By Elizabeth Ziemba, President, Medical Tourism Training, Inc.

The lack of credible, consistent data is one of the major shortcomings of the international medical travel sector. No one really knows how many people are traveling outside their home countries for health and wellness, dental and medical services. A Google search of the phrase “number of US citizens medical tourists 2013” produced results including (1) an estimate of 900,000 from Patients Beyond Borders (a); (2) 60,000-750,00 total medical travelers from the Centers for Disease Control (b); and (3) “growing numbers” with no data at all from a New York Times article.


The CDC article sums up the sector’s problems. “Medical tourism is a worldwide, multibillion-dollar phenomenon that is expected to grow substantially in the next 5–10 years. However, little reliable epidemiologic data on medical tourism existiv. Inability to collect accurate data results in projections, estimates, and guesses that are poor foundations upon which to build business plans, revenue projections and other information needed to answer one fundamental question: Does the revenue generated by the sector justify the substantial investments being made? Without organizations collecting and measuring the same data points, the answer to that question will remain a mystery.


The inability of the international medical tourism sector to provide reliable data continues to relegate it to the sidelines of global healthcare services. In other words, a nice niche but basically irrelevant in the scheme of things. It is time for governments, providers, and other interested parties to come together to foster the growth of international medical travel. In order to do that, a clearer understanding of the market itself is needed.

The “Medical Tourism” Market is not a Monolithic Block

A more nuanced view of the “medical tourism” sector reveals that there are various audiences or market segments for the services offered by the variety of entities and organizations seeking to capitalize on the trend of traveling for health, wellness, dental and medical services.


Five major marketing segments emerge when “medical tourism” markets are dissected: tourists; medical tourists; medical travelers; international patients; and accompanying guests. Each segment has different reasons for traveling, is a different size market that is attractive to different service providers, spends different amounts on services, and requires different services to be provided.


By carefully segmenting the market, marketing messages and services can also be refined, generating better results and more revenue.


“Tourists” comprise the largest overall numbers of the five market segments. They travel for vacation or business and often consume wellness services such as spa treatments, weight loss or exercise programs, as well as complementary and alternative medicine. These services are offered at hotels, spas, resorts, and purpose built communities and generally are delivered by non-clinically trained individuals. The average spend per person is modest but because of the low cost, individuals may opt to enjoy more than one type of service.


The catch all term “medical tourism” has lost its significance and should be used with more specificity to describe someone who travels for business or pleasure but intends to engage in low acuity dental and/or medical procedures. Typical services accessed include dental care, plastic and bariatric surgery, eye care, IVF treatments, and executive check-ups. The size of the market is the most difficult to measure because the services are offered at various types of providers such as dental and medical clinics located over a disbursed geographical area. The dollar spend is considerably more than what the average tourist pays for health and wellness services but substantially less than individuals in the next category.


“Medical travelers” are individuals who leave their country of residence to receive complex medical treatment delivered by licensed medical professionals, typically in a hospital setting. These treatments include medical care in orthopedics, cardiology, oncology, pediatrics, neurology, and stem cell. Executive check-ups are also offered in this category as hospitals seek to build relationships with individuals who may need medical services as a result of the findings of those check-ups or in the future. This market segment is the smallest of the three but generates the highest dollar spend per individual. Continuing to refer to these individuals as “medical tourists” trivializes the magnitude of the complex medical services delivered by skilled, licensed medical professionals. Referring to these patients instead as “medical travelers” accords them the respect they deserve.


“International patients” are those individuals who are non-country nationals visiting or living in a country who elect to receive or must receive health, wellness, dental, and medical services. These individuals include emergency admissions, ex-pats, retirees, students, and military and their family members. Separating international patients from medical tourists or medical travelers is an important distinction for several reasons.


First, counting emergency admissions as “medical travelers” distorts the number of people who intentionally travel for medical care, inflating the numbers that are routinely reported. No one travels to another country to have a heart attack or break a limb. Counting these individuals as “international patients” is a more accurate reflection of their status. Second, many of the individuals in the categories listed have access to health care systems through insurance programs – either national health insurance or private health insurance. They are integrated into health services rather than accessing it as an intentional choice. Third, data is distorted when providers request nationality and use that information for classification rather than also asking for residence. Many non-nationals reside in countries and should be considered “international patients”, not medical tourists or medical travelers.


“Accompanying guests” are family members or friends who travel with the primary customer (regardless of the segment) to offer companionship as well as emotional and other types of support. These individuals may engage in the decision making process prior to travel, participate in the experience with the primary customer, may assist with recovery, and certainly have their own view of the experience that is communicated to third parties throughout the process. Accompanying guests are crucial to reputation management – if they are unhappy about any aspect of the experience, they will communicate that unhappiness to a lot of people.


By utilizing common definitions within countries and across the sector as a whole, providers and governments can begin to collect meaningful data to better understand who is accessing health, dental and medical services and whether international medical travel is having a positive or negative benefit for individuals providers, organizations, and governments. A more refined understanding of the international medical travel market provides a framework for understanding how the different sectors can work together to foster overall economic growth.

Moving From One Segment to the Next

Market research shows that tourists are three times more likely to become medical tourists and that medical tourists are two to three times more likely to become medical travelers. In other words, people who are familiar with a destination are substantially more inclined to use low acuity dental and medical services than individuals who have never visited a country before. Those individuals who have used services as “medical tourists” develop the comfort and familiarity with a destination to engage in more complex medical care as “medical travelers”. Conversely, once an individual visits a destination and has a positive experience, that person can be sold more of the same types of services already delivered by that provider as well as encouraged to move up and down the acuity scale. That type of movement requires coordination, collaboration, and cooperation across sectors to maximize potential. To encourage the three C’s, good data is necessary to track your own success as well as encouraging others to partner with you.


Moving toward uniform definitions within the sector and improving data collection are essential to growth in the sector.

Creating a Uniform Lexicon

Without common agreed upon definitions stemming from a nuanced view of the international medical travel sector, it will be virtually impossible to collect reliable data upon which to measure the success – or failure – of the sector. Data will continue to be inflated. Emergency admissions by tourists and international patients as well as foreign military members stationed abroad will be counted as “medical tourists”. True medical travelers who return for post-discharge follow up visits will be counted as “another medical tourist” each time they are re-admitted as part of the same procedure.


The sector has matured to the point where a uniform process that makes sense is essential for the industry to grow and reach its potential. Such a move requires transparency and leadership. Who will take the first step in establishing clear categories within the international medical travel sector and sharing those definitions and data collection methods for others to emulate? Until there is a bold visionary willing to take that risk, the sector will be consigned to poor step-child status in the global delivery of health, wellness, dental and medical services.

Copyright © 2015 by Medical Tourism Training, Inc. Newport, Rhode Island, USA. Proprietary Information: All rights reserved. No part of thisdocument may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying and recording, or by information storage and retrieval system, without written permission from Medical Tourism Training.

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Elizabeth Ziemba

Elizabeth Ziemba

President at Medical Tourism Training
With a diverse background in public health, law and business, Elizabeth brings a unique set of skills and experience to Medical Tourism Training with services including assessment tools, online and onsite training, workshops, and consulting services for governments, providers, facilitators, associations and others involved in medical travel.