Relationships Among Medical Activity Perceived Functional Values, Satisfaction Trust, and Revisit Intention in Medical Tourism: A Case Study on CLMV Tourists in Thailand

Authors

  • Chutharat Chitthanom Graduate School of Tourism Management National Institute of Development Administration (NIDA)

Keywords:

medical tourism, medical activity, perceived functional values, satisfaction, trust, revisit intention

Abstract

In this study, we examined the roles of servicescape (medical activity), perceived value, satisfaction, trust, and revisit intention in the medical tourism of Udon Thani Province, Thailand. Data were collected from foreign tourists
visiting Udon Thani from Cambodia, Laos, Myanmar, and Vietnam. A field survey was conducted at a private hospital by distributing questionnaires to 652 tourists visiting Udon Thani for medical activity. It was observed that medical
activity, perceived functional value, satisfaction, and trust have significant associations affecting revisit intentions, while satisfaction and trust also acted as significant mediators. Findings also indicated that convenience, not price, played the most crucial role, and thus countries should not focus solely on promoting price advantages. Moreover, the government and all stakeholders of the tourism industry should focus on these factors to contribute to the success and sustainability of medical tourism.

References

Adams, K., Snyder, J., Crooks, V. A., & Berry, N. S. (2018). A critical examination of empowerment discourse in medical tourism: The case of the dental tourism industry in Los Algodones, Mexico. Globalization and Health, 14(1), 1–10.

Agustin, C., & Singh, J. (2005). Curvilinear effects of consumer loyalty determinants in relational exchanges. Journal of Marketing Research, 42(1), 96–108.

Ahmed, Z., & Yeasmeen, F. (2016). First world healthcare by third world provider: Position of Bangladesh. Journal of Health Science Research, 1(2), 29–33.

Al-Sabbahy, H. Z., Ekinci, Y., & Riley, M. (2004). An investigation of perceived value dimensions: Implications for hospitality research. Journal of Travel Research, 42(3), 226–234.

Andaleeb, S. S., Siddiqui, N., & Khandakar, S. (2007). Patient satisfaction with health services in Bangladesh. Health Policy and Planning, 22(4), 263–273.

Anderson, E. W., & Sullivan, M. W. (1993). The Antecedents and consequences of customer satisfaction for firms. Marketing Science, 12(2), 125–143.

Anderson, J. C., & Gerbing, D. W. (1988). Structural equation modeling in practice: A review and recommended two-step approach. Psychological Bulletin, 103(3), 411–423.

Bajs, I. P. (2015). Tourist perceived value, Relationship to satisfaction, and behavioral intentions: The example of the croatian tourist destination dubrovnik. Journal of Travel Research, 54(1), 122–134.

Baker, D. A., & Crompton, J. L. (2000). Quality, satisfaction and behavioral intentions. Annals of Tourism Research, 27(3), 785–804.

Bennett, M., King, B., & Milner, L. (2004). The health resort sector in Australia: A positioning study. Journal of Vacation Marketing, 10(2), 122–137.

Bies, W., & Zacharia, L. (2007). Medical tourism: Outsourcing surgery. Mathematical and Computer Modelling, 46(7–8), 1144–1159.

Bitner, M. J. (1990). Evaluating service encounters: The effects of physical surroundings and employee responses. Journal of Marketing, 54(2), 69–82.

Bitner, M. J. (1992). Servicescapes : The Impact of Physical Surroundings on Customers and Employees. 56(4), 57–71.

Bonn, M. A., Joseph-Mathews, S. M., Dai, M., Hayes, S., & Cave, J. (2007). Heritage/cultural attraction atmospherics: Creating the right environment for the heritage/cultural visitor. Journal of Travel Research, 45(3), 345–354.

Bookman, M. Z., & Bookman, K. R. (2007). Medical tourism in developing countries. MacMillan.

Booms, B. H., & Bitner, M. J. (1981). Marketing strategies and organisation structures for service firms. In J. Donnelly & W. R. George (Eds.), Marketing of Services. American Marketing Association.

Bracken, B. A., & Barona, A. (1991). State of the art procedures for translating, validating and using psychoeducational tests in cross-cultural assessment. School Psychology International, 12(1–2), 119–132.

