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- P-ISSN1738-3110
- E-ISSN2093-7717
- SCOPUS, ESCI
ISSN : 1738-3110
Factors Influencing Chinese Customers' Selection of Health Care Service Countries: Focusing on Word-of-Mouth Moderating Effects
Lee, Hoon-Young
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 the relations 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.
- keywords
- Word-of-Mouth, Medical Characteristics, Travel Attractiveness, Choice Intention
Reference
Adams, E. K., & Wright, G. E. (1991). Hospital choice of medicare beneficiaries in a rural market: Why not the closest? Journal of Rural Health, 7(2), 134-152.
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.
Arndt, J. (1967). Role of product-related conversations in the diffusion of a new product. Journal of Marketing Research, 4(3), 291-295.
Aronson, E., Turner, J. A., & Carlsmith, J. M. (1963). Communication credibility and communication discrepancy as determinants of opinion change. Journal of Abnormal and Social Psychology, 67(1), 31-36.
Bansal, H. S., & Voyer, P. A. (2000). Word-of-Mouth process within a services purchase decision context. Journal of Service Research, 3(2), 166-177.
Berry, W. D., & Feldman, S. (1985). Multiple Regression in Practice. Beverly Hills, CA: Sage.
Bies, W., & Zacharia, L. (2007). Medical tourism: Outsourcing surgery. Mathematical and computer modelling, 46(7-8), 1144-1159.
Bone, P. F. (1995). Word-of-mouth effects on short-term and long-term product judgments. Journal of Business Research, 32(3), 213-223.
Boulding, W., Kalra, A., Staelin, R., & Zeithaml, V. A. (1993). A dynamic process model of service quality: From expectations to behavioral intentions. Journal of Marketing Research, 30(1), 7-27.
Brown, J. J., & Reingen, P. H. (1987). Social ties and word-of-mouth referral behavior. Journal of Consumer Research, 14(3), 350-362.
Burkett, L. (2007). Medical tourism. Journal of Legal Medicine, 28(2), 223-245.
Buttle, F. A. (1998). Word-of-mouth: Understanding and managing referral marketing. Journal of Strategic Marketing, 6(3), 241-254.
Caballero-Danell, S., & Mugomba, C. (2007). Medical tourism and its entrepreneurial opportunities: A conceptual framework for entry into the industry. Unpublished master’s thesis, University of Gothenburg, Gothenburg, Sweden. Retrieved March, 7, 2010, from http://gupea.ub.gu.se/dspace/handle/2077/4671.
Carrera, P. M., & Bridges, J. F. P. (2006). Globalization and healthcare: Understanding health and medical tourism. Expert Review of Pharmacoeconomics and Outcomes Research, 6(4), 447-454.
Cheung, M. Y., Luo, C., Sia, C. L., & Chen, H. (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.
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 Korea study. Journal of Business Research, 57(8), 913-921.
Chow, S. (2011). China Tourism Market Report. Retrieved December 24, 2011, from http://www.china-online-marketing.com/news/china-market-n ews/china-tourism-market/.
Connell, J. (2006). Medical tourism: sea, sun, sand ... surgery. Tourism Management, 27(6), 1093-1100.
Connell, J. (2013). Contemporary medical tourism: Conceptualisation, culture and commodification. Tourism Management, 34, 1-13.
Duhan, D. F., Johnson, S. D., Wilcox, J. B., & Harrell, G. D. (1997). Influences on consumer use of word-of-mouth recommendation sources. Journal of the Academy of Marketing Science, 25(4), 283-295.
Feldman, S. P., & Spencer, M. C. (1965). The effect of person influence in the selection of consumer services. In proceedings of the Fall conference of the American Marketing Association, ed. Peter D. Bennett, Chicago:American Marketing Association, 440-452.
Fishbein, M., & Ajzen, I. (2010). Predicting and Changing Behavior: The Reasoned Action Approach. New York:Psychology Press.
