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This study aims to explore the consumer perceptions of cognition and intention to visit pilot zone of international medical tourism as emerging, developed medical tourism destinations.

Using a survey-based quantitative method, based on a survey of 439 tourists who have cross-border travel experience, the partial least squares approach was performed to test the hypotheses.

The results show that internal factors had a stronger influence on destination image compared to external factors. Among different factors, preferential policies had the greatest impact on intention to visit. Perceived quality had a stronger effect on intention to visit than preference. Geographical distance had a varied effect, with those furthest away in Northeast China showing greater intention to visit compared to closer regions.

This study explores the impact of multidimensional destination perception on medical tourists’ behavioural intention in emerging destinations by integrating the push-pull theory and theory of planned behaviour and tests how geographical distance affects intention to visit emerging destinations. Using China international medical tourism pilot area as a typical case of medical tourism emerging destinations for empirical analysis. This research offers guidance for branding and marketing strategies, contributes to a deeper understanding of medical tourists’ destination choices, enriches the theoretical explanation of emerging destination choice in medical tourism and provides valuable insights for destination recovery.