Medical Tourism for Cosmetic Procedures: Credibility Assessment of Service Providers via Online Health Forums

Introduction

Seeking beauty is a global phenomenon. Popularity of plastic surgery is on the rise among youths. In the US, people younger than age 35 account for 19.1% of cosmetic surgeries performed (American Society for Aesthetic Plastic Surgery, 2016). Thai youths are no exception. Despite expenses and risks, they long for the “Korean look” – “Light skin, an oval-shaped face and a high bridge on the nose” (Fisher, 2016). While the younger generation is increasingly accepting cosmetic procedures, risks associated with them are not well understood (Ng, Yeak, Phoon, & Lo, 2014).

Medical tourism is the movement of patients across borders in the pursuit of cost-effective medical treatment and health (Lunt & Carrera, 2010; Reddy, 2017). A growing number of immigrants in the U.S. are also seeking medical tourism services in their homeland for emotional and therapeutic reasons (Jang, 2017). Medical tourism is quickly becoming a new international business trend because of its attractiveness to tourists who need cost-effective medical services. Given comparable medical procedures only cost 20% to 30% of those in Western countries, Asian countries such as India, Thailand, Malaysia, Singapore, South Korea, and Taiwan attract the highest number of medial tourists, according to Transparency Market Research (2016). The medical tourism market in Asia is expected to reach $22 billion by 2022 (ReportLinker, 2017). Based on the data from the International Society of Aesthetic Plastic Surgery, Business Insider (2015) estimated that South Korea had the highest per capita cosmetic procedures in the world in 2014.

Apart from these cost advantages, medical tourism poses healthcare regulatory and legal concerns across borders (Terry, 2007). These concerns are rooted in both geographical and psychological distances between consumers and healthcare providers (Zhang, Seo, & Lee, 2013). To address them, consumers rely on information from healthcare providers’ websites. A private hospital’s website lacking relevant information may negatively influence a medical tourist’s decision to select that hospital (Moghavvemi et al., 2017). Another important information source is online health forums. Actual patients share their experiences, and prospective patients can discuss their concerns with others. These forums can not only address questions and concerns more fully than non-interactive websites, but also are typically the next step once needed information is not found through search engines (Roberts & Demner-Fushman, 2016).

While proliferate, online health forums are not without challenges. First, the identity of forum members is often not fully disclosed. Second, descriptions of patients’ experiences may not be comprehensive and can leave out critical information. Third, reviews of doctors and hospitals can be biased when highly satisfied or dissatisfied patients post them. Fourth, it is unclear how much social influence and other factors have an impact on the use of online discussion forums and if this affects the intention of users to adopt medical tourism services. Lastly, medical tourists often express anxiety about receiving medical tourism services from a foreign doctor in a foreign facility.

These discussion forums play an increasingly important role in assessing the credibility of doctors and hospitals. For this study, we define credibility as the prospective patient’s belief that the service provider is “honest, reliable, and competent” (Ba & Pavlou, 2002, p. 246). However, given the aftermentioned five challenges, it is still not certain whether online discussion forums, and in particular their features, can increase the credibility of hospitals and doctors for users’ decision-making.