Frenzen, J. K., & Davis, H. L. (1990). Purchasing behavior in embedded markets. Journal of Consumer Research, 17(1), 1-12.
Gartner, W. C., & Ruzzier, M. K. (2011). Tourism destination brand equity dimensions: Renewal versus repeat market. Journal of Travel Research, 50(5), 471-481.
Gearing, C. E., Swart, W. W., & Var, T. (1974). Establishing a measure of touristic attractiveness. Journal of Travel Research, 12(4), 1-8.
Gilly, M. C., Graham, J. L., Wolfinbarger, M. F., & Yale, L. J. (1998). A dyadic study of interpersonal information search. Journal of the Academy of Marketing Science, 26(2), 83-100.
Godes, D., & Mayzlin, D. (2004). Using online conversations to study word-of-mouth communication. Marketing Science, 23(4), 545-560.
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.
Goodrich, J. N. (1993). Socialist Cuba: A study of health tourism. Journal of Travel Research, 32(1), 36-41.
Grönroos, C. (1984). A service quality model and its marketing implication. European Journal of Marketing, 18(4), 36-44.
Hair, J. F., Jr., Black, W. C., Babin, B. J., Anderson, R. E., & Tatham, R. L. (2006). Multivariate data analysis. Upper Saddle River, NJ: Pearson Education.
Haywood, K. M. (1989). Managing word of mouth communications. Journal of Service Marketing, 3(2), 55-67.
He, M., & Yang, A. (2012). Chinese outbound trips quintupled in ten years with more attention on quality. Retrieved January 13, 2012, fromhttp://www.chinanews.com/gn/2012/10-07/4228629.shtml.
Henning-Thurau, T., Gwinner, K. P., Walsh, G., & Gremler, D. D. (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.
Herbig, P., & Milewicz, J. (1995). The relationship of reputation and credibility to brand success. Journal of Consumer Marketing, 12(4), 5-10.
Herr, P. M., Kardes, F. R., & Kim, J. (1991). Effects of word-of-mouth and product-attribute information on persuasion:An accessibility-diagnosticity perspective. Journal of Consumer Research, 17(4), 454-462.
Herrick, D. M. (2007). Medical tourism: global competition in health care. National Center for Policy Analysis, November.
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.
Hu, Y., & Ritchie, J. R. B. (1993), Measuring destination attractiveness:A contextual approach, Journal of Travel Research, 32(2), 25-34.
Hunter, W. C. (2007). Medical tourism: A new global niche. International Journal of Tourism Sciences, 7(1), 129-140.
Jambul, A., & Dzhulayeva, A. (2014). Development of quality management in the Republic of Kazakhstan. The East Asian Journal of Business Management, 5(2), 23-29.
Jin, X., Weber, K., & Bauer, T. (2012). Impact of clusters on exhibition destination attractiveness: Evidence from Mainland China. Tourism Management, 33(6), 1429-1439.
Katz, E., & Lazarsfeld, P. F. (1955), Personal Influence, Glencoe, IL: Free Press. In Brown, J. J., & Reingen, P. H. (1987). Social ties and word-of-mouth referral behavior. Journal of Consumer Research, 14(3), 350-362.
Kim, Y-M., Kireyeva, A. A., & Youn, M-K. (2014). Effects of SNS characteristics upon consumers’ awareness, purchase intention, and recommendation. Journal of Industrial Distribution & Business, 5(1), 27-37.
Kisielius, J., & Sternthal, B. (1986). Examining the vividness controversy: An availability: Valence interpretation. Journal of Consumer Research, 12(4), 418-431.
Korea Tourism Organization. (2012). The review of medical tourism in Korea in 2012. Retrieved April 19, 2012, from http://know.tour.go.kr/ptourknow/knowplus/kChannel/kChan nelReport/kChannelReportDetail.do?seq=100820.
Kozak, M., & Rimmington, M. (1998). Benchmarking: Destination attractiveness and small hospitality business performance. International Journal of Contemporary Hospitality Management, 10(5), 184-188.