Chang, C.-S., Chen, S.-Y., & Lan, Y.-T. (2013). Service quality, trust, and patient satisfaction in interpersonal-based medical service encounters. BMC Health Services Research. Retrieved August 17, 2018, https://doi.org/10.1186/1472-6963-13-22

Chen, C.-F., & Chen, F.-S. (2010). Experience quality, perceived value, satisfaction and behavioral intentions for heritage tourists. Tourism Management, 31(1), 29–35.

Chiu, C.-M., Hsu, M.-H., Lai, H., & Chang, C.-M. (2012). Re-examining the influence of trust on online repeat purchase intention. Decision Support Systems, 53(4), 835–845.

Choi, K.-S., Cho, W.-H., Lee, S., Lee, H., & Kim, C. (2004). The relationships among quality, value, satisfaction and behavioral intention in health care provider choice: A South Korean study. Journal of Business Research, 57(8), 913–921.

Chu, P., Lee, G.-Y., & Chao, Y. (2012). Service quality , customer satisfaction , customer trust , and loyalty in an e-banking context. Social Behaviour and Personality, 40(8), 1271–1284.

Cohen, E. (2008). Medical tourism in Thailand. AU-GSB, 1(1), 24–37.

Cole, S. T., & Scott, D. (2004). Examining the mediating role of experience quality in a model of tourist experiences. Journal of Travel & Tourism Marketing, 16(1), 79–90.

Connell, J. (2006). Medical tourism: Sea, sun, sand and ... surgery. Tourism Management, 27(6), 1093–1100.

Cronin, J. J., & Taylor, S. A. (1992). Measuring service quality: A reexamination and extension. Journal of Marketing, 56(3), 55–68.

del Bosque, I. R., & San Martín, H. (2008). Tourist satisfaction a cognitive-affective model. Annals of Tourism Research, 35(2), 551–573.

Department of Health Service Support. (2015). Summary report of the Medical Hub policy for fiscal year 2015. Retrieved January 15, 2018, from http://hss.moph.go.th/fileupload_doc/2017-12-18-1-17-37017764.pdf

Department of Health Service Support. (2016). Summary report of the medical hub policy for fiscal year 2015. Retrieved January 15, 2018, from https://hss.moph.go.th/fileupload/2560-102.pdf

Donabedian, A. (1996). The effectiveness of quality assurance in primary care. International Journal for Quality in Health Care, 8(4), 401–407.

Dugan, E., Trachtenberg, F., & Hall, M. A. (2005). Development of abbreviated measures to assess patient trust in a physician, a health insurer, and the medical profession. BMC Health Services Research, 5, 1–7.

Edvardsson, B., Johnson, M. D., Gustafsson, A., & Strandvik, T. (2000). The effects of satisfaction and loyalty on profits and growth: Products versus services. Total Quality Management, 11(7), 917–927.

Ehrbeck, T., Guevara, C., & Mango, P. (2008). Mapping the market for medical travel. The McKinsey Quarterly. Retrieved January 15, 2018, from http://www.heal-wheel-india.com/white-pappers/McKinsey-Report-Medical-Travel.pdf

Eleuch, Amira. (2011). Healthcare service quality perception in Japan. International journal of health care quality assurance, 24, 417-429.

Ford, R., Sturman, Michael C., & Heaton, Cherrill P. (2012). Managing quality service in hospitality: how organizations achieve excellence in the guest experience. Cengage Learning.

Fornara, F., Bonaiuto, M., & Bonnes, M. (2006). Perceived hospital environment quality indicators: A study of orthopaedic units. Journal of Environmental Psychology, 26(4), 321–334.

Fornell C, Larcker DF. (1981). Structural equation models with unobservable variables and measurement error: algebra and statistics. Journal of Marketing Research. 18(3), 382-388.

Gallarza, M. G., & Gil Saura, I. (2006). Value dimensions, perceived value, satisfaction and loyalty: an investigation of university students travel behaviour. Tourism Management, 27(3), 437–452.

Gan, L. L., & Frederick, J. R. (2015). Medical tourism: consumers’ concerns over risk and social challenges. Journal of Travel and Tourism Marketing, 32(5), 503–517.

