Factors Affecting Motivation and

Customer Experience of Medical

Tourism: Case Study of Plastic

Surgeries in South Korea.

Ivanova Maria
 Higher Diploma in International Hotel and Tourism

Management

HTMi Switzerland

Introduction

Lately, medical tourism became very popular among travellers and

moreover, they pursue the value of money and quality (Bristow et

al. 2011). Plastic surgeries are one of the reasons for medical

tourism nowadays. Moreover, plastic surgeries have increased its

popularity recently (Park et al., 2009). South Korea is now promoted

as the best destination to travel for plastic surgeries (Tang,

undated). It is also stated that tourist choose South Korea because

it’s cheap and qualitative (Ibid). Therefore the author has chosen

South Korea as a case study in the research paper. In modern and

dynamic tourism industry it is an essence to evaluate the motivators

of people travelling. According to Gnoth (1997), in tourism

management it is very important and useful to understand the

motivations of travellers to visit a certain country for particular

reason. Moreover, Swarbrooke and Horner (2007) add that

numerous motivators always affect the tourists. Additionally, various

tourists travelling for the same reason may have different

motivators (Ibid). According to Rice (1997, p.117), “Motivation is the

mixture of wants, needs and drives within the individual which seek

gratification through the acquisition of some experience or object”.

Moreover there are different theories, which can be applied for the
motivation and customer experience. Oh and Pizam (2008)

evaluated that the motivation of tourists should be criticised by

push and pull theory. Nonetheless, Gnoth (1997) additionally

suggest drive theory and expectancy theory as a motivation

process. Moreover he applies drive theory as an emotional

motivation and expectancy theory as cognitive. Therefore, there are

various kinds of motivations, which can be specifically explaining

the reasons and behaviour of tourists.

When a traveller has decided on the destination and purpose of

going the actual consumer experience starts (Hanefors and

Mossberg, 1998). Plastic surgeries are very famous among all

genders and generations nowadays. Nonetheless, not much

research has been done on motivation of consumers to travel to

South Korea for plastic surgeries’ services. Handley (2010) has

researched on how medical tourism makes South Korea sustainable

country. In sciencedirect.com researcher has found many papers

about rural tourism in South Korea, but not much about medical

tourism. According to Yu and Ko (2012), there is a gap in research

on medical tourism in South Korea. Motivation and customer

experience was in a great study at all times. “…Many researchers

seek a continuum construct to explain tourist

motivations”(Woodside and Martin, 2008, p.21). In our modern 21 st

century it is needed to understand your customers’ motivation and

to evaluate the post-purchase experience. According to Bansal and

Eiselt(2003), there is a great section of research where the

motivation and decision making is highly discussed. Nonetheless,

there are not enough studies about motivation for medical tourism,

even though the concern about medical tourism is growing rapidly

in past few years (Yu and Ko, 2011). It is considered that the more

studies will be done on this topic the more tourists will receive

greater level satisfaction and future perception of the country, as

the country will know the wants and needs of tourists (Yu and Ko,

2011). Furthermore, Wongkit and McKercher (2013) add that there

is only a little research has been done which goes in more details for

medical tourism.

Motivation and Customer Experience – Definitions

and Concepts

Tourist’s Motivation Process

Motivation is an influencing factor on the behaviour of the consumer

(Prebensen et al., 2012). Gnoth (1997) distinguish motive and

motivation; referring to him, motive is what induces person to

commit an activity, whether motivation always include the object of

the activity. Moreover Solomon et al. (2006) evaluate motivation as

guidance of consumer. According to Yoon and Uysal (2005)

motivation is a response to wants and needs of the consumer. A lot

of subjects describe motivation from different angles. Parks and

Guay (2009) consider motivation in two ways: conscious and

unconscious. Meanwhile, Gnoth (1997) view motivation as cognitive

or emotional process. Moreover, there is a process of motivation

suggested by Graham and Weiner (undated); Parks and Guay

(2009); Gnoth (1997). They divide the process of motivation into five

elements: choice of behaviour, latency of behaviour, intensity of

behaviour, persistence of behaviour and conscious or unconscious

reactions. All these elements have a great affection on the

motivation of a person as it measures the purpose, the effort given

to achieve the goal, how well can he/she last to reach the desirable

outcome and the behaviour after the result is achieved (Ibid).

However, Hoyer et al. (2013) examine four factors influencing

motivation: personal importance, values, needs and goals of the

consumer, risk of the activity and reasonable incompatibility with

the position of the consumer. Besides these two theories, Schiffman

and Kanuk (2010) appraise movement of the motivation process.

They assert that needs can be never appeased, novel needs appear

when auld ones are satisfied and achievement or setback will affect

the set goals.

It is really important to understand the motivation of tourists and

process of their thinking to choose this particular destination and

what affected their decision (Prebensen et al., 2012).