LaBarbera, P. A., & Mazursky, D. (1983). A longitudinal assessment of consumer satisfaction/dissatisfaction: The dynamic aspect of the cognitive process. Journal of Marketing Research, 20(4), 393-404.
Lai, C., Li, X,, & Harrill, R. (2013). Chinese outbound tourists’perceived constraints to visiting the United States. Tourism Management, 37, 136-146.
Lane, P. M., & Lindquist, J. D. (1988). Hospital choice: A summary of the key empirical and hypothetical findings of the 1980s. Journal of Health Care Marketing, 8(4), 5-20.
Litvin, S. W., Goldsmith, R. E., & Pan, B. (2008). Electronic word-of-mouth in hospitality and tourism management. Tourism Management, 29(3), 458-468.
MacReady, N. (2007). Developing countries court medical tourists. The Lancet, 369(9576), 1849-1850.
Mangold, W. G., Miller, F., & Brockway, G. R. (1999). Word-of-mouth communication in the service marketplace. The Journal of Service Marketing, 13(1), 73-89.
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. Salt Lake City, UT: University of Utah, 211-218.
Mayo, E. J., & Jarvis, L. P. (1981). The psychology of leisure travel, effective marketing and selling of travel services. Cabdirect. org.
McAlexander, J. H., Kaldenberg, D. O., & Koenig, H. F. K. (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.
Middleton, V. T. C. (1988a). Marketing in travel and tourism. Oxford: Heinemann.
Middleton, V. T. C. (1998b). Sustainable tourism: A marketing perspective. Oxford: Butterworth-Heinemann.
Nisbett, R., & Ross, L. (1980). Human Inference: Strategies and Shortcomings of Social Judgment. Prentice-Hall, Englewood Cliffs, NJ. In W. G. Mangold, F. Miller, & G. R. Brockway. (1999). Word-of-mouth communication in the service marketplace. Journal of Service Marketing, 13(1), 73-89.
Nunnally, J. C. (1967). Psychometric Theory. New York:Mc-Graw-Hill Book Company. In Gibert A. Churchill, Jr. (1979). A paradigm for developing better measures of marketing constructs. Journal of Marketing Research, XVI(February), 64-73.
Office of Travel & Tourism Industries. (2012). Top 10 international markets: 2012 visitation and spending. Retrieved 2012, from http://travel.trade.gov/outreachpages/inbound.general_infor mation.inbound_overview.html.
Parasuraman, A., Zeithaml, V. A., & Berry, L. L. (1985). A conceptual model of service quality and its implications for future research. Journal of Marketing, 49(4), 41-50.
Parasuraman, A., Zeithaml, V. A., & Berry, L. L. (1988). SERVQUAL: A multiple item scale for measuring consumer perceptions of service quality. Journal of Retailing, 64(1), 12-37.
Parasuraman, A., Zeithaml, V. A., & Berry, L. L. (1994). Alternative scales for measuring service quality: A comparative assessment based on psychometric and diagnostic criteria. Journal of Retailing, 70(3), 201-230.
Potluri, R. M., Yigezu, Y., Ansari, R., & Khan, S. R. (2015). Interactive quality in ethiopian telecom’s service encounters:A dyadic perspective. Journal of Industrial Distribution & Business, 6(1), 27-35.
Price, L. L., Feick, L. F., & Higie, R. A. (1989). Preference heterogeneity and coorientation as determinants of perceived information influence. Journal of Business Research, 19(3), 227-242.
Ritchie, J. R. B., & Zins, M. (1978). Culture as determinant of the attractiveness of a tourism region. Annals of Tourism Research, 5(2), 252-267.
Ryu, G., & Han, J. K. (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.
Saunders, D. R. (1956). Moderator variables in prediction. Educational and Psychological Measurement, 16(2), 209-222.