Gaur, S., Xu, Y., Quazi, A., & Nandi, S. (2011). Relational impact of service providers' interaction behavior in healthcare. Managing Service Quality: An International Journal, 21(1), 67-87.

Gong, T., & Yi, Y. (2018). The effect of service quality on customer satisfaction, loyalty, and happiness in five Asian countries. Psychology & Marketing, 35(6), 427-442.

Gooding, S. K. S. (1995). Quality, sacrifice, and value in hospital choice for major treatment, sacrifice assumes more imprtance. Journal of Health Care Marketing, 15(4), 24–31.

Ha, J., & (Shawn) Jang, S. C. (2010). Perceived values, satisfaction, and behavioral intentions: The role of familiarity in Korean restaurants. International Journal of Hospitality Management, 29(1), 2–13.

Hair, J.F., Black W.C., Babin B.J., & Anderson R.E., (2010). Multivariate data analysis: A global perspective (7th ed.). Pearson Prentice Hall.

Han, H. (2013). The healthcare hotel: Distinctive attributes for international medical travelers. Tourism Management, 36, 257–268.

Han, H., & Hwang, J. (2013). Multi-dimensions of the perceived benefits in a medical hotel and their roles in international travelers’ decision-making process. International Journal of Hospitality Management, 35, 100–108.

Han, H., & Hwang, J. (2018). Growing competition in the healthcare tourism market and customer retention in medical clinics: New and experienced travellers. Current Issues in Tourism, 21(6), 680-702.

Han, H., & Hyun, S. S. (2013). Image congruence and relationship quality in predicting switching intention: Conspicuousness of product use as a moderator variable. Journal of Hospitality & Tourism Research, 37(3), 303–329.

Han, H., & Hyun, S. S. (2015). Customer retention in the medical tourism industry: Impact of quality, satisfaction, trust, and price reasonableness. Tourism Management, 46, 20–29.

Han, H., Kim, Y., Kim, C., & Ham, S. (2015). Medical hotels in the growing healthcare business industry: Impact of international travelers’ perceived outcomes. Journal of Business Research, 68(9), 1869–1877.

Han, J., Kang, H. J., & Kwon, G. H. (2017). Understanding the servicescape of nurse assistive robot: The perspective of healthcare service experience. 2017 14th International Conference on Ubiquitous Robots and Ambient Intelligence, URAI 2017, (July 2013), 644–649.

Headley, D. E., & Miller, S. J. (1993). Measuring service quality and its relationship to future consumer behavior. Journal of Health Care Marketing, 13(4), 32–41.

Hellier, P.K., Geursen, G.M., Carr, R.A. and Rickard, J.A. (2003). Customers repurchase intention: A general structural equation model. European Journal of Marketing, 32(11), 1762-1800.

Henderson, J. C. (2004). Paradigm shifts: National tourism organisations and education and healthcare tourism. The case of Singapore. Tourism and Hospitality Research, 5(2), 170–180.

Henderson, J. C. (2008). Healthcare tourism in southeast asia. Tourism Review International, 7(3), 111–121.

Heung, V. C. S., Kucukusta, D., & Song, H. (2010). A conceptual model of medical tourism: Implications for future research. Journal of Travel & Tourism Marketing, 27(3), 236–251.

Heung, V. C. S., Kucukusta, D., & Song, H. (2011). Medical tourism development in Hong Kong: An assessment of the barriers. Tourism Management, 32(5), 995–1005.

Holliday, R. (2014). Neoliberal governance and international medical travel in Malaysia. Australian Geographer, 45(1), 93–94.

Hooi Ting, D. (2004). Service quality and satisfaction perceptions: curvilinear and interaction effect. International Journal of Bank Marketing, 22(6), 407–420.

Horowitz, M., & Rosensweig, J. (2008). Medical tourism vs. traditional international medical travel: A tale of two models. International Medical Travel Journal, 3, 1–14.

Hui, T. K., & Wan, D. (2009). Health-care tourism in Singapore. Advances in Hospitality and Leisure, 1(5),109–123.

