Accreditation signals, service quality, and trust in domestic medical tourism: an expert-based FAHP prioritization model

Domestic medical tourism decision-making is characterized by high uncertainty and severe information asymmetry, as patients often select providers without prior knowledge of clinical quality. Evidence on how accreditation signals are prioritized relative to experiential service-quality attributes and psychological states within a single hierarchy remains limited. This study develops a theory-informed expert-prioritization model of revisit intention toward Joint Commission International (JCI)-accredited hospitals. Signaling Theory and the Stimulus–Organism–Response framework serve as conceptual lenses, not tested behavioral mechanisms. A Fuzzy Analytic Hierarchy Process (FAHP) synthesized the judgments of 15 purposively selected experts through a two-round Delphi process and structured pairwise comparisons. Experts assigned the highest priority to JCI accreditation signals (61.73% of global weight), ahead of service-quality attributes (21.41%) and psychological states (16.86%); patient safety standards ranked first (0.3029), followed by brand reputation and quality certification (0.1572 each). The leading pattern remained stable under leave-one-expert-out, subgroup, and ±10%/±20% perturbation checks (Spearman ρ = 0.964–1.000), supporting internal rank-order stability but not patient-level validity. These findings represent expert-derived strategic priorities, not direct evidence of patient behavior. Hospitals may treat JCI accreditation as a high-priority strategic signal requiring clear communication and service-delivery alignment; patient-level validation remains necessary.