Consumer Motivation Theories

There are different types of motivators which make tourist travel

 (Swarbrooke and Horner, 2007). Various authors and researcher
LR own capacities to bring skills to bear and influence outcomes (e.g. self-concept, self-
56,9 suggest
efficacy,several theories.
locus of control). Moreover,
For example, particular
if a person type ‘‘ifofI will
thinks as follows: tourism
study is
hard tonight, I will get abetter gradeon tomorrow’s math test’’ his/her expectancy will
behigh.
approached by numerous theories of tourist motivation. “Push and
Instrumentality. This is theperson’s perception of theprobability that performance
will lead to a specific outcome. It is related to the individual’s beliefs or expectations
pullthat
factors are central concepts in tourist motivation literature”
790 ‘‘if heor shebehaves in acertainway, heor shewill get certain things’’ (Nadler and
Lawler, 1977, p. 218). Thefollowing casecan beone exampleof high instrumentality:
(Pesonen,
‘‘if I get abe2011, p.71). Klenosky
tter gradeontomorrow’s math(2002)
test,I willand Gnoth
get an‘A (1997) claim that
inmath’’.
Instrumentality ranges from 1to +1. Thevalue 1instrumentality indicates that
in every
the second tourists’
outcome decision
(grade ‘‘A’’ inmaking process
math) is certain withoutthere is outcome
the first a pull (a
and
betterpush
grade on tomorrow’s math test). Furthermore, +1 instrumentality indicates that the
first outcome
factor. Moreover (a better grade on
Murray tomorrow’s
(1938) citedmath test) is(1997)
Gnoth a necessary and sufficient
interprets these
conditionof thesecondoutcome(grade‘‘A’’in math).
Vroom’sexpectancy theory canbedepictedas follows (seeFigures 1and 2).
two factors as “need” and “press”. Kim and Lee (2000) discovered
Public library customer motivation model
thatAsthere is always
Vroom (1964) pointed a
outlink betweenwill
that individuals push and pull
be motivated if thefactors. Push
y meet three
criteria. First, they must value the behavioral outcome valence. Second, they must
factors inthat
believe tourism industry
the desired are
behavior is inside
instrumental factors which
in achieving are
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nt outcome. In
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to proceed a they must expe
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whether pull factors performing
are the
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directed and make aexpectancy
travellertheory, it is possibletoconstruct
to choose a particular age neral model ofover
destination
how customers are motivated to use library products in public library settings (see
Figure3).
some First
other country
of all, (Gnoth,
theexpectancy 1997;
represents Klenosky,
thecustomers’ 2002; ofYoon
perception and
how hard Uysal,
it will
be to access library products and the probability of the customers’ successful
2005). Moreover,
achieveme Pesonen
nt of access (2011)Second,
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thecustomers factors
vethatintheytourism
can
find the library products that they are looking for through their access to products.
as aThird,
magnetism of thehave
the library products destination. To for
different valence the
theauthor’s
customers topoint
satisfy oftheirview
information needs.
push and pull theory is more applicable to this case, as in medical

tourism motivation there are external and internal factors, which

affects their decision.

Figure 1.
Vroom’s expectancy
theory

Figure 1: Expectancy Theory (Vroom, 1964)

Figure 2.
Vroom’s expectancy
theory

Another theory suggested by Vroom (1964) citied Lee (2007) is

expectancy theory. Weber (1997) evaluated expectation as one of

the most influencing motive to travel. Pizam and Milman (1993)

explain expectancy theory as a tourist’s perception about

destination. Moreover, Schiffman and Kanuk (2010) elaborate

expectancy theory as a previous experience of a traveller in a past.

According to Shiffman and Kanuk (2010, p.181), “In a marketing

context, people tend to perceive products attributes to their own

expectations”. Lee (2007) stated that expectancy theory also

appears to generate a positive result in a tourist’s perception.

Moreover Gnoth (1997) stated that expectancy theory is a cognitive

process as it includes thinking and rationale deliberation.

Expectancy theory consists of three main inseparable parts that will

lead to motivation: expectancy, instrumentality and valence

(Shepperd and Taylor, 1999; Lambright, 2010). Instrumentality is

one of the components of this theory (Vroom, 1964 citied Lee,

2007); it is a measure of chances that the outcome will be according

to the tourist’s perception. Valence belongs to values formatted by a

tourist about destination and how the goal of the consumer is

achieved by this particular destination (Ibid).

Expectancy theory is very important in tourism as it is also

composing from the opinions of other people travelling to the same

destination, therefore the expectations will increase and wants of

the consumer will raise as well (Schiffman and Kanuk, 2010); hence

the destination have to satisfy these needs and wants to gain trust

from the customer.

Formation of customer experience and its affect on

customer satisfaction

Satisfaction is very demanding and broad process (Bosque and

Martin, 2008). Experience of the tourist in particular destination

plays a great role in forming satisfaction (Meng et al., 2008).

Satisfaction is a fulfilment of customer needs and posterior

assessment of the experience gained during stay in destination

(Sanchez et al., 2006). According to Devesa et al. (2010) satisfaction

and motivation are main measures in tourist’s behaviour. Moreover,

Chi and Qu (2008) regard gratification and consumer participation in

the process of travelling as inseparable elements. Consumer

experience has a great influence on the tourist’s satisfaction and

creates a perception of the destination. Hoyer et al. (2013) wrote

that there could be satisfaction as well as dissatisfaction of the

destination. Consumers are pursuing of exclusive experience from

their travelling (Rageh et al., 2013). Martin-Ruiz et al. (2011) include

service experience, service value, quality, convenience and price as

major components in creation of customer experience. Experience

in the same destination may vary according to the type of tourist

(Sheng and Chen, 2013; Chang and Horng, 2010). Moreover

consumer experience is very individual process (Ibid).

