ABSTRACT

Purpose – Given globalization, the new niche market of medical tourism is likely to experience sustainable growth for various reasons, such as aging populations and a shift in the medical consumerism paradigm toward prevention. Importantly, understanding medical customers’ behavior is necessary to benefit from a competitive advantage in this industry. The existing research primarily accessed the key factors of medical quality and costs to explain health customers’ behavior but is limited in terms of enabling an understanding of the decision process. This limitation exists because, given the intangibility and greater associated risks in the highly professional industry of international medical tourism, most customers lack the knowledge and experience needed to evaluate the central factors—such as the medical competence of health care countries—before purchases. Therefore, they actively search for useful information through various distributions to reduce uncertainty and to make better choices. Interestingly, most of these information channels are associated with word-of-mouth (WOM). However, no evidence is found in the literature to estimate the effect of WOM in the medical tourism field. Thus, this study focuses on WOM to explore its interaction with key medical characteristic factors and the attractiveness of destinations referred to by sources. This study also affects customers’ evaluations and, in turn, influences their intention to seek health care services abroad. Research design, data, and methodology – The literature review addressed an interesting research model for estimating therelations among WOM, medical characteristics, attractiveness, and customers’ choice intention regarding international health care. In the key economic regions in China, such as Beijing, Shanghai, Jiangsu, Shandong, and Guangdong, 2,500 survey questionnaires were distributed to potential customers of different ages, education, and income levels. A resulting 1,717 (68.68 percent of the original 2,500) usable surveys were obtained for analysis. Moderated regression analysis was used to determine the effects of WOM in the decision process regarding international health care destinations. Results – The results indicate that WOM is a good moderator of the relationships between the factors evaluated by sources and customers. More importantly, the WOM effects reflect the factors of tie strength, credibility, and vividness. The results also reveal that, given the moderating role of WOM, the intention of potential Chinese customers to seek the referred health care country varies according to the medical characteristics of medical competency and reputation as evaluated by customers. In contrast, the travel attractiveness of the attractions, facilities, accessibility, and social environment are critical determinants of destination choice intention. Conclusions – The moderating role of WOM has been confirmed through the international healthcare destination selection process. Medical tourism managers should user WOM as an effective marketing tool for industry development. Specially, marketers should consider the effects of WOM determinants, such as tie strength, credibility, and vividness, to develop an effective strategy. Furthermore, this study estimates the factors that affect customers’ selection of medical tourism destinations. Health care managers or policy makers should consider a broad variety of variables that may attract more Chinese customers to international health care.

KEYWORD

Word-of-Mouth, Medical Characteristics, Travel Attractiveness, Choice Intention

REFERENCES(93)open

  1. [jounal] Adams, E. K. / 1991 / Hospital choice of medicare beneficiaries in a rural market: Why not the closest? / Journal of Rural Health 7 (2) : 134 ~ 152

  2. [jounal] Argan, M. / 2012 / Word-of-Mouth(WOM)as a tool of health communication : A case study of Turkey / Journal of Society for Development in New Net Environment in B & H 6 (1) : 216 ~ 221

  3. [jounal] Arndt, J. / 1967 / Role of product-related conversations in the diffusion of a new product / Journal of Marketing Research 4 (3) : 291 ~ 295

  4. [jounal] Aronson, E. / 1963 / Communication credibility and communication discrepancy as determinants of opinion change / Journal of Abnormal and Social Psychology 67 (1) : 31 ~ 36

  5. [jounal] Bansal, H. S. / 2000 / Word-of-Mouth process within a services purchase decision context / Journal of Service Research 3 (2) : 166 ~ 177

  6. [book] Berry, W. D. / 1985 / Multiple Regression in Practice / Sage

  7. [jounal] Bies, W. / 2007 / Medical tourism: Outsourcing surgery / Mathematical and computer modelling 46 (7) : 1144 ~ 1159

  8. [jounal] Bone, P. F. / 1995 / Word-of-mouth effects on short-term and long-term product judgments / Journal of Business Research 32 (3) : 213 ~ 223

  9. [jounal] Boulding, W. / 1993 / A dynamic process model of service quality : From expectations to behavioral intentions / Journal of Marketing Research 30 (1) : 7 ~ 27

  10. [jounal] Brown, J. J. / 1987 / Social ties and word-of-mouth referral behavior / Journal of Consumer Research 14 (3) : 350 ~ 362

  11. [jounal] Burkett, L. / 2007 / Medical tourism / Journal of Legal Medicine 28 (2) : 223 ~ 245

