastructure construction. Based on the standards of building an internationally renowned health and wellness tourism destination by the Organization [102], KPK should strengthen public infrastructures such as medical institutions, public transportation, and sports venues. According to Li and Akintoye [103] government departments can improve public infrastructure construction through innovative purchases, joint ventures, joint construction, lease use rights, etc.; at the same time, government officials can attract them through service outsourcing, BOT model (build-operate-transfer), and incentive systems. Social capital participates in the construction of health tourism infrastructure. As Macbeth, Carson [104] discussed Social capital in the light of these findings. The current study suggests focusing on infrastructure construction mainly involves the following areas. First, extraordinary health and tourism facilities, including new or expanded treatment centers, tourism hospitals, health care centers, medical tourism institutions, etc., and additional medical and health care facilities in A-level scenic spots, PTDCS, and star-rated hotels, health care facilities, leisure facilities, etc. The second is barrier-free facilities. The construction level of barrier-free facilities will be comprehensively improved in A-level scenic spots, star hotels, tourist vehicles, and public restrooms. The third is the KPK tourism information system, which can provide services such as information retrieval and consultation, booking payment, electronic tickets, sharing comments, complaints, and customer service for KPK Tourism; at the same time, the system should have a mobile APP version, an online version, and a simplified version of the information system for the elderly.

Limitation

There are some limitations to this study. These limitations can lead to further research. First, the present study is conducted in the context of KPK Pakistan; future research studies should be carried out in other developing countries in terms of generalizability of the findings. Second, future research should encourage examining other dependent variables, specifically revenue and foreign exchange earnings. Finally, cross culture comparative study needed. Furthermore, future research is needed to additionally recognize the short-term relationship between the variables through the Johansen Cointegration and Vector Error Correction Model (VECM).

5. Conclusions

Based on the above analysis, the following research conclusions are drawn. First, the driving factors for the innovation and development of the health tourism industry in the sharing economy environment. The framework consists of four parts: market demand power, industry supply power, infrastructure power, and external environmental power; each power system and its internal power factors complement each other and interact with each other, the scale of market demand, market consumption structure, external industry competition, and internal industry. Upgrades in medical facilities, transportation facilities, sports facilities, commercial service facilities, policy environment, economic environment, humanities environment, and technological environment all affect the innovation and development of the health and wellness tourism industry.
Second, the empirical results show that the innovative development of the health and wellness tourism industry in KPK in the past ten years has shown a rapid growth trend, and industrial development has significant innovation-driven characteristics. The scale of market demand, commercial service facilities, economic environment, technological environment, and medical facilities, sports facilities, transportation facilities, etc., have a more significant impact on the innovation and development of KPK tourism industry, while the human environment, market consumption structure, internal industrial upgrading, external industrial competition, and policy environment have a significant impact on the innovation and development of the KPK tourism industry. The degree of influence is relatively small.

Author Contributions

Conceptualization, N.U., S.Z. and Y.H.; methodology, N.U., M.A.S. and Y.H.; writing, N.U. and S.Z. Editiding, S.Z., H.H., M.A.S., A.V.-M.; supervision, Y.H. project administration; H.H., A.V.-M. and G.S.-S.; funding acquisition, H.H., A.V.-M. and G.S.-S. All authors have read and agreed to the published version of the manuscript.

Funding

Reconstructing the Architecture System based on the coherence mechanism of “Achitecture-humen-environment” in the chinese context, Key project of national natural science foundation of china, grant number 52038007,2021-01-2025-12.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Not applicable.

Data Availability Statement

The data presented in this study are available on request. The data are not publicly available due to privacy.

Conflicts of Interest

The authors declare that there is no conflict of interest.

