In the past few years, using health care treatment abroad is a trend, resulting from growing dependence on technology worldwide, uneven access to health resources and the accelerated globalization of both health care and tourism. “Medical Tourism,” wherever patients travel for surgery operations, health treatment activities, has grown promptly in the past decade, especially for cosmetic surgery (Woodman, 2008). So far, there have been no studies discussing the antecedents and consequences of service quality in medical tourism. This study proposes for the determinants of the service quality, to a high variety of customers or visitors of the hospitals that offer medical tourism. Moreover, this study argues that perceived risk could moderate the relationship between customers’ satisfaction and service quality. A survey questionnaire was developed for a survey of suitable respondents traveling in Thailand who experienced medical care services. The relationships between customers’ satisfaction for tourism and medical service quality, behavioral intention and moderated by perceived risk in medical tourism has been examined by factor analysis, and regression analysis has been statistically conducted. The results show that of customers or tourist foreigner patients attach varying degrees of importance to danger, risk of tourism quality and health care under study, that they perceive different performance levels as well. This is true across the different channels considered. Thus, as Thailand had protesting in the down town area of the capital from March through May 2010, mean visiting danger, risk in tourism quality affect customer satisfaction in medical care of tourists. Therefore tourists receiving medical care may not recommend friends and relatives to come to Thailand during the protesting for purchase, re-purchase, and non-purchase of the service.

REFERENCES

Ajzen, I., & Fishbein, M. (1980). Understanding attitudes and predicting social behavior: Prentice-Hall.
Akama, J. S., & Kieti, D. M. (2003). Measuring tourist satisfaction with Kenya's wildlife safari: A case study of Tsavo West National Park. Tourism Management, 24(1), 73-81.
Algesheimer, R., Dholakia, U. M., & Herrmann, A. (2005). The social influence of brand community: Evidence from European car clubs. Journal of Marketing, 69(3), 19-34.
Armstrong, J., Morwitz, V., & Kumar, V. (2000). Sales forecasts for existing consumer products and services: Do purchase intentions contribute to accuracy? International Journal of Forecasting, 16(3), 383-397.
Asch, S., Kerr, E., Keesey, J., Adams, J., Setodji, C., Malik, S., et al. (2006). Who is at greatest risk for receiving poor-quality health care? The New England journal of medicine, 354(11), 1147.
Baker, D., & Crompton, J. (2000). Quality, satisfaction and behavioral intentions. Annals of Tourism Research, 27(3), 785-804.
Bates, D. W., Ebell, M., Gotlieb, E., Zapp, J., & Mullins, H. (2003). A proposal for electronic medical records in US primary care. Journal of the American Medical Informatics Association, 10(1), 1.
Bauer, R., & Hancock, R. (1960). Consumer behavior as risk taking. Chicago, IL, 384-398.
Berry, L., & Bendapudi, N. (2007). Health care: A fertile field for service research. Journal of Service Research, 10(2), 111.
Berry, L. L., Seiders, K., & Grewal, D. (2002). Understanding service convenience. The Journal of Marketing, 66(3), 1-17.
Bigne, J., Sanchez, M., & Sanchez, J. (2001). Tourism image, evaluation variables and after purchase behaviour: Inter-relationship. Tourism Management, 22(6), 607-616.
Blackwell, R., Miniard, P., & Engel, J. (2001). Consumer behavior 9th. Mason, OH, South-Western.
Blendon, R. J., Schoen, C., DesRoches, C. M., Osborn, R., Scoles, K. L., & Zapert, K. (2002). Inequities in health care: A five-country survey. Health Affairs, 21(3), 182.
Bolton, R. (1998). A dynamic model of the duration of the customer's relationship with a continuous service provider: The role of satisfaction. Marketing Science, 17(1), 45-65.
Bone, P. (1995). Word-of-mouth effects on short-term and long-term product judgments. Journal of Business Research, 32(3), 213-223.
Bookman, M. Z., & Bookman, K. R. (2007). Medical tourism in developing countries: Palgrave Macmillan.
Bowman, D., & Narayandas, D. (2001). Managing customer-initiated contacts with manufacturers: The impact on share of category requirements and word-of-mouth behavior. Journal of Marketing Research, 38(3), 281-297.
Campbell, M., & Goodstein, R. (2001). The moderating effect of perceived risk on consumers' evaluations of product incongruity: Preference for the norm. Journal of Consumer Research, 28(3), 439-449.
Chen, J., & Gursoy, D. (2001). An investigation of tourists' destination loyalty and preferences. International Journal of Contemporary Hospitality Management, 13(2), 79-85.
Chueh, T., & Kao, D. (2004). The moderating effects of consumer perception to the impacts of country-of-design on perceived quality. Journal of American Academy of Business, 4(1/2), 70-74.
Connell, J. (2006). Medical tourism: Sea, sun, sand and ... surgery. Tourism Management, 27(6), 1093-1100.
