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Poor quality of services in the health-care sector of the developing countries like Bangladesh forces affluent patients to seek advanced medical treatment from abroad. The purpose of this study is to explore the outbound medical tourists’ satisfaction and loyalty on the basis of the quality of the health-care service provided by foreign medical institutions.

The medical tourists from Bangladesh who have got medical services from Indian medical institutions were taken as a sample by applying a purposive sampling technique. For the measurement of outbound medical tourists’ satisfaction, the dimensions of the HEALTHQUAL model were adopted. A self-administrated questionnaire was the major tool for collecting data from the respondents. Using partial least square-structural equation model multivariate statistical technique and with the aid of SmartPLS software, primary data collected from 218 final respondents were analyzed.

The findings of this study reveal that four dimensions of the HEALTHQUAL model, namely, empathy, tangibility, efficiency, and safety have a significant positive impact on building medical tourists’ overall satisfaction, and then the overall satisfaction also has a positive level of significance on building loyalty towards foreign medical service providers.

The findings of this study can be a helpful instrument for the developing countries to rethink and reshuffle their own existing health-care system for providing quality medical services and at the same time, the medical tourists importing countries to sharpen their existing service quality as well as to attract more medical tourists in the future.

A handful of research has been carried out, especially focused on health-care service quality measurement and the relationship of health-care service quality with satisfaction and loyalty from the perspective of developing countries outbound medical tourists. Thus, this research work will give a flavor to think of health-care service quality in a different dimension.

The objective of the study is to measure outbound medical tourists' satisfaction and loyalty based on medical tourists' experience from a developing country's perspective.

The medical tourists taken medical services from India constituted the population of this study. By applying a purposive and snowball sampling techniques, samples were selected. Based on the expectation confirmation theory (ECT) and a modified medical tourism experience model, this study empirically analyzed the research hypotheses by applying the partial least square–structural equation modeling (PLS–SEM) technique.

The empirical result revealed that the experience of service quality, medical tourism infrastructure and experience of medical tourism expenses has a direct impact on medical tourists' satisfaction. Furthermore, destination appeal and culture has a significant moderating effect on the relationship between medical tourists' satisfaction and destination loyalty. Multigroup analysis (MGA) was performed to examine group differences of the model. The MGA results revealed that, based on age, the research model remains undifferentiated between groups. In contrast, based on income, the only relationship, medical tourism infrastructure and medical tourists' satisfaction significantly differ between groups, while others remain identical from each other.

The study results will contribute both theoretically and practically. Theoretically, the study will be a helpful instrument to figure out medical tourists' behavior through the lens of ECT in a developing country’s perspective. Furthermore, practically this study results will assist policymakers and practitioners of medical tourism in formulating strategies and making future decisions effectively.

The study has uniqueness in two aspects. First, the study empirically revealed Bangladeshi medical tourists' experience and behavioral intention to Indian medical tourism destinations. Second, the study’s findings exposed quantifiable insights into the Bangladesh–India medical tourism phenomenon.