New trends for medical spas

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Por Ann Brady
Etiquetado como MedicinaBienestar
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If you’re feeling frazzled, burnt out, perhaps need a little facial work, there’s a medical spa that will meet your needs. But how can you be sure you’re in safe hands? Here, two experts explore the growth of this trillion-dollar-plus industry and explain why the ISO standard for medical spas is a valuable tool that not only keeps the sector healthy and innovative, but also ensures quality.

Once upon a time, and not so very long ago, spas were all about manicures, pedicures, massages – lots of massages – from Swedish massage, sports massage, therapeutic massage to Eastern-inspired Ayurveda massage, hot stone massage, the list goes on. Every hotel and resort that claimed to offer luxury facilities had a spa attached, offering all of the above, and people flocked to these spas in their droves to be oiled, pummelled, pampered and swathed in fluffy towels. They were the go-to places to step out of the fast lane, to switch off, wind down and de-stress.

Then the industry moved on and, along with it, the menu of therapies and treatments. The emphasis shifted more to wellness and well-being. The new thinking was that as well as the massages, facials and body wraps, why not take a more holistic approach and focus on treating the whole body? So along with beauticians and physiotherapists, medical experts were on hand to check on health and advise on procedures to improve and maintain it. The medical spa was born.

Young man receiving a facial treatment in a health beauty spa.

Holistic approach

When we think of medical spas and clinical treatments, countries like Switzerland spring to mind. And the Grand Resort Bad Ragaz in the foothills of the Alps near Zurich is a good example of an enterprise that built its success on thermal waters. It has since moved with the times and is regarded as one of the leading well-being and medical health resorts in Europe. On its Website, the resort’s medical health director, Teo Albarano, says: “Prevention is increasingly dominant in any approach to health, which is why the fusion of medical check-ups and wellness makes sense.”

Another go-to resort for the rich and famous, the world­-renowned Mayr clinic in Austria that made its name in treating problems with the gut now “holistically combines medical treatment, nutrition, exercise and awareness training”. It promises clients a better awareness of their body to enjoy “greater balance and health”.

According to the 2018 Global Wellness Economy Monitor, a research report by the Global Wellness Institute providing comprehensive data on the sector, more and more of us are combining pampering with personalized medical treatments. The institute says that wellness is now a USD 4.2 trillion global industry. And the American Med Spa Association (AmSpa), in a Medical Spa State of the Industry Report in 2019, says the industry is not only growing quickly but is also “evolving into one of the leading growth industries in the nation”. The report adds that the average medical spa brings in USD 1 million a year.

In this digital age, the age of the so-called Fourth Industrial Revolution, technology is also driving the industry. According to AmSpa, technology “is key to current med spa growth” because it has made advances in non-invasive treatments such as Botox more affordable and widely available. As AmSpa says: “As long as technology allows people to turn back the hands of time in an easy and (relatively) pain-free manner, there will be a market.”

Enjoying peace of mind

As the world becomes ever more interconnected, and people seek a healthier lifestyle, the medical spa industry looks set to continue its rapid growth. According to the Medical Spa Market Size, Share & Trends Analysis Report, compiled by business consultancy firm Grand View Research, the global medical spa market size “is expected to reach USD 33.9 billion by 2026, registering a compound annual growth rate of 13.8 %”. And an “increasing number of aesthetic treatment alternatives is projected to be one of the key growth-driving factors”.

For the discerning tourist of the digital age, a loll on a beach lounger after a relaxing massage is no longer enough. Staying healthy today doesn’t refer simply to a lack of illness and disease, but to a more holistic state of being. João Pinto Barbosa, who has had more than 20 years’ experience in the spa and health resorts industry in Europe and South America, describes this as “a state where mental, physical and emotional health are in harmony. That’s something noticeable not only in the elderly population but also among younger generations. It is reflected in a variety of choices that include corporate wellness, personalized care, healthy nutrition, physical exercise, travel and hospitality and mental well-being”.

However, all spas, medical or otherwise – and no matter what the treatment – promise peace of mind. Somewhere to iron away the wrinkles and cares of modern life. But for those of us thinking about dipping a toe in the world of medical spas for the first time, how can we be sure that the treatment we have signed up for – be it plastic surgery, varicose vein removal, laser hair removal or even treatment for a more serious health issue – will be administered by fully qualified medical experts, thereby ensuring peace of mind? In this burgeoning industry, how can trust and safety be guaranteed?

Turkish baths in Jermyn Street, London, circa 1800.


Staying healthy today doesn’t refer simply to a lack of illness and disease, but to a more holistic state of being.

Standard’s key role

A physical therapist lowers a senior female patient into the pool using a spa lift.

Barbosa believes that ISO 21426, Tourism and related services – Medical spas – Service requirements, plays a key role in dissipating confusion for consumers as it provides a clear definition of medical spas. He was Marketing Manager and Head of Executive Committee at the European Spas Association (ESPA), which represents over 1 400 medical spas and health resorts, and was ESPA’s representative at the ISO medical spas working group of experts.