  12. [jounal] Buttle, F. A. / 1998 / Word-of-mouth : Understanding and managing referral marketing / Journal of Strategic Marketing 6 (3) : 241 ~ 254

  13. [web] Caballero-Danell, S. / Medical tourism and its entrepreneurial opportunities: A conceptual framework for entry into the industry

  14. [jounal] Carrera, P. M. / 2006 / Globalization and healthcare : Understanding health and medical tourism / Expert Review of Pharmacoeconomics and Outcomes Research 6 (4) : 447 ~ 454

  15. [jounal] Cheung, M. Y. / 2009 / Credibility of electronic word-of-mouth : Informational and normative determinants of on-line consumer recommendations / International Journal of Electronic Commerce 13 (4) : 9 ~ 38

  16. [jounal] Choi, K. -S. / 2004 / The relationships among quality, value, satisfaction and behavioral intention in health care provider choice : A South Korea study / Journal of Business Research 57 (8) : 913 ~ 921

  17. [web] Chow, S. / China Tourism Market Report

  18. [jounal] Connell, J. / 2006 / Medical tourism : sea, sun, sand. . . surgery / Tourism Management 27 (6) : 1093 ~ 1100

  19. [jounal] Connell, J. / 2013 / Contemporary medical tourism : Conceptualisation, culture and commodification / Tourism Management 34 : 1 ~ 13

  20. [jounal] Duhan, D. F. / 1997 / Influences on consumer use of word-of-mouth recommendation sources / Journal of the Academy of Marketing Science 25 (4) : 283 ~ 295

  21. [confproc] Feldman, S. P. / 1965 / The effect of person influence in the selection of consumer services / proceedings of the Fall conference of the American Marketing Association : 440 ~ 452

  22. [book] Fishbein, M. / 2010 / Predicting and Changing Behavior: The Reasoned Action Approach / Psychology Press

  23. [jounal] Frenzen, J. K. / 1990 / Purchasing behavior in embedded markets / Journal of Consumer Research 17 (1) : 1 ~ 12

  24. [jounal] Gartner, W. C. / 2011 / Tourism destination brand equity dimensions : Renewal versus repeat market / Journal of Travel Research 50 (5) : 471 ~ 481

  25. [jounal] Gearing, C. E. / 1974 / Establishing a measure of touristic attractiveness / Journal of Travel Research 12 (4) : 1 ~ 8

  26. [jounal] Gilly, M. C. / 1998 / A dyadic study of interpersonal information search / Journal of the Academy of Marketing Science 26 (2) : 83 ~ 100

  27. [jounal] Godes, D. / 2004 / Using online conversations to study word-of-mouth communication / Marketing Science 23 (4) : 545 ~ 560

  28. [jounal] Gooding, S. K. S. / 2000 / Quality, sacrifice, and value in hospital choice : A comparative study of rural and suburban consumer perspectives / Journal of Hospital Marketing 13 (2) : 23 ~ 42

  29. [jounal] Goodrich, J. N. / 1993 / Socialist Cuba : A study of health tourism / Journal of Travel Research 32 (1) : 36 ~ 41

  30. [jounal] Grönroos, C. / 1984 / A service quality model and its marketing implication / European Journal of Marketing 18 (4) : 36 ~ 44

  31. [book] Hair, J. F. Jr. / 2006 / Multivariate data analysis / Pearson Education

  32. [jounal] Haywood, K. M. / 1989 / Managing word of mouth communications / Journal of Service Marketing 3 (2) : 55 ~ 67

  33. [web] He, M. / Chinese outbound trips quintupled in ten years with more attention on quality

  34. [jounal] Henning-Thurau, T. / 2004 / Electronic word-of-mouth via consumer-opinion platforms: What motivates consumers to articulate themselves on the internet? / Journal of Interactive Marketing 18 (1) : 38 ~ 52

  35. [jounal] Herbig, P. / 1995 / The relationship of reputation and credibility to brand success / Journal of Consumer Marketing 12 (4) : 5 ~ 10

  36. [jounal] Herr, P. M. / 1991 / Effects of word-of-mouth and product-attribute information on persuasion : An accessibility-diagnosticity perspective / Journal of Consumer Research 17 (4) : 454 ~ 462

  37. [report] Herrick, D. M. / 2007 / Medical tourism: global competition in health care

  38. [jounal] Heung, V. C. S. / 2011 / Medical tourism development in Hong Kong : An assessment of the barriers / Tourism Management 32 (5) : 995 ~ 1005

  39. [jounal] Hu, Y. / 1993 / Measuring destination attractiveness : A contextual approach / Journal of Travel Research 32 (2) : 25 ~ 34

