An emerging trend in medical tourism is the flow of patients from developed countries seeking treatment in developing nations. Medical tourism seemingly acts as a valve for capacity limitations and cost escalation at home. In contrast to the prevailing view that developing countries mainly offer a price advantage, we argue that the underlying success factor for the sustainable competitiveness of a healthcare destination is neither price nor medical quality, but patient-centred, highly personalised service quality. This conclusion is based on a comprehensive narrative analysis of the lived experiences of patients from developed countries who receive invasive medical procedures at one of the largest private hospitals in Thailand, which has been described as emblematic for the trend of internationalisation of healthcare and a model that many other hospitals in Asia follow. We find that, while a low price might initiate interest in medical treatment abroad, return visits are built on profound patient satisfaction, and even bonding, to doctors and nurses. Successful health destinations need to provide foreign patients unexpectedly pleasant experiences through organisational innovations and service quality based on superior patient-doctor-nurse relationship.

Purpose -The purpose of this paper is to propose a general model that examines the contextual factors underlying the decision-making process of international hospital outshopping. Design/methodology/approach -Patients who chose medical treatment abroad were selected to analyze the drivers of internationalization in medical services. A total number of 27 international patients who traveled from developed countries to receive medical treatment at the largest hospital in Thailand were interviewed and their responses assessed through narrative analysis. Findings -The narrative analysis reveals that while high costs and the deteriorating conditions of health care in developed countries are initially driving consumers to leave their local service area and choose foreign service providers, pull factors such as innovation, organizational efficiency, emotional service quality and patient-doctor relationships in service encounters are nurturing a real preference for choosing foreign health care providers. Research limitations/implications -This exploratory study is limited to the largest hospital in South East Asia. Future research could expand upon its findings and comparisons be made with other different foreign health care providers. Practical implications -In order to attract foreign customers a personal service, such as medical treatment, must be based on and sustained by continuous innovation in service quality. Originality/value -The paper is the first empirical in-depth study that examines the factors underlying the decision-making process of international hospital outshopping.