He is a great advocate of the standard: “Before ISO 21426 (and also ISO 17679, Tourism and related services – Wellness spa – Service requirements), it was common to see many – actually, too many – definitions of ‘spaʼ in Europe and worldwide. Now, because of ISO 21426, consumers know exactly what a medical spa is and what services they cover.”

In a booming, fast-growing sector, Barbosa says ISO 21426 has brought more transparency and fairer competition. The pluses for medical spas that comply with the standard’s requirements include a reduction in costs due to an improvement in processes, as well as more reliable and better-quality services. “This is a major step forward for any spa in order to gain consumer trust and preference. I’m pretty sure that by applying ISO 21426, medical spa facilities will get more satisfied guests, more economic success and more international reputation through better quality.”

He highlights the fact that, in times of uncertainty, the big challenge for medical spas is raising awareness of their many benefits, either as part of a healing process, a preventive approach or wellness programmes. ISO 21426 helps to underscore the message that all this improves the quality of life and well-being of citizens.

Covered swimming pool at a spa in Vienna, Austria.

Consumer confidence

Technical Manager Maricruz Cádiz of ICTE, the Spanish Institute for Quality Tourism, has also been the project leader of ISO 21426 for medical spas. She, too, stresses the confidence for consumers inherent in the standard. She says that ISO 21426 “establishes the service provision requirements in medical spas, defined as legally recognized health establishments, with medical supervision, using mineral waters with therapeutic effects and other specific natural resources such as gases or peloids in health treatments”.

From the ancient Greeks to the present day, she points out that people have sought the healing properties of mineral medicinal waters. Nowadays, she goes on to say, the interest of the general population in health and well-being, as well as the need to disconnect from the multiple obligations in our daily life, has generated special interest in services aimed at promoting well-being, some of them based on water treatments.

However, when it comes to medicinal properties, not all waters are equal. Cádiz says that, beyond the relaxing effect, only waters with mineral medicinal properties have been proven effective for the prevention and treatment of certain diseases. Carbonic waters, for example, stimulate appetite and favour the proper functioning of the circulatory system; and bicarbonate waters are recommended for problems with the digestive system. “All this shows us the importance of valuing the benefits of these mineral medicinal waters used in medical spas and, at the same time, of establishing the requirements for the provision of a quality service. That is the reason for the ISO 21426 standard for medical spas.”

As well as requirements related to the evaluation and monitoring of the properties of natural resources used in health treatments, Cádiz says ISO 21426 also establishes the requirements related to the provision of medical spa services, its facilities and equipment, hygiene, cleaning and maintenance, along with the profiles and qualifications of the personnel providing the health treatments.

Despite the boom worldwide in this sector of the wellness market – or indeed because of it – it’s not all peace and serenity. Barbosa highlights some of the risks. In Europe, for instance, medical spas are underused and, in some countries, suffer from a lack of recognition from health authorities, health funds and medical doctors. “That’s the reason why it is crucial for the medical spa industry to increase awareness among European citizens and authorities that the industry is not only an essential part of the healthcare system but also an important driver of local and regional economies,” he says.

Risks and opportunities

Another big risk for this sector is unfair competition from so-called spa services that can harm and undermine the overall reputation of the authentic medical spa industry. Barbosa says: “As I mentioned earlier, that is why the ISO standards, both for the medical spa and the wellness spa, are so important to clarify consumers’ perceptions about what is a genuine and officially recognized spa facility.”

Cádiz agrees, saying that ISO 21426 is an opportunity to differentiate and value the beneficial effects of mineral medicinal waters for the prevention and treatment of certain diseases. She sees the standard as “a key tool to adapt the service, infrastructure and equipment of medical spas to the expectations of the current client” – and an increasingly informed and demanding client, who as well as the benefit of the treatment also seeks quality and detail in service.

So, what have these two experts learned about this burgeoning industry and ISO 21426? For Barbosa, one of the biggest challenges at ESPA was representing 20 countries with so many regulations, business models and views of the medical spa market. For this reason, he says, now that ISO 21426 is a reality after so many years of work, “the most valuable lesson I learned is that a single European vision and legal framework for what matters most in the medical spa business is possible to achieve”. Cádiz says: “In a world where the pursuit of well-being takes on special relevance, this standard constitutes a tool to open medical spas to all audiences and promote the benefits.”

As Barbosa points out, this current trend is here to stay and will become more and more important. “Given the nature of the services provided by the vast majority of medical spas, this 360º healthy-way-of-life approach is an outstanding opportunity to stay ahead of the curve and look to the future needs of society. Three strategic key drivers are crucial for the medical spa industry to take advantage of this trend and fulfil consumer expectations: health, innovation and quality. 

Instructor leading students in a yoga class.
ISOfocus Julio/Agosto 2020


Our well-being issue provides wellness tips, looks into the benefits of sport and e-bike standards, discusses medical spas and thalassotherapy and provides you with loads of insights in the booming medical tourism industry.

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Elizabeth Gasiorowski-Denis
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