  40. [jounal] Hunter, W. C. / 2007 / Medical tourism : A new global niche / International Journal of Tourism Sciences 7 (1) : 129 ~ 140

  41. [jounal] Ainur Jambul / 2015 / Development of Quality Management in the Republic of Kazakhstan / The East Asian Journal of Business Management 5 (2) : 23 ~ 29

  42. [jounal] Jin, X. / 2012 / Impact of clusters on exhibition destination attractiveness : Evidence from Mainland China / Tourism Management 33 (6) : 1429 ~ 1439

  43. [jounal] Brown, J. J. / 1987 / Social ties and word-of-mouth referral behavior / Journal of Consumer Research 14 (3) : 350 ~ 362

  44. [jounal] Yong-Min Kim / 2014 / Effects of SNS Characteristics upon Consumers’ Awareness, Purchase Intention, and Recommendation / 산경연구논집 5 (1) : 27 ~ 37

  45. [jounal] Kisielius, J. / 1986 / Examining the vividness controversy : An availability : Valence interpretation / Journal of Consumer Research 12 (4) : 418 ~ 431

  46. [web] Korea Tourism Organization / The review of medical tourism in Korea in 2012

  47. [jounal] Kozak, M. / 1998 / Benchmarking : Destination attractiveness and small hospitality business performance / International Journal of Contemporary Hospitality Management 10 (5) : 184 ~ 188

  48. [jounal] LaBarbera, P. A. / 1983 / A longitudinal assessment of consumer satisfaction/dissatisfaction : The dynamic aspect of the cognitive process / Journal of Marketing Research 20 (4) : 393 ~ 404

  49. [jounal] Lai, C. / 2013 / Chinese outbound tourists’perceived constraints to visiting the United States / Tourism Management 37 : 136 ~ 146

  50. [jounal] Lane, P. M. / 1988 / Hospital choice: A summary of the key empirical and hypothetical findings of the 1980s / Journal of Health Care Marketing 8 (4) : 5 ~ 20

  51. [jounal] Litvin, S. W. / 2008 / Electronic word-of-mouth in hospitality and tourism management / Tourism Management 29 (3) : 458 ~ 468

  52. [jounal] MacReady, N. / 2007 / Developing countries court medical tourists / The Lancet 369 (9576) : 1849 ~ 1850

  53. [jounal] Mangold, W. G. / 1999 / Word-of-mouth communication in the service marketplace / The Journal of Service Marketing 13 (1) : 73 ~ 89

  54. [confproc] Mayo, E. J. / 1973 / Regional images and regional travel behavior;Research for changing travel patterns: Interpretation and Utilization / Proceedings of the Travel Research Association Fourth Annual Conference : 211 ~ 218

  55. [web] Mayo, E. J. / The psychology of leisure travel, effective marketing and selling of travel services

  56. [jounal] McAlexander, J. H. / 1994 / Service quality measurement : Examination of dental practices sheds more light on the relationship between service quality, satisfaction, and purchase intentions in a health care setting / Journal of Health Care Marketing 14 (3) : 34 ~ 40

  57. [book] Middleton, V. T. C. / 1988 / Marketing in travel and tourism / Heinemann

  58. [book] Middleton, V. T. C. / 1998 / Sustainable tourism : A marketing perspective / Butterworth-Heinemann

  59. [jounal] W. G. Mangold / 1999 / Word-of-mouth communication in the service marketplace / Journal of Service Marketing 13 (1) : 73 ~ 89

  60. [jounal] Gibert A. Churchill, Jr. / 1979 / A paradigm for developing better measures of marketing constructs / Journal of Marketing Research XVI : 64 ~ 73

  61. [web] Office of Travel & Tourism Industries / Top 10 international markets: 2012 visitation and spending

  62. [jounal] Parasuraman, A. / 1985 / A conceptual model of service quality and its implications for future research / Journal of Marketing 49 (4) : 41 ~ 50

  63. [jounal] Parasuraman, A. / 1988 / SERVQUAL : A multiple item scale for measuring consumer perceptions of service quality / Journal of Retailing 64 (1) : 12 ~ 37

  64. [jounal] Parasuraman, A. / 1994 / Alternative scales for measuring service quality : A comparative assessment based on psychometric and diagnostic criteria / Journal of Retailing 70 (3) : 201 ~ 230

  65. [jounal] Rajasekhara Mouly Potluri / 2015 / Interactive Quality in Ethiopian Telecom’s Service Encounters: A Dyadic Perspective / 산경연구논집 6 (1) : 27 ~ 35