Cox, D., & Cox, A. (2001). Communicating the consequences of early detection: The role of evidence and framing. The Journal of Marketing, 65(3), 91-103.
Crandall, R., Robinson, J., & Shaver, P. (1973). Measures of social psychological attitudes: Institute for Social Research Ann Arbor, MI.
Crompton, J., & Love, L. (1995). The predictive validity of alternative approaches to evaluating quality of a festival. Journal of Travel Research, 34(1), 11.
Cronin Jr, J., Brady, M., & Hult, G. (2000). Assessing the effects of quality, value, and customer satisfaction on consumer behavioral intentions in service environments. Journal of Retailing, 76(2), 193-218.
Cronin Jr, J., & Taylor, S. (1992). Measuring service quality: A reexamination and extension. The Journal of Marketing, 56(3), 55-68.
Danaher, P. J., & Arweiler, N. (1996). Customer satisfaction in the tourist industry. Journal of Travel Research, 35(1), 89.
Dowling, G. (1999). Perceived risk. The Elgar Companion to Consumer Research and Economic Psychology, 419-424.
Dube, L., & Morgan, M. S. (1996). Trend effects and gender differences in retrospective judgments of consumption emotions. The Journal of Consumer Research, 23(2), 156-162.
Fay, C. (1994). Royalties from loyalties. Journal of Business Strategy, 15(2), 47-51.
Flavian, C., Martinez, E., & Polo, Y. (2001). Loyalty to grocery stores in the Spanish market of the 1990s. Journal of Retailing and Consumer Services, 8(2), 85-93.
Fukahori, H., Baba, Y., Hioki, F., Monkong, S., Intarasombat, P., & Malathum, P. (2010). Healthcare services for Japanese elderly long-staying in Thailand from the perspective of the patient and healthcare providers: A survey study. Archives of gerontology and geriatrics.
Fullerton, G. (2005). How commitment both enables and undermines marketing relationships. European Journal of Marketing, 39(11/12), 1372-1388.
Glazer, A., & Rothenberg, L. (1999). Increased capacity may exacerbate rationing problems: with applications to medical care. Journal of health economics, 18(5), 671-680.
Goldsmith, R., & Litvin, S. (1998). Identifying the vacation travel innovator. Journal of Vacation Marketing, 4(4), 327.
Goodrich, J. (1993). Socialist Cuba: A study of health tourism. Journal of Travel Research, 32(1), 36.
Gotlieb, J. B., Grewal, D., & Brown, S. W. (1994). Consumer satisfaction and perceived quality: Complementary or divergent constructs? Journal of Applied Psychology, 79(6), 875.
Grewal, D., Krishnan, R., Baker, J., & Borin, N. (1998). The effect of store name, brand name and price discounts on consumers' evaluations and purchase intentions. Journal of Retailing, 74(3), 331-352.
Haber, S., & Lerner, M. (1999). Correlates of tourist satisfaction. Annals of Tourism Research, 26(1), 197-201.
Han, X., Kwortnik Jr, R., & Wang, C. (2008). Service loyalty: An integrative model and examination across service contexts. Journal of Service Research, 11(1), 22.
Havitz, M. E., Dimanche, F., & Bogle, T. (1994). Segmenting the adult fitness market using involvement profiles. Journal of Park and Recreation Administration, 12(3), 38-56.
Hawkins, D., Best, R., Coney, K., & Koch, E. (1998). Consumer behavior: Building marketing strategy: McGraw-Hill/Irwin.
Herrick, D. (2007). Medical tourism: global competition in health care. Policy Report, 304.
Horowitz, M. D., Rosensweig, J. A., & Jones, C. A. (2007). Medical tourism: Globalization of the healthcare marketplace. Medscape General Medicine, 9(4), 33.
Howden, C., & Pressey, A. (2008). Customer value creation in professional service relationships: The case of credence goods. The Service Industries Journal, 28(6), 789-812.
Hui, T., Wan, D., & Ho, A. (2007). Touristsí satisfaction, recommendation and revisiting Singapore. Tourism Management, 28(4), 965-975.
Kao, Y. F., Huang, L. S., & Wu, C. H. (2008). Effects of theatrical elements on experiential quality and loyalty intentions for theme parks. Asia Pacific Journal of Tourism Research, 13(2), 163-174.
Karaarslan, I. (2009). Joint commission on international accreditation workshop: Planning, development and provision of laboratory services. Clinical Biochemistry, 42(4-5), 284-287.
Kenagy, J. W., Berwick, D. M., & Shore, M. F. (1999). Service quality in health care. JAMA: the journal of the American Medical Association, 281(7), 661.
Kozak, M., & Rimmington, M. (2000). Tourist satisfaction with Mallorca, Spain, as an off-season holiday destination. Journal of Travel Research, 38(3), 260.
Mitchell, V. W., & Greatorex, M. (1993). Risk perception and reduction in the purchase of consumer services. The Service Industries Journal, 13(4), 179-200.
