Safety, Trust, and Behavioral Determinants in Medical Tourism Decision-Making: A Systematic Review and Integrated Framework
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Abstract
Background/ problem: Medical tourism has grown into a multibillion-dollar industry; however, research remains fragmented across isolated theoretical perspectives and is concentrated in limited geographic contexts. A key gap concerns how safety perceptions, trust, and psychological needs, rather than cost alone, shape cross-border healthcare decision-making.
Objective/ purpose: This systematic literature review synthesizes a decade of scholarship (2015–2025) to investigate the extent to which safety, trust, and psychological factors, rather than cost alone, drive cross-border healthcare decision-making. It proposes an integrated behavioral framework connecting the theory of planned behavior (TPB), protection motivation theory (PMT), self-determination theory (SDT), and trust theory across antecedents, mediating mechanisms, and outcomes to provide a more comprehensive theoretical lens for understanding medical tourism behaviors.
Design and Methodology: Following PRISMA guidelines, 34 peer-reviewed Scopus-indexed articles were systematically analyzed to examine behavioral intentions, service quality, satisfaction, and revisit intentions at international medical tourism destinations.
Results: The findings suggest that medical tourism is better understood as a safety and trust-driven coping response to healthcare system failure. Safety expectancy and waiting time appeared to be stronger decision drivers than cost considerations in the reviewed studies. Doctor interaction quality consistently emerged as the strongest service quality predictor across the reviewed studies.
Conclusion and Implications: This review indicates a potential reframing of medical tourism as a safety and trust-driven behavioral response, highlighting the relevance of the theories (TPB, PMT, SDT) and trust-based explanations. Providers should emphasize safety communication, marketers should strengthen cognitive trust signals, and policymakers should address the constraints of wait time. Future research should adopt cross-cultural and longitudinal designs to clarify these behavioral pathways across contexts.
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