  66. [jounal] Price, L. L. / 1989 / Preference heterogeneity and coorientation as determinants of perceived information influence / Journal of Business Research 19 (3) : 227 ~ 242

  67. [jounal] Ritchie, J. R. B. / 1978 / Culture as determinant of the attractiveness of a tourism region / Annals of Tourism Research 5 (2) : 252 ~ 267

  68. [jounal] Ryu, G. / 2009 / Word-of-mouth transmission in setting with multiple opinions : The impact of other opinions on WOM likelihood and valence / Journal of Consumer Psychology 19 (3) : 403 ~ 415

  69. [jounal] Saunders, D. R. / 1956 / Moderator variables in prediction / Educational and Psychological Measurement 16 (2) : 209 ~ 222

  70. [web] Singapore Tourism Board / Annual report on tourism statistics 2012

  71. [jounal] Devinder Pal Singh / 2014 / Online Shopping Motivations, Information Search, and Shopping Intentions in an Emerging Economy / The East Asian Journal of Business Management 4 (3) : 5 ~ 12

  72. [jounal] Smith, P. C. / 2007 / Global outsourcing of healthcare : A medical tourism decision model / Journal of Information Technology Case and Application Research 9 (3) : 19 ~ 30

  73. [web] Statistics Indonesia / Number of foreign visitor arrivals to Indonesia by country of residence, 2002-2011

  74. [web] Statistics New Zealand / International visitor arrivals to New Zealand: December 2013

  75. [jounal] Suh, Y. K. / 2004 / Preferences and trip expenditures-a conjoint analysis of visitors to Soul, Korea / Tourism Management 25 (1) : 127 ~ 137

  76. [jounal] Sweeney, J. C. / 2012 / Word-of-mouth: Measuring the power of individual messages / European Journal of Marketing 46 (1/2) : 237 ~ 257

  77. [web] Travel China Guide / China outbound tourism in 2014

  78. [jounal] Turner, L. / 2007 / First world health care at third world price : globalization, bioethics and medical tourism / Biosocienties 2 (3) : 303 ~ 325

  79. [web] United Nations World Tourism Organization / The Chinese Outbound Tourism Market

  80. [jounal] Vengesayi, S. / 2008 / Destination attractiveness : Are there relationships with destination attributes / The Business Review 10 (2) : 289 ~ 294

  81. [jounal] Vengesayi, S. / 2010 / Tourism destination attractiveness : The mediating effect of destination support services / The Business Review 16 (2) : 179 ~ 185

  82. [jounal] Wang, Y. / 2006 / The roles of brand equity and corporate reputation in CRM : A Chinese study / Corporate Reputation Review 9 (3) : 179 ~ 197

  83. [jounal] Wang, Z. / 2008 / Health information, credibility, homophily, and influence via the internet : Web sites versus discussion groups / Health Communication 23 (4) : 358 ~ 368

  84. [jounal] Brown, J. J. / 1987 / Social ties and word-of-mouth referral behavior / Journal of Consumer Research 14 (3) : 350 ~ 362

  85. [jounal] Wilson, E. J. / 1993 / Source effects in communication and persuasion research : A meta-analysis of effect size / Journal of the Academy of Marketing Science 21 (2) : 101 ~ 112

  86. [jounal] Ye, B. H. / 2011 / Motivations and experiences of mainland Chinese medical tourists in Hong Kong / Tourism Management 32 (5) : 1125 ~ 1127

  87. [confproc] Ye, B. H. / 2008 / Motivation of medical tourists: An exploratory case study of Hong Kong medial tourists / Paper presented at the Asia Pacific Tourism Association (APTA) Annual Conference

  88. [jounal] Yeoh, E. / 2013 / Understanding medical tourists : Word-of-mouth and viral marketing as potent marketing tools / Tourism Management 34 : 196 ~ 201

  89. [jounal] Yip, W. C. / 1998 / Determinants of patient choice of medical provider : A case study in rural China / Health Policy and Planning 13 (3) : 311 ~ 322

  90. [jounal] Yu, J. Y. / 2012 / A cross-cultural study of perceptions of medical tourism among Chinese, Japanese and Korean tourists in Korea / Tourism Management 33 (1) : 80 ~ 88

  91. [jounal] Zedeck, S. / 1971 / Problems with the use of"moderator"variables / Psychological Bulletin 76 (4) : 295 ~ 310

  92. [jounal] Zeithaml, V. A. / 1996 / The behavioral consequences of service quality / Journal of Marketing 60 (2) : 31 ~ 46

  93. [jounal] Zhang, J. / 2013 / The impact of psychological distance on Chinese customers when selecting an international health service country / Tourism Management 35 : 32 ~ 40