Moreover, direct and indirect relations and interrelations between variables were measured. During the research, the variables of the previously elaborated Lithuanian Tourist Satisfaction Index model (activities in the destination, destination marketing, environmental preservation, and natural features) were analysed in a framework of their impact on tourism satisfaction and loyalty. Seeking for better ways to retain loyal customers, the aim of our research is to reveal core factors affecting Lithuanian tourist loyalty. Tourist satisfaction is an important factor to work on in achieving a tourism organization's goals however, the real company's competitive advantage unfolds in the potential of loyal customers. The intensifying competition in the tourism market forces travel agencies and tour operators to seek for new and improved ways for customer attraction and retention. The average value for push and pull factors motivation, in this study were very strong and for a purchase decision, the highest mean is a sub variable social factor while the effect of push and pull factors motivation towards purchase decision behavior at The Gleneagles hospital in Penang, Malaysia achieved 31.7%. The results show that there were positive impact of push and pull factors motivation towards a purchase decision. After data collection was completed, the Statistical Package for Social Sciences (SPSS) will be used to analyze and interpret the result.

There were only 90 completed responses that met all the required criteria.

This is a quantitative study and survey method is used to collect data. This study developed a theoretical structural model to examine the influence of push and pull factors motivation towards a purchase decision. A theoretical analysis and empirical research using the competitive advantage of the nation theory together with a hierarchy of need theory. Such entities are defined by combining factors that influence foreigners who, having both health and tourism activity. This book involves discovering what are the motivations and factors that influence customers in deciding for medical tourism service in the case of Malaysia country. In an Asian context, and of direct relevance to this chapter, Singh (2008) estimated that US$4.4 billion revenue will be generated by medical tourism in Thailand, Singapore, Malaysia, and India in 2012. Evans (2008) reported that the estimated worth of the worldwide medical tourism market was about US$ 60 billion in 2006 and projected it to climb to US$100 billion by 2012.

Medical tourism appears to be a rapidly growing tourism product and market.

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