Medical tourism, a thriving industry encompassing both healthcare and tourism sectors, has experienced exponential growth over the past decades. The intensifying competition within the global market necessitates a closer examination of the pivotal role played by the perceptions of medical tourists in their decision-making process regarding health destination visits. Thus, this study aims to explore the interplay between international medical tourists' perceptions of health resort attractions and their expectations, while also investigating the mediating effect (expectations) of these perceptions on their behavioral intentions to seek medical and healthcare treatments in a Malaysian health resort. Drawing on the Expectation Confirmation Theory (ECT) and the Theory of Planned Behavior (TPB), this research employed a quantitative research method, surveying 386 international medical tourists. The distribution of the survey questionnaire utilized the online internet email method. The study employed the partial least square structural equation modeling (PLS-SEM) method to examine the hypothesized relationships. The results conclusively support the positive influence of health resort attractions on international medical tourists' expectations and behavioral intentions. Consequently, this study provides valuable implications for the future growth and development of the health resort and medical tourism industry in Malaysia.