Hui, T. K., Wan, D., & Ho, A. (2007). Tourists’ satisfaction, recommendation and revisiting Singapore. Tourism Management, 28(4), 965–975.

Hunter-Jones, P. (2005). Cancer and tourism. Annals of Tourism Research, 32(1), 70–92.

Hutton, J. D., & Richardson, L. D. (1995). Healthscapes: The role of the facility and physical environment on consumer attitudes, satisfaction, quality assessments, and behaviors. Health Care Management Review, 20(2). 48-61.

Iranmanesh, M., Moghavvemi, S., Zailani, S., & Hyun, S. S. (2018). The role of trust and religious commitment in Islamic medical tourism. Asia Pacific Journal of Tourism Research, 23(3), 245–259.

Jaapar, M., Musa, G., Moghavvemi, S., & Saub, R. (2017). Dental tourism: examining tourist profiles, motivation and satisfaction. Tourism Management, 61, 538–552.

Jang, S., & Feng, R. (2007). Temporal destination revisit intention: The effects of novelty seeking and satisfaction. Tourism Management, 28(2), 580–590.

Kashyap, R., & Bojanic, D. C. (2000). A Structural analysis of value, quality, and price perceptions of business and leisure travelers. Journal of Travel Research, 39(1), 45–51.

Khan, M. J., Chelliah, S., & Haron, M. S. (2016). Medical tourism destination image formation process: A conceptual model. International Journal of Healthcare Management, 9(2), 134–143.

Kim, M., Koo, D. W., Shin, D. J., & Lee, S. M. (2017). From Servicescape to loyalty in the medical tourism industry: A medical clinic’s service perspective. Inquiry: The Journal of Health Care Organization, Provision and Financing, 54, 1–16.

Kouthouris, C., & Alexandris, K. (2005). Can service quality predict customer satisfaction and behavioral intentions in the sport tourism industry? An application of the SERVQUAL model in an outdoors setting. Journal of Sport & Tourism, 10(2), 101–111.

Kozak, M., & Rimmington, M. (2000). Tourist satisfaction with Mallorca Spain, as an off-season holiday destination. Journal of Travel Research, 38(2), 260–269.

Lankton, N. K., Wilson, E. V., & Mao, E. (2010). Antecedents and determinants of

information technology habit. Information Management, 47, 300-307.

Lautier, M. (2008). Export of health services from developing countries: The case of Tunisia. Social Science and Medicine, 67(1), 101–110.

Lee, C. K., Yoon, Y. shik, & Lee, S. K. (2007). Investigating the relationships among perceived value, satisfaction, and recommendations: The case of the Korean DMZ, Tourism Management, Vol.28 No.1, pp. 204-214. Tourism Management, 28(1), 204–214.

Lee, J., Kim, J., & Moon, J. Y. (2000). What makes internet users visit cyber stores again? key design factors for customer loyalty. Proceedings of the SIGCHI Conference on Human Factors in Computing Systems, 2(1), 305–312.

Lee, Y., Lee, C., Choi, J., Yoon, S. M., & Hart, R. J. (2014). Tourism’s role in urban regeneration: Examining the impact of environmental cues on emotion, satisfaction, loyalty, and support for Seoul’s revitalized Cheonggyecheon stream district. Journal of Sustainable Tourism, 22(5), 726–749.

Lee, Y., Lee, C., Lee, S., & Babin, B. J. (2008). Festivalscapes and patrons’ emotions, satisfaction, and loyalty. Journal of Business Research, 61(1), 56–64.

Liang, Z. X., Hui, T. K., & Sea, P. Z. (2017). Is price most important? Healthcare tourism in Southeast Asia. Tourism Geographies, 19(5), 823–847.

Lin, C.-H. (2013). Determinants of revisit intention to a hot springs destination: Evidence from Taiwan. Asia Pacific Journal of Tourism Research, 18(3), 183–204.

Loureiro, S. M. C. (2017). Medical tourists’ emotional and cognitive response to credibility and Servicescape. Current Issues in Tourism, 20(15), 1633–1652.

Lovelock, C., & Wirtz, J. (2016). Services marketing : people, technology, strategy (8th ed). World Scientific Publishing.