Singapore Tourism Board. (2014). Annual report on tourism statistics 2012. Retrieved January 21, 2014, from https://www.stbtrc.com.sg/images/links/X1AnnualReportTourismStatistics_2012.pdf.
Singh, D. P. (2014). Online shopping motivations, information search, and shopping intentions in an emerging economy. The East Asian Journal of Business Management, 4(3), 5-12.
Smith, P. C., & Forgione, D. A. (2007). Global outsourcing of healthcare: A medical tourism decision model. Journal of Information Technology Case and Application Research, 9(3), 19-30.
Statistics Indonesia. (2011). Number of foreign visitor arrivals to Indonesia by country of residence, 2002-2011. Retrieved 2011, from http://www.bps.go.id/eng/tab_sub/view.php?tabel=1&daftar=1&id_subyek=16¬ab=16.
Statistics New Zealand. (2014). International visitor arrivals to New Zealand: December 2013. Retrieved February 03, 2014, from http://www.stats.govt.nz/browse_for_stats/population/Migration/international-visitor-arrivals-dec-13.aspx.
Suh, Y. K., & Gartner, W. C. (2004). Preferences and trip expenditures-a conjoint analysis of visitors to Soul, Korea. Tourism Management, 25(1), 127-137.
Sweeney, J. C., Soutar, G. N., & Marzzarol, T. (2012). Word-of-mouth: Measuring the power of individual messages. European Journal of Marketing, 46(1/2), 237-257.
Travel China Guide (2014), China outbound tourism in 2014. Retrieved 2014, from http://www.travelchinaguide.com/tourism/2014statistics/outb ound.htm.
Turner, L. (2007). First world health care at third world price:globalization, bioethics and medical tourism. Biosocienties, 2(3), 303-325.
United Nations World Tourism Organization. (2006). The Chinese Outbound Tourism Market. Retrieved September 22, 2009, from http://www.unwto.org/newsroom/Releases/2006/november/c hineseoutbound.htm.
Vengesayi, S. (2008). Destination attractiveness: Are there relationships with destination attributes. The Business Review, 10(2), 289-294.
Vengesayi, S. (2010). Tourism destination attractiveness: The mediating effect of destination support services. The Business Review, 16(2), 179-185.
Wang, Y., Kandampully, J. A., Lo, H.-P., & Shi, G. (2006). The roles of brand equity and corporate reputation in CRM:A Chinese study. Corporate Reputation Review, 9(3), 179-197.
Wang, Z., Walther, J. B., Pingree, S., & Hawkins, R. P. (2008). Health information, credibility, homophily, and influence via the internet: Web sites versus discussion groups. Health Communication, 23(4), 358-368.
Whyte, W. H., Jr. (1954). The Web of Word of Mouth. Fortune, 50 (November), 140-143. In Brown, J. J., & Reingen, P. H. (1987). Social ties and word-of-mouth referral behavior. Journal of Consumer Research, 14(3), 350-362.
Wilson, E. J., & Sherrell, D. L. (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.
Ye, B. H., Qiu, H. Z., & Yuen, P. P. (2011). Motivations and experiences of mainland Chinese medical tourists in Hong Kong. Tourism Management, 32(5), 1125-1127.
Ye, B. H., Yuen, P. P., Qiu, H. Z., & Zhang, V. 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, Bangkok, Thailand.
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.
Yip, W. C., Wang, H., & Liu, Y. (1998). Determinants of patient choice of medical provider: A case study in rural China. Health Policy and Planning, 13(3), 311-322.
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.
Zedeck, S. (1971). Problems with the use of “moderator”variables. Psychological Bulletin, 76(4), 295-310.
Zeithaml, V. A., Berry, L. L., & Parasuraman, A. (1996). The behavioral consequences of service quality. Journal of Marketing, 60(2), 31-46.
Zhang, J., Seo, S., & Lee, H. (2013). The impact of psychological distance on Chinese customers when selecting an international health service country. Tourism Management, 35, 32-40.
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