Perceived risk of cosmetic surgery tourism : scale development and its application in segmenting Chinese cosmetic surgery tourists

Abstract

Cosmetic surgery tourism, whereby people travel abroad to undergo cosmetic procedures to enhance their appearance, is a rapidly expanding global phenomenon. Despite the rapid growth in the number of international patients and extensive media coverage, knowledge of many key characteristics of cosmetic surgery tourists, such as their background and decision-making, remains limited (De La Hoz-Correa, Munoz-Leiva, & Bakucz, 2018). To fill this gap, this study investigated the perceived risk of cosmetic surgery tourism (PRCST). Specifically, it aimed to develop a valid and reliable scale to measure the PRCST. Applying the multi-attribute expected utility theory, the study examined the decision-making process of cosmetic surgery tourists by considering perceived risk as a key determinant of medical travel decisions. Furthermore, this study provided information on the personal and behavioral characteristics of cosmetic surgery tourists by investigating the heterogeneity of the cosmetic surgery tourism market with respect to perceived risk. China's outbound cosmetic surgery tourism market was used as the research context. This research had two objectives: (1) to develop a scale to measure the PRCST and (2) to segment the cosmetic surgery tourism market based on the PRCST, then identify the personal and behavioral characteristics of the different segments. The PRCST scale was developed through a rigorous scale development procedure applying qualitative and quantitative research (Churchill, 1979; DeVellis, 2012; Hu & Bentler, 1999; Lynn, 1986; Su & Parham, 2002). The three main stages of scale development were item generation, scale purification, and scale validation. Subsequently, this study segmented cosmetic surgery tourists based on the PRCST, and profiled the segments obtained in terms of socio-demographic context, past experiences, and cosmetic surgery travel characteristics. It used a hybrid segmentation method combining latent class (LC) modeling and the chi-square automatic interaction detection (CHAID) algorithm (Magidson & Vermunt, 2005). The results showed that the multidimensional PRCST scale consisted of 4 dimensions with 19 items: Cost Risk (5 items), Medical Risk (5 items), Vacation Risk (5 items), and Destination Risk (4 items). Cost Risk represented the time and monetary costs associated with cosmetic surgery tourism. Medical Risk represented the problems related to poor surgical outcomes or poor performance of medical service providers. Vacation Risk represented the unfavorable situations encountered by cosmetic surgery tourists after their cosmetic procedures, such as complications, insufficient vacation opportunities, and immigration issues. Destination Risk represented the hostile environment of a cosmetic surgery tourism destination. In addition, the results revealed that cosmetic surgery tourists were divided into three segments based on the PRCST. These segments were labeled "Risk Neutral," "Risk Concerned," and "Risk Sensitive," and represented 39%, 39%, and 22% of the cosmetic surgery tourism market, respectively. Tourists in these three segments had distinct personal and behavioral characteristics. Specifically, the number of visits to a destination, age, and gender were powerful predictors of the risk perception of cosmetic surgery tourists. In terms of cosmetic surgery travel characteristics, the three segments differed in terms of trip purpose, cosmetic surgery expenditure, length of stay, travel arrangement method, clinic decision horizon, accommodation type, and type of cosmetic procedure. This study offers several theoretical contributions and practical implications. It contributes to the perceived risk literature by conceptualizing the perceived risk of patient-consumers or patient-tourists in the context of multi-purpose travel decisions and by developing a reliable PRCST scale. It also significantly contributes to the medical tourism literature by broadening knowledge on the risk perception, decision-making, and personal and behavioral characteristics of cosmetic surgery tourists. In addition, it broadens the range of tourism segmentation methodologies. In terms of practical implications, this empirical study provides advice for marketing practitioners on establishing effective destination marketing strategies to attract Chinese cosmetic surgery tourists with different personal and behavioral characteristics. Moreover, this study helps service providers in the cosmetic surgery tourism industry to develop products suitable for various segments and to deliver quality services by adding value to their cosmetic surgery tourism products.