Lunt, N., & Carrera, P. (2010). Medical tourism: Assessing the evidence on treatment abroad. Maturitas, 66(1), 27–32.

MacReady, N. (2007). Developing countries court medical tourists. Lancet, 369(9576), 1849–1850.

Mathieu, J. E., DeShon, R. P., & Bergh, D. D. (2008). Mediational inferences in organizational research: Then, now, and beyond. Organizational Research Methods, 11(2), 203–223.

Mathur, T., Das, G., & Paul, U. K. (2016). Convenience, satisfaction, and post-purchase behavior in India’s health insurance market. Journal of Global Marketing, 29(4), 218–232.

Maung, N. L. Y., & Walsh, J. (2014). Decision factors in medical tourism: Evidence from Burmese visitors to a hospital in Bangkok. Journal of Economics and Behavioral Studies, 6(2), 84–94.

Mechinda, P., Serirat, S., Popaijit, N., Lertwannawit, A., & Anuwichanont, J. (2010). The relative impact of competitiveness factors and destination equity on tourists loyalty in Koh Chang, Thailand. International Business & Economics Research Journal (IBER), 9(10). Retrieved August 7, 2019, from https://doi.org/10.19030/iber.v9i10.643

Mehrabian, A., & Russell, J. A. (1974). An approach to environmental psychology. In An approach to environmental psychology. The MIT Press.

Mekong Tourism. (2018). Thailand medical tourism market: Status and outlook, development. Retrieved August 11, 2018, from https://www.mekongtourism.org/thailand-medical-tourism-market-status-outlook-development-2018-2022/

Ministry of Tourism and Sports. (2017). Tourism Economy Review. Retrieved September 16, 2018, from https://www.mots.go.th/ewt_dl_link.php?nid=8404

Ministry of Tourism and Sports. (2018). International tourist arrivals to Thailand. Retrieved January 16, 2018, from https://www.mots.go.th/mots_en57/main.php?filename=index

Moghavvemi, S., Ormond, M., Musa, G., Mohamed Isa, C. R., Thirumoorthi, T., Bin Mustapha, M. Z., … Chiremel Chandy, J. J. (2017). Connecting with prospective medical tourists online: A cross-sectional analysis of private hospital websites promoting medical tourism in India, Malaysia and Thailand. Tourism Management, 58, 154–163.

Namasivayam, K., & Mattila, A. S. (2007). Accounting for the joint effects of the servicescape and service exchange on consumers’ satisfaction evaluations. Journal of Hospitality & Tourism Research, 31(1), 3–18.

NaRanong, A., & NaRanong, V. (2011). The effects of medical tourism: Thailand’s experience. Bulletin of the World Health Organization, 89(5), 336–344.

Nash, R., Thyne, M., & Davies, S. (2006). An investigation into customer satisfaction levels in the budget accommodation sector in Scotland: a case study of backpacker tourists and the Scottish youth hostels association. Tourism Management, 27(3), 525–532.

Oh, H. (1999). Service quality, customer satisfaction, and customer value: A holistic perspective. International Journal of Hospitality Management, 18(1), 67–82.

Ozawa, S., & Sripad, P. (2013). How do you measure trust in the health system? A systematic review of the literature. Social Science and Medicine, 91, 10–14.

Pan, T. J., & Chen, W. C. (2014). Chinese medical tourists - their perceptions of Taiwan. Tourism Management, 44, 108–112.

Park, J., Ahn, J., & Yoo, W. (2017). The effects of price and health consciousness and satisfaction on the medical tourism experience. Journal of Healthcare Management / American College of Healthcare Executives, 62(6), 405-417.

Petrick, J. F., Morais, D. D., & Norman, W. C. (2001). An examination of the determinants of entertainment vacationers’ intentions to revisit. Journal of Travel Research, 40(1), 41–48.

Prayag, G., Hosany, S., Muskat, B., & Del Chiappa, G. (2017). Understanding the relationships between tourists’ emotional experiences, perceived overall image, satisfaction, and intention to recommend. Journal of Travel Research, 56(1), 41–54.

Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40(3), 879–891.

