Bridging Tourism and Healthcare: The Impact of Service Quality, Waiting Time, and Patient Expectations On Traveller Satisfaction in Bali

Jean Andrina Liem; Vicia Gloria; Meiriyanti Dhita Nur Afifa; Clara Sembiring

doi:10.58421/misro.v5i1.918

DOI:

https://doi.org/10.58421/misro.v5i1.918

Authors

Jean Andrina Liem Universitas Pelita Harapan https://orcid.org/0000-0003-3876-6688
Vicia Gloria Universitas Pelita Harapan
Meiriyanti Dhita Nur Afifa Universitas Pelita Harapan
Clara Sembiring Universitas Pelita Harapan

Keywords:

Service Quality, Waiting Time, Patient Satisfaction, Traveller Patients, Dissatisfaction Group, Medical Tourism

Abstract

This study examines the influence of service quality, facilities, waiting time, and patient expectations on healthcare traveller satisfaction in Bali, a leading global tourism destination where casual medical needs frequently arise. As international travel increases, so does the demand for accessible, efficient, and high-quality healthcare services for tourists experiencing common illnesses or requiring administrative medical support. Using a modified 19-item SERVQUAL-based questionnaire, data were collected from 138 international travellers who received care at a private clinic in Pecatu, Bali. Reliability and validity testing demonstrated strong psychometric properties (Cronbach’s Alpha = 0.899; all items above r-table 0.361). Moderated Regression Analysis (MRA) was applied to evaluate both direct and interaction effects. Results show that the model explains 59% of the variance in satisfaction (R² = 0.590). Service quality exhibited the strongest positive direct effect on satisfaction (p < 0.001), while facilities showed an unexpected negative direct effect, and waiting time had no significant direct impact. Patient expectations demonstrated a significant negative effect and played a crucial moderating role. High expectations weakened the positive effect of service quality while strengthening the influence of facilities and waiting time on satisfaction. These findings underscore that traveller satisfaction is shaped not only by operational performance but also by the psychological standards tourists bring to their healthcare encounters. The study contributes to expectancy-disconfirmation theory in medical tourism and emphasizes the need for transparent communication, standardized service delivery, modern facility enhancements, and strategic expectation management. Strengthening these areas will support Bali’s competitiveness as a trusted and efficient healthcare destination for international travellers.

Downloads

Download data is not yet available.

References

W. Piyaphanee Et Al., “Healthcare Seeking During Travel: An Analysis By The Geosentinel Surveillance Network Of Travel Medicine Providers,” J Travel Med, Vol. 30, No. 3, May 2023, Doi: 10.1093/Jtm/Taad002.

H. Zhang, W.-M. Ma, J.-J. Zhu, L. Wang, Z.-J. Guo, And X.-T. Chen, “How To Adjust The Expected Waiting Time To Improve Patient’s Satisfaction?,” Bmc Health Serv Res, Vol. 23, No. 1, P. 455, May 2023, Doi: 10.1186/S12913-023-09385-9.

M. Zakaria Et Al., “Determinants Of Bangladeshi Patients’ Decision-Making Process And Satisfaction Toward Medical Tourism In India,” Front Public Health, Vol. 11, May 2023, Doi: 10.3389/Fpubh.2023.1137929.

K. Vilkman, S. H. Pakkanen, T. Lääveri, H. Siikamäki, And A. Kantele, “Travelers’ Health Problems And Behavior: Prospective Study With Post-Travel Follow-Up,” Bmc Infect Dis, Vol. 16, No. 1, P. 328, Dec. 2016, Doi: 10.1186/S12879-016-1682-0.

M. Soliman, S. Gulvady, A. M. Elbaz, M. Mosbah, And M. S. Wahba, “Robot-Delivered Tourism And Hospitality Services: How To Evaluate The Impact Of Health And Safety Considerations On Visitors’ Satisfaction And Loyalty?,” Tourism And Hospitality Research, Vol. 24, No. 3, Pp. 393–409, Jul. 2024, Doi: 10.1177/14673584231153367.

M. Nilashi Et Al., “Revealing Travellers’ Satisfaction During Covid-19 Outbreak: Moderating Role Of Service Quality,” Journal Of Retailing And Consumer Services, Vol. 64, P. 102783, Jan. 2022, Doi: 10.1016/J.Jretconser.2021.102783.

N. X. Nguyen, K. Tran, And T. A. Nguyen, “Impact Of Service Quality On In-Patients’ Satisfaction, Perceived Value, And Customer Loyalty: A Mixed-Methods Study From A Developing Country,” Patient Prefer Adherence, Vol. Volume 15, Pp. 2523–2538, Nov. 2021, Doi: 10.2147/Ppa.S333586.

C. K. Meng, S. K. Piaralal, M. A. Islam, M. F. Bin Yusof, And R. S. Chowdhury, “International Medical Tourists’ Expectations And Behavioral Intention Towards Health Resorts In Malaysia,” Heliyon, Vol. 9, No. 9, P. E19721, Sep. 2023, Doi: 10.1016/J.Heliyon.2023.E19721.

Md. S. Mahmud, R. P. Lima, Md. M. Rahman, And S. Rahman, “Does Healthcare Service Quality Affect Outbound Medical Tourists’ Satisfaction And Loyalty? Experience From A Developing Country,” Int J Pharm Healthc Mark, Vol. 15, No. 3, Pp. 429–450, Aug. 2021, Doi: 10.1108/Ijphm-04-2020-0028.