Mowen, J. C., & Mowen, M. M. (1991). Time and outcome valuation: Implications for marketing decision making. The Journal of Marketing, 55(4), 54-62.
Newman, B. (2006). Medical tourism. Optometry-Journal of the American Optometric Association, 77(12), 581-581.
Noe, F., & Uysal, M. (1997). Evaluation of outdoor recreational settings a problem of measuring user satisfaction. Journal of Retailing and Consumer Services, 4(4), 223-230.
Oglethorpe, J., & Monroe, K. (1987). Risk perception and risk acceptability in consumer behavior: Conceptual issues and an agenda for future research.
Oliver, R. (1980). A cognitive model of the antecedents and consequences of satisfaction decisions. Journal of Marketing Research, 17(4), 460-469.
Oliver, R. L. (1999). Whence consumer loyalty? The Journal of Marketing, 63 IS -, 33-44.
Oppermann, M. (1998). Travel horizon: A valuable analysis tool? Tourism Management, 19(4), 321-329.
Oppermann, M. (2000). Tourism destination loyalty. Journal of Travel Research, 39(1), 78.
Otto, J. E., & Ritchie, J. (1996). The service experience in tourism. Tourism Management, 17(3), 165-174.
Parasuraman, A., Berry, L., & Zeithaml, V. (1993). More on improving service quality measurement. Journal of Retailing, 69(1), 140-147.
Parasuraman, A., Berry, L. L., & Zeithaml, V. A. (1991). Refinement and reassessment of the SERVQUAL scale. Journal of Retailing, 67(4), 420.
Parasuraman, A., Zeithaml, V., & Berry, L. (1985). A conceptual model of service quality and its implications for future research. The Journal of Marketing, 49(4), 41-50.
Pritchard, M., & Howard, D. (1997). The loyal traveler: Examining a typology of service patronage. Journal of Travel Research, 35, 2-10.
Rittichainuwat, B., Qu, H., & Mongknonvanit, C. (2002). A study of the impact of travel satisfaction on the likelihood of travelers to revisit Thailand. Journal of Travel & Tourism Marketing, 12(2), 19-43.
Schiffman, L., & Kanuk, L. (2000). Consumer behavior: Upper Saddle River, New Jersey: Prentice-Hall, Inc.
Scott, D., Tian, S., Wang, P., & Munson, W. (1995). Tourism Satisfaction and the Cumulative Nature of Tourists' Experiences'. Leisure Research Symposiun, Texas: San Antonio.
Seddon, M., Marshall, M., Campbell, S., & Roland, M. (2001). Systematic review of studies of quality of clinical care in general practice in the UK, Australia and New Zealand. Quality in health care, 10(3), 152.
Segouin, C., Hodges, B., & Brechat, P. (2005). Globalization in health care: Is international standardization of quality a step toward outsourcing? International Journal for Quality in Health Care, 17(4), 277.
Seiders, K., Voss, G. B., Grewal, D., & Godfrey, A. L. (2005). Do satisfied customers buy more? examining moderating influences in a retailing context. Journal of Marketing.
Slovic, P., Finucane, M., Peters, E., & MacGregor, D. (2004). Risk as analysis and risk as feelings: Some thoughts about affect, reason, risk, and rationality. Risk Analysis, 24(2), 311-322.
Slovic, P., Peters, E., Finucane, M., & MacGregor, D. (2005). Affect, risk, and decision making. Health Psychology, 24, S35-S40.
Smith, R. D., Chanda, R., & Tangcharoensathien, V. (2009). Trade in health-related services. The Lancet, 373(9663), 593-601.
Sweeney, J. C., Soutar, G. N., & Johnson, L. W. (1999). The role of perceived risk in the quality-value relationship: A study in a retail environment. Journal of retailing, 75(1), 77-105.
Taylor, S., & Baker, T. (1994). An assessment of the relationship between service quality and customer satisfaction in the formation of consumers' purchase intentions. Journal of Retailing, 70(2), 163-178.
Taylor, T. (1998). Better loyalty measurement leads to business solutions. Marketing News, 32(22), 41-42.
Terry, N. P. (2006). Under-regulated health care phenomena in a flat world: Medical tourism and outsourcing. W. New Eng. L. Rev., 29, 421.
Westbrook, R. (1980). A rating scale for measuring product/service satisfaction. The Journal of Marketing, 44(4), 68-72.
Woodman, J. (2008). Patients beyond borders Taiwan edition: Everybody's guide to affordable, world-class medical care abroad: Patients Beyond Borders.
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.
Yoon, Y., & Uysal, M. (2005). An examination of the effects of motivation and satisfaction on destination loyalty: A structural model. Tourism Management, 26(1), 45-56.
York, D. (2008). Medical tourism: the trend toward outsourcing medical procedures to foreign countries. Journal of Continuing Education in the Health Professions, 28(2), 99-102.
Yu, L., & Goulden, M. (2006). A comparative analysis of international tourists' satisfaction in Mongolia. Tourism Management, 27(6), 1331-1342.