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Sustainability 13 13344 g001 550
Figure 1. Framework Health tourism industry innovation driven development power system.
Figure 1. Framework Health tourism industry innovation driven development power system.
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Table
Table 1. Index system of driving factors for the innovation and development of the health tourism industry.
Table 1. Index system of driving factors for the innovation and development of the health tourism industry.
LevelElement Evaluation Index
Market demandMarket demand scale
Market consumption structure external industry competition		Number of tourists (X1)
Number of elderly population (X2)
Dynamics systemInternal industry upgrades medical facilities
Transportation facilities		Health care as a share of consumer spending (X3)
Beds in nursing homes (X4)
Infrastructure Power SystemSports facilities
Commercial Service Facilities		Tourism revenue/tertiary industry (X5)
Number of health beds per 10,000 population (X6)
Mileage of road routes per square kilometre (X7)
Number of buses and trams per 10,000 inhabitants (X8)
Per capita sports area (X9)
Total retail sales of consumer goods per capita (X10)
External environmental dynamic systemPolicy environment
Economic environment
Humanities environment
science and technology environment		Growth rate of tertiary industry investment (X11)
GDP per capita (X12)Per capita disposable income of permanent residents (X13)
Cultural institutions per 10,000 population (X14)
Number of patents granted (X15)
Table
Table 2. Statistical value of the driving factors for the innovation and development of the KPK health care tourism industry from 2009 to 2018.
Table 2. Statistical value of the driving factors for the innovation and development of the KPK health care tourism industry from 2009 to 2018.
Index2008200920102011201220132014201520162017
Total number of tourists (100 million yuan) (X0)561.53703.23917.851268.621662.151171.022003.37225026453308
Tourists (100 million yuan) (X1) 1.011.231.622.222.93.083.493.924.55.42
Number of elderly population (10,000) (X2)319.39325.35333.41337.73341.03352.84359.27367.11381.97406.54
Health care as a share of consumer spending (X3) 0.06130.0660.06380.05880.06390.06790.070.07380.0820.0822
Beds in nursing homes (piece) (X4) 61,19969,17176,99691,746102,251113,066156,76383,47385,51182,005
Tourism revenue/tertiary industry (%) (X5)26.8928.4232.1835.0138.2433.730.0230.0131.1234.59
Number of health beds per 10,000 population (X6)23.9226.529.1632.1836.2940.744.0648.7552.356.79
Road mileage per km2 (X7)1.3181.3471.4191.4391.4651.4911.5461.7061.7341.795
Buses and electric vehicles per 10,000 population (X8)3.2922.8252.6182.682.714.074.1694.2564.2734.4466
Per capita sports area (m2) (X9) 0.680.80.911.11.21.371.371.371.37
Total retail sales of consumer goods per capita (RMB) (X10)7291867110,62412,01913,75817,09519,15921,385397826,349
Growth rate of tertiary industry investment (X11) 0.2490.2810.3160.2490.2850.2170.1850.1610.1190.0068
GDP per capita (yuan) (X12) 20,61823,08527,80034,76239,23643,59948,28852,83758,50263,689
Per capita disposable income of permanent residents (X13) 991510,36111,77514,05516,26316,56918,35220,11022,03424,153
Cultural institutions per 10,000 population (X14) 0.0370.0420.0420.0420.0420.0520.0540.0550.0560.058
Patent grants (X15) 4820750112,08015,52520,36424,82824,31238,91542,73834,780
Table
Table 3. Index weight calculation result.
Table 3. Index weight calculation result.
LevelElementIndex Weight
Market demandMarket demand scalenumber of tourists (X1)0.0642
Seek motivationNumber of elderly population (X2)0.0606
system IndustryMarket consumption structureProportion of healthcare in consumer expenditure (X3) 0.0702
supplyExternal industry competitionNumber of beds in elderly care institutions (X4)0.0532
Give motivationInternal industrial upgradingTourism income/tertiary industry (X5)0.053
systemExternal industry competitionNumber of sanitary beds per 10,000 people (X6)0.0687
Industrial supplyInternal industrial upgradingHighway mileage per square kilometer (X7)0.0711
Give motivationMedical FacilitiesNumber of public automobile and electric vehicles per 10,000 people (X8)0.0998
systemTransportation FacilitiesSports ground area per capita (X9)0.0697
Infrastructure Total retail sales of consumer goods per capita (X10)0.0693
PowerSports Facilities
commercial service facilities 		Tertiary industry investment growth rate (X11)0.043
System
outer ringcultural environmentGDP per capita (X12)0.0676
Per capita disposable income of permanent residents (X13)0.0694
Environmental dynamicsEconomic environmentNumber of cultural institutions per 10,000 people (X14)0.0721
systemTechnological environmentNumber of patents granted (X15)0.081
Table
Table 4. Level of innovation and development of KPK tourism industry from 2009 to 2018.
Table 4. Level of innovation and development of KPK tourism industry from 2009 to 2018.
YearScoreYear Score
20080.07820130.555
20090.15420140.641
20100.22120150.712
20110.28620160.807
20120.39720170.884
Table
Table 5. Calculated value of correlation coefficient.
Table 5. Calculated value of correlation coefficient.
Year
Index		2008200920102011201220132014201520162017
X10.98620.99420.98720.98820.98710.98960.9860.98410.98490.9163
X20.63110.65890.70750.82120.99630.96680.86670.78270.68060.558
X30.63810.64430.71820.90050.95660.95130.86340.80080.73390.5704
X40.74710.74510.76870.79690.87960.83950.65190.70620.61420.4854
X50.6590.67490.67870.73810.81720.98510.80860.72290.63180.5358
X60.77730.78780.82570.92480.95890.99750.95820.93610.82610.6723
X70.64870.67720.71570.83180.98880.94460.8620.83330.70620.563
X80.62120.71850.82990.98570.8280.89680.99440.89840.74470.5949
X90.77910.76430.78620.86610.98820.96320.9480.91840.75570.5824
X100.88760.8850.8880.99390.89710.97170.97870.9840.9510.7722
X110.52780.5080.49660.67810.70480.98180.78450.64960.50470.3338
X120.85290.87030.8790.90850.98030.980510.96670.88530.7165
X130.78110.81710.84460.89510.97980.97810.95260.91990.83180.6829
X140.69090.68080.74540.88240.91110.95560.95550.85340.72190.5759
X150.89650.92660.99910.94840.9340.94410.91260.70870.74170.7142
Table
Table 6. Evaluation results of grey relational degree and relational order.
Table 6. Evaluation results of grey relational degree and relational order.
ElementEvaluation IndexCorrelationAssociative Order
Market demand scaleNumber of tourists (X1)
Number of elderly population (X2)		0.98038
0.76698		1
12
Market consumption structure
External industry competition		Proportion of healthcare in consumer expenditure (X3)
Number of beds in elderly care institutions (X4)		0.77777
0.72345		10
14
Internal industrial upgrading
Medical Facilities		Tourism income/tertiary industry (X5)
Number of sanitary beds per 10,000 people (X6)		0.72521
0.86629		13
6
Transportation Facilities