P. Angelina Lontaan, F. G.Langi, And J. S. Kekenusa, “Analysis Of Factors Related To Waiting Time For Services In The Outpatient Department Of Manado Regional Hospital,” International Journal Of Health And Pharmaceutical (Ijhp), Vol. 5, No. 3, Pp. 406–411, Aug. 2025, Doi: 10.51601/Ijhp.V5i3.428.

N. M. D. Kurniasari, D. Nym. Widyanthini, I. K. H. Mulyawan, And I. Md. A. Wirawan, “Travel Health Knowledge And Perception Of Foreign Backpackers Traveling In Bali,” Jurnal Ilmu Kesehatan Masyarakat, Vol. 12, No. 2, Pp. 128–142, Jun. 2021, Doi: 10.26553/Jikm.2021.12.2.128-142.

J. Han, Y. Zuo, R. Law, S. Chen, And M. Zhang, “Service Quality In Tourism Public Health: Trust, Satisfaction, And Loyalty,” Front Psychol, Vol. 12, Aug. 2021, Doi: 10.3389/Fpsyg.2021.731279.

T. N. Fook, L. M. Peng, And Y. W. Mun, “Hospital Brand Image And Trust Leading Towards Patient Satisfaction: Medical Tourists’ Behavioural Intention In Malaysia,” Healthc Low Resour Settings, Feb. 2024, Doi: 10.4081/Hls.2024.12276.

D. C. Ferreira, I. Vieira, M. I. Pedro, P. Caldas, And M. Varela, “Patient Satisfaction With Healthcare Services And The Techniques Used For Its Assessment: A Systematic Literature Review And A Bibliometric Analysis,” Healthcare, Vol. 11, No. 5, P. 639, Feb. 2023, Doi: 10.3390/Healthcare11050639.

M. A. Darzi, S. B. Islam, S. O. Khursheed, And S. A. Bhat, “Service Quality In The Healthcare Sector: A Systematic Review And Meta-Analysis,” Lbs Journal Of Management & Research, Vol. 21, No. 1, Pp. 13–29, Sep. 2023, Doi: 10.1108/Lbsjmr-06-2022-0025.

A. Askari Et Al., “Explanation Of Challenges To Health Tourism Development From The Perspective Of Managers: A Qualitative Study,” J Educ Health Promot, Vol. 14, No. 1, Jul. 2025, Doi: 10.4103/Jehp.Jehp_26_24.

K. M. Angelo, P. E. Kozarsky, E. T. Ryan, L. H. Chen, And M. J. Sotir, “What Proportion Of International Travellers Acquire A Travel-Related Illness? A Review Of The Literature,” J Travel Med, Vol. 24, No. 5, Sep. 2017, Doi: 10.1093/Jtm/Tax046.

M. K. Rahman, “Medical Tourism: Tourists’ Perceived Services And Satisfaction Lessons From Malaysian Hospitals,” Tourism Review, Vol. 74, No. 3, Pp. 739–758, Jun. 2019, Doi: 10.1108/Tr-01-2018-0006.

A. Alsharif, S. M. Isa, And M. N. Alqudah, “Smart Tourism, Hospitality, And Destination: A Systematic Review And Future Directions,” 2024, Center For International Scientific Research Of Vso And Vspp. Doi: 10.29036/Jots.V15i29.746.

J. Liu, C. M. Hall, C. Zhu, And V. Ting Pong Cheng, “Redefining The Concept Of Smart Tourism In Tourism And Hospitality,” Anatolia, Vol. 35, No. 3, Pp. 566–578, 2024, Doi: 10.1080/13032917.2023.2282712.

Y. Kusumawardhani, “Strategy For Increasing Millennial Tourist Visits In The Mulyaharja Thematic Village,” Jurnal Hospitality Dan Pariwisata, Vol. 9, No. 1, Feb. 2023, Doi: 10.30813/Jhp.V9i1.4208.

P. Zhang, J. Wang, And R. Li, “Tourism-Type Ontology Framework For Tourism-Type Classification, Naming, And Knowledge Organization,” Heliyon, Vol. 9, No. 4, Apr. 2023, Doi: 10.1016/J.Heliyon.2023.E15192.

U. Gretzel, M. Sigala, Z. Xiang, And C. Koo, “Smart Tourism: Foundations And Developments,” Electronic Markets, Vol. 25, No. 3, Pp. 179–188, Sep. 2015, Doi: 10.1007/S12525-015-0196-8.

A. Nur, Y. Wilopo, And M. Kholid Mawardi, “Pengelolaan Kawasan Wisata Sebagai Upaya Peningkatan Ekonomi Masyarakat Berbasis Cbt (Community Based Tourism) (Studi Pada Kawasan Wisata Pantai Clungup Kabupaten Malang),” 2016.

S. Budilaksono, E. P. Dewi, F. Nurzaman, A. Rosadi, And F. Febrianty, “Empowering Msmes In Supporting The Tourism Industry By Facilitating Msmes Features In Smart Tourism Applications,” Darmabakti Cendekia: Journal Of Community Service And Engagements, Vol. 4, No. 1, Pp. 1–7, May 2022, Doi: 10.20473/Dc.V4.I1.2022.1-7.