Moreover they say that expectations of the tourist are an essential

part of the whole experience. Scheng and Chen (2013) break down
experience into two parts: active and passive. According to them,

active includes replenishment of knowledge and development of

intelligence, while passive is more about leisure. Satisfaction

appears during and after the experience. Tourist’s satisfaction

depends on the quality of service and provision of the goods (Kim,

2011). Experience and satisfaction of the tourists is very important

to the destination as the perceptions are being created during these

two processes and it has to take into consideration all needs and

wants of the traveller.

Review of existing empirical research in medical

tourism motivation

Segmentation by motivation in healthcare and spa tourism

According to Bieger and Laesser (2002), segmentation is very

important in tourism industry. Rid et al. (2013) explain that

motivation is one of the factors to be included in the segmentation

process. Dubai Department of Tourism & Commerce Marketing

(2012) indicates spa tourism as part of medical tourism. Erdeli

(2011) divide travellers according to the various types of spas,

therefore they can achieve higher percentage of tourists basing on

their motivation: spas for debilitated care, for cardio care, for

breathing issues, alimentary issues and for nervous disorders.

According to Mak et al. (2008), there are a huge variety of motives,

which are driving people to travel. First is recreation, therefore they

assume that the segment is business or employed people who are

seeking for escape and relaxation (Ibid).

Tawil (2011) states that the motivation of the luxurious people is

better facilities and quality service. Moreover, he adds that these

people are usually less price sensitive. Chen et al. (2013) made a

research of what is the motivation of elder travellers. He found out

that the main motive of them is seeking of health treatments.

Another factor, which was taken into consideration, was the

provision of a warm atmosphere. Pesonen et al. (2011) have created

different clusters according to types of travellers. Outdoor travellers

are seeking for joyful and recreational spa experiences, whether

vacationists are motivated by the idea to get the services of sauna.

Moreover, the main motive of heritage tourists is hygiene of spa

services (Ibid). Therefore, motivation is very important to study to

better segment country’s target and achieve higher levels of

satisfaction (Beh and Bruyere, 2007).

Motivation in medical tourism

As stated by Li et al. (2013), if the country or the companies are

aware of the motivation of the travellers or guests, they may better

interpret their consumers’ behaviour. The learning process of the

consumer is a key success to satisfy his/her needs (Ibid). According

to Chen et al. (2013) there are several motivators of medical

tourists; the main are: enjoyment, pleasure and practice of various

services. Another leading motivators suggested by Singh (2013)

include: price of medical services, confidentiality of treatments, and

certification of specialists. However, Laesser (2011) have mentioned

that the main factor affecting the motivation of medical tourists is to

care or improve something in their appearance. Another important

motivation was to feel comfortable in the medical destination

environment (Ibid).

Two of the dominant factors in medical travellers’ motivation were

prestige and notoriety of the destination (Ye et al., 2011). Also they

added that the personnel play a great role in deciding whether to go

or no. Four motivators were presented by Jotikasthira (2010): to

recover and heal the sickness, to receive the services of plastic

incision, to get therapeutic check up and to correct and enhance the

overall well-being. Musa et al. (2011) identified five main factors,

which analyse the motivation precisely: how good is the assistance,

the cost, spiritual aspect, cultural aspect and the additional services

provide. The most important factor influencing the motivation is the

quality of service: the history of the destination about medical

tourism, accessibility, the variety of serviced provided and the

reputation of the destination (Ibid). There are plenty of motivators,

which are affecting traveller decision. Moreover, Farmaki (2012)

stated that the motivation is considered to internal as well as

external; therefore it is important to know how to affect the tourist

motives for travelling.

Conclusion and Recommendations

To conclude everything from above, motivation drives people to act

(Schiffman and Kanuk, 2010). Motivation is the phenomena, which

gives us an answer on why people do something (Williams, 2002)

and makes it clearer to recognize the reasons behind (Kay, 2003).

According to Williams (2002), products, in this case services, have a

special value to the consumer, therefore it will create an experience

afterwards. Besides, destination perception plays a great role in

consumers’ motivation (Nicoletta and Servidio, 2012). The author

has researched on the motivation, customer experience and

satisfaction as well as two theories on the motivation in this paper.

Expectancy theory and push and pull theory (Gnoth, 1997, Vroom,

1964 cited in Lee, 2007) are the theories which are mostly

applicable to examine motivation of the tourists (Kay, 2003).

Nonetheless, there can be still a gap in understanding human’s

motivation to travel (Ibid). It is important to understand motivation

and experience of the customer, so South Korea may increase the

quality of the services. The author recommends to broad this topic

and does more research to those who are interested in this study.

There are several people who may benefit from this study: national

tourism board of South Korea, researchers on motivation and people

who are interested in consumer behaviour.

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