Purpose The objective of this research is to explore the multifaceted drivers of dissatisfaction in medical tourism and to identify patterns in post-experience complaint behaviors. The study adopts a process-oriented perspective to conceptualize how negative experiences may evolve into broader reputational risks. Accordingly, it proposes conceptual models that map the potential patterns of progression from negative encounters to brand image erosion and destination disloyalty. Design/methodology/approach A total of 365 negative reviews containing 1,240 complaints and 353 reactive behaviors were collected from six international online platforms. Using qualitative thematic analysis, complaints were categorized into 5 main themes and 22 sub-themes. Post-experience behaviors were analyzed to understand how medical tourists respond to service failures and how these reactions threaten the reputations of destinations and providers. Two conceptual models – the Negative Medical Tourism Experience Model (NMTE) and the Medical Tourism Experience Negativity Chain Model (MTENC) – were developed. Findings The most common complaints were poor medical service quality, financial problems, administrative failures, inadequate aftercare and insufficient health and safety procedures. Reactive behaviors included not recommending services, accusing providers of dishonesty, negative eWOM, legal action, service refusal, insulting language, praising alternative providers, and leaving low ratings. The highest density of coded negative themes was observed in Türkiye, Thailand, and Mexico, with esthetic procedures, dental care, emergency services, and hair transplantation emerging as the most frequently criticized service areas. Practical implications Findings highlight the need for healthcare providers to enhance service quality, strengthen post-treatment care, and proactively manage complaint behaviors to protect the destination brand image. Originality/value This study contributes to the literature by offering a process-oriented perspective that organizes the patterns of negativity in medical tourism. Its contribution lies in the development of the NMTE and MTENC models, which conceptually illustrate how individual service failures may be associated with broader reputational risks. By integrating corporate reputation frameworks with medical tourist complaint behavior, the study proposes a novel “complaint chain” framework that provides a structured understanding of the relationship between micro-level service encounters and macro-level destination disloyalty.
Alan et al. (Sun,) studied this question.