The Role of Risk, Culture, Image and Quality on Destination Loyalty: Perspectives from International Medical Tourists toward Thailand as a Medical Tourism Destinationole of Risk, Culture, Image and Quality on Destination Loyalty: Perspectives from International Medical Tourists toward Thailand as a Medical Tourism Destination

Abstract

The purpose of the study was to develop as well as evaluate a theoretical structural model for establishing a medical tourist’s loyalty by incorporating five important constructs including risk, culture, image, quality, and satisfaction. More specifically, the seven main objectives were proposed, as followed: 1) to investigate how the underlying dimensions of international medical tourists’ perceived risk 2) to investigate the relationship between perceived risk and destination image in terms of cognitive, affective and overall image perceived by medical tourists 3) to examine the relationships among risk, quality, overall image perceived by medical tourists and their satisfaction 4) to examine the role of culture in creating loyalty and its variables namely quality and satisfaction 5) to explore the role of overall image and satisfaction on consumer loyalty toward the medical tourism destination 6) to test the moderating role of medical tourists’ perceived risk on the relationship between overall image of destination and satisfaction as well as the relationship between satisfaction and loyalty and 7) to examine the mediating role of satisfaction between perceived medical product and service quality and consumer loyalty as well as between overall image of the destination and consumer loyalty. A total 205 respondents and 13 interviewees were collected from international medical tourists in Thailand. To achieve the purposes of this study, seventeen hypotheses were developed and Structural Equation Modeling was conducted to investigate them. The findings are as followed. There is not a direct negative relationship between risk and cognitive image as well as affective image perceived by international medical tourists in Thailand. Hypothesis 1 ii and 2 were not supported. The following hypotheses (Hypothesis 3 and Hypothesis 4) are supported on a direct negative relationship between cognitive image as well as affective image, and overall image of a destination perceived by international medical tourists. Hypothesis 5, there was not a direct positive relationship between risk and quality perceived by medical tourists. Hypothesis 6, the result found that quality perceived by international medical tourists positively influences their perceived overall image of Thailand as a medical tourism destination. Hypothesis 7, the finding showed that quality perceived by medical tourists had a significant influence their satisfaction. Hypothesis 8, there is not a direct positive relationship between medical tourists’ culture and their perceived quality. For testing the moderating effect of culture, Hypothesis 10 was supported. The finding confirmed that there was a significant moderating effect of culture on the impact of satisfaction on loyalty but not on the impact of quality on satisfaction. Thus, Hypothesis 9 was not supported. Hypothesis 11, 12 and 13 were supported. The results confirmed that there was a direct positive relationship between overall and satisfaction as well as loyalty. Also, satisfaction had a direct positive impact on loyalty. Moreover, the findings presented that perceived risk partially moderates the relationship between overall image and satisfaction as well as the relationship between satisfaction and loyalty. Thus, Hypothesis 14 and 15 were supported. Finally, Hypothesis 16 was supported and the finding confirmed that satisfaction positively mediates the relationship between quality and loyalty but not on the relationship between overall image and loyalty (Hypothesis 17). The findings of this study contribute to the theoretical and practical implications of medical tourism industry. The findings of this study are expected to make major contributions to the existing theory. The results of the study provide important implications of strategies to develop and enhance effort for their product and services so as to keep consumer loyalty. Furthermore, the iii findings can provide useful information for destinations that seek to keep their market share and their consumer loyalty, in order to develop more effective strategies related to decrease consumer’ perceived risk, to develop quality of product and service, destination image, and consumer satisfaction.