This study drew upon social exchange and place attachment theories in adopting an integrative analytical approach to examine local resident perceptions of medical tourism impact in Hainan, China, particularly using a sample of 502 residents. The adapted importance–performance analysis framework charted multidimensional positive and negative tourism impact as perceived by local residents. Result of structural equation modeling revealed that ecological preservation, community benefits, and cultural enrichment enhanced residents' positive word-of-mouth (WOM) and support intentions. Place attachment partially moderated the relationship among the perceived performance of medical tourism impact, positive WOM, and support intention. These integrative analytical techniques identified nuances within the host perspectives, thereby advancing the understanding of medical tourism's localized influences. Lastly, this study emphasizes tailoring policy to intrinsic resident motivations and heterogeneous viewpoints for sustainable medical tourism development.