Medical tourism
Based on Wikipedia: Medical tourism
Every year, nearly seven thousand Polish women board planes and trains heading west. Their destination isn't Paris for shopping or Barcelona for beaches. It's British hospitals, where they can legally access abortion services that their own country denies them. They're part of a global phenomenon that has quietly reshaped healthcare: millions of people crossing borders not for vacation, but for medicine.
Welcome to the strange, sprawling world of medical tourism.
The Great Reversal
For most of history, medical tourism flowed in one direction. Wealthy patients from developing nations traveled to prestigious hospitals in London, New York, or Zurich, seeking treatments unavailable at home. The assumption was simple: richer countries meant better medicine.
That assumption has been turned on its head.
Today, Americans fly to Thailand for heart surgery. Britons head to Hungary for dental work. Canadians cross into Mexico for orthopedic procedures. The flow of patients has reversed, and money is the main reason why.
Consider a liver transplant. In the United States, you might pay three hundred thousand dollars. Fly to Taiwan, and the same procedure costs around ninety-one thousand. That's not a small discount—it's seventy percent off. For uninsured or underinsured Americans, that price difference isn't just attractive. It's the difference between getting treatment and going without.
The numbers are staggering. In 2007, roughly seven hundred fifty thousand Americans sought healthcare abroad. By the following year, projections suggested that figure would double. A Deloitte Consulting forecast predicted American medical tourism could grow tenfold within a decade. For US healthcare providers, that represents billions in potential lost revenue.
Why People Leave
The motivations for medical tourism vary by country, revealing the particular failures of each healthcare system.
In the United States, it's about money. American healthcare costs are famously astronomical, and insurance coverage is famously patchy. When your insurance won't cover a knee replacement, or limits which surgeon can perform it, or dictates which artificial joint you can receive, the math sometimes favors a plane ticket to Costa Rica.
In the United Kingdom, it's about time. The National Health Service provides universal coverage, but demand outstrips supply. Waiting lists stretch for months or years. British patients who can afford it sometimes choose to pay out of pocket abroad rather than wait twenty-six weeks for a hip replacement at home.
Canada faces similar bottlenecks. In 2005, nearly eight hundred thousand Canadian patients sat on medical waiting lists, averaging over nine weeks of delay. The Canadian government has even established official waiting time benchmarks—a tacit acknowledgment that delays are inevitable. Twenty-six weeks for a hip replacement. Sixteen weeks for cataract surgery. For patients in pain, those weeks feel very long indeed.
Then there are the regulatory gaps. Different countries approve different drugs and treatments. The Food and Drug Administration in America and the European Medicines Agency in Europe don't always agree on what's safe and effective. A cancer treatment approved in Germany might not be available in the United States. A fertility procedure legal in Spain might be banned in Italy. Patients seeking options their home country won't provide have strong incentive to look elsewhere.
The Destinations
Medical tourism has created unlikely healthcare hubs around the world.
India has positioned itself as a major player. Industry reports project India's healthcare sector could reach two hundred eighty billion dollars, driven partly by international patients seeking cost-effective care, faster service, and specialized treatments unavailable at home. Indian hospitals now market themselves globally, touting advanced technology and skilled surgeons trained at Western institutions.
Thailand has become famous for both general medical procedures and cosmetic surgery. Bangkok hospitals cater to international patients with English-speaking staff, luxury accommodations, and prices that undercut Western alternatives by huge margins.
Turkey has carved out a particular niche in hair transplants—hence the Substack article that prompted this essay. Istanbul clinics perform thousands of these procedures annually, drawing patients from across Europe and the Middle East with prices a fraction of what clinics charge in London or Berlin.
The full roster of popular destinations reads like an unusual travel guide: Canada, Cuba, Costa Rica, Israel, Jordan, Malaysia, Mexico, Singapore, South Korea, Taiwan, Thailand, Turkey, and the United States itself—which still attracts international patients seeking cutting-edge treatments unavailable elsewhere.
For cosmetic surgery specifically, the list shifts: Brazil, Colombia, the Czech Republic, the Dominican Republic, Egypt, Greece, Iran, Italy, Lebanon, Poland, South Korea. Each country has developed particular specialties and price points, creating a global marketplace for everything from nose jobs to tummy tucks.
The Oldest Form of Healthcare
Medical tourism might seem like a modern phenomenon, but people have been traveling for treatment for thousands of years.
The first documented medical tourists were ancient Greeks who journeyed to a small territory in the Saronic Gulf called Epidauria. This was the sanctuary of Asklepios, the god of healing. Pilgrims slept in the temple, hoping Asklepios would visit them in dreams and reveal cures for their ailments. It was part religious devotion, part desperate hope—not so different from modern patients traveling to experimental clinics.
European spa towns represent another early form of medical tourism. In the eighteenth century, patients flocked to places like Bath in England or Baden-Baden in Germany, believing the mineral waters could cure everything from gout to liver disease to bronchitis. Whether the waters actually worked is debatable. What's clear is that the combination of treatment and travel, medicine and leisure, is nothing new.
Sanitaria—facilities for treating tuberculosis patients with fresh air and rest—drew patients to mountain retreats in Switzerland and the American Southwest. Before antibiotics, these were among the few treatments available for consumption, as tuberculosis was then called. The sanatorium at Davos, Switzerland, later made famous by Thomas Mann's novel "The Magic Mountain," attracted wealthy tubercular patients from across Europe.
Circumvention Tourism
Some medical tourists aren't seeking cheaper prices or shorter wait times. They're seeking procedures their home countries have outlawed.
This is circumvention tourism—travel specifically to access medical services that are legal at the destination but illegal at home.
Abortion is the most common example. Before Ireland legalized abortion in 2018, thousands of Irish women traveled to England each year for the procedure. Polish women still make this journey, crossing borders their government would prefer they not cross. In the 1980s and 1990s, Ireland even tried to prevent young rape victims from traveling abroad for abortions—bans that were ultimately struck down by Ireland's Supreme Court, leading to "right to travel" constitutional amendments in Ireland and other countries.
Assisted suicide draws patients to Switzerland, one of the few places where foreigners can legally end their lives with medical assistance. Organizations like Dignitas have helped thousands of terminally ill patients from countries where such assistance is prohibited.
Fertility treatments occupy grayer territory. Some countries restrict in vitro fertilization, limit who can access surrogacy, or ban freezing embryos. Patients seeking these services travel to jurisdictions with more permissive laws. For prospective parents unable to conceive through conventional means, a flight to a country with different regulations can mean the difference between having children and not.
One particularly unusual example is Women on Waves, an organization that uses a ship as a mobile abortion clinic. The vessel sails to countries with restrictive abortion laws, picks up patients, and travels to international waters. Once in international waters, the ship flies the flag of a country where abortion is legal, and that country's laws apply. It's a floating legal loophole.
Dental Tourism: A Case Study
Dental tourism illuminates how the economics of medical travel actually work.
Consider porcelain veneers—the thin shells that cover the front of teeth to improve their appearance. The veneer itself might be manufactured in the same Swedish lab regardless of where you get the procedure done. Yet in Australia, that veneer might cost twenty-five hundred Australian dollars. In India, the same Swedish-made veneer costs roughly twelve hundred Australian dollars.
Why the difference? It's not the material—that's identical. It's not shipping—a veneer weighs almost nothing. The difference lies in overhead, labor costs, real estate, malpractice insurance, and profit margins. An Indian dental clinic operates in a lower-cost environment across nearly every dimension.
Dental tourism has exploded because dental care is often poorly covered by insurance, procedures are usually elective enough to plan around, and the quality difference between a skilled dentist in Mumbai and one in Melbourne may be negligible. For expensive procedures like implants, crowns, or full-mouth reconstructions, the savings can easily exceed the cost of international travel and accommodations.
The Quality Question
The obvious concern with medical tourism is quality. Are you trading your health for a lower price tag?
The answer is complicated.
International healthcare accreditation has emerged to address these concerns. The oldest such body is Accreditation Canada, which began certifying foreign hospitals in 1968 when it accredited the Bermuda Hospital Board. It has since expanded to hospitals in over ten countries.
Joint Commission International, or JCI, is the global arm of the organization that accredits American hospitals. Founded in 1994, JCI applies American-style standards to international facilities. Many foreign hospitals now seek JCI accreditation specifically to attract American patients—a seal of approval that signals compliance with familiar standards.
British accreditation schemes like QHA Trent offer alternatives. Organizations like GCR.org monitor quality metrics across nearly five hundred thousand medical clinics worldwide. Some hospitals pursue dual accreditation, obtaining both JCI certification to appeal to Americans and Accreditation Canada or QHA Trent to appeal to other markets.
These accreditation systems vary in rigor, cost, and focus. They represent genuine attempts to establish international quality standards, but they're imperfect. Accreditation doesn't guarantee outcomes. It signals that a hospital meets certain procedural and safety requirements—necessary but not sufficient for excellent care.
The Risks Are Real
Medical tourism carries genuine dangers that don't exist—or exist to a lesser degree—with local care.
Infectious disease exposure is one concern. Traveling to Thailand or South Africa means exposure to diseases uncommon in North America or Europe. Gastrointestinal illnesses