Qu, H., Kim, L. H., & Im, H. H. (2011). A model of destination branding: Integrating the concepts of the branding and destination image. Tourism Management, 32(3), 465–476.

Robert, D. J., & Rossiter, J. (1982). Store atmosphere: an environmental psychology Approach. J Retailig, 58(1), 34–57.

Ryu, K., & Han, H. (2010). Influence of the quality of food, service, and physical environment on customer satisfaction and behavioral intention in quick-casual restaurants: Moderating role of perceived price. Journal of Hospitality & Tourism Research, 34(3), 310–329.

Sahoo, D., & Ghosh, T. (2016). Healthscape role towards customer satisfaction in private healthcare. International Journal of Health Care Quality Assurance, 29(6), 600–613.

Sánchez, J., Callarisa, L., Rodríguez, R. M., & Moliner, M. A. (2006). Perceived value of the purchase of a tourism product. Tourism Management, 27(3), 394–409.

Santos, C.P., & Basso, K. (2012). Do ongoing relationships buffer the effects of service recovery on customers' trust and loyalty? International Journal of Bank Marketing, 30(3), 168-192.

Shahijan, M., Rezaei, S., Preece, C., & Ismail, W. (2015). International medical travelers' behavioral intention: An empirical study in Iran. Journal of Travel & Tourism Marketing, 32(5), 475-502.

Singh, J., & Sirdeshmukh, D. (2000). Agency and trust mechanisms in consumer satisfaction and loyalty judgments. Journal of the Academy of Marketing Science, 28(1), 150–167.

Sirdeshmukh, D., Singh, J., & Sabol, B. (2002). Consumer trust, value, and loyalty in relational exchanges. Journal of Marketing, 66(1), 15–37.

Suess, C., & Mody, M. (2018). The influence of hospitable design and service on patient responses. Service Industries Journal, 38(1–2), 127–147.

Szymanski, D. M., & Henard, D. H. (2001). Customer satisfaction: A meta-analysis of the empirical evidence. Journal of the Academy of Marketing Science, 29(1), 16–35.

Trachtenberg, F., Dugan, E., & Hall, M. A. (2005). How patients’ trust relates to their involvement in medical care. The Journal of Family Practice, 54(4), 344–352.

Turley, L. W., & Milliman, R. E. (2000). Atmospheric effects on shopping B experimental evidence. Journal of Business Research, 211(49), 193–211.

Turner, L. (2009). “Dental tourism”: Issues surrounding cross-border travel for dental care. Journal of the Canadian Dental Association, 75(2), 117–119.

Um, S., Chon, K., & Ro, Y. (2006). Antecedents of revisit intention. Annals of Tourism Research, 33(4), 1141–1158.

Vijaya, R. M. (2010). Medical tourism: Revenue generation or international transfer of healthcare problems? Journal of Economic Issues, 44(1), 53–70.

van de Vijver, F. J. R., & Tanzer, N. K. (2004). Bias and equivalence in cross-cultural assessment: An overview. European Review of Applied Psychology, 54(2), 119-135.

Wernz, C., Thakur Wernz, P., & Phusavat, K. (2014). Service convergence and service integration in medical tourism. Industrial Management & Data Systems, 114(7), 1094–1106.

Wongkit, M., & McKercher, B. (2016). Desired attributes of medical treatment and medical service providers: A case study of medical tourism in Thailand. Journal of Travel and Tourism Marketing, 33(1), 14–27.

Woodside, A. G., Frey, L. L., & Daly, R. T. (1989). Linking service quality, customer satisfaction, and behavioral intention. Journal of Health Care Marketing, 9(4). 5-17.

Yeoh, E., Othman, K., & Ahmad, H. (2013). Understanding medical tourists: Word-of-mouth and viral marketing as potent marketing tools. Tourism Management, 34, 196–201.

Yu, J. Y., & Ko, T. G. (2012). A cross-cultural study of perceptions of medical tourism among Chinese, Japanese and Korean tourists in Korea. Tourism Management, 33(1), 80–88.

Yu, Y., & Dean, A. (2001). The contribution of emotional satisfaction to consumer loyalty. International Journal of Service Industry Management, 12(3), 234–250.

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2020-09-30