Sports facilities		Highway mileage per square kilometer (X7)
Number of public automobile and electric vehicles per 10,000 people (X8)
Sports ground area per capita (X9)		0.77736
0.81125
0.83515		11
8
7
Commercial Service Facilities
Policy Environment		Total retail sales of consumer goods per capita (X10)
Tertiary industry investment growth rate (X11)		0.92094
0.61697		2
15
Economic environmentGDP per capita (X12)
Per capita disposable income of permanent residents (X13)		0.90399
0.86830		3
5
cultural environmentNumber of cultural institutions per 10,000 people (X14)0.79739
Technological environmentNumber of patents granted (X15)0.872314
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MDPI and ACS Style

Ullah, N.; Zada, S.; Siddique, M.A.; Hu, Y.; Han, H.; Vega-Muñoz, A.; Salazar-Sepúlveda, G. Driving Factors of the Health and Wellness Tourism Industry: A Sharing Economy Perspective Evidence from KPK Pakistan. Sustainability 2021, 13, 13344. https://doi.org/10.3390/su132313344

AMA Style

Ullah N, Zada S, Siddique MA, Hu Y, Han H, Vega-Muñoz A, Salazar-Sepúlveda G. Driving Factors of the Health and Wellness Tourism Industry: A Sharing Economy Perspective Evidence from KPK Pakistan. Sustainability. 2021; 13(23):13344. https://doi.org/10.3390/su132313344

Chicago/Turabian Style

Ullah, Nadeem, Shagufta Zada, Muhammad Amir Siddique, Yike Hu, Heesup Han, Alejandro Vega-Muñoz, and Guido Salazar-Sepúlveda. 2021. "Driving Factors of the Health and Wellness Tourism Industry: A Sharing Economy Perspective Evidence from KPK Pakistan" Sustainability 13, no. 23: 13344. https://doi.org/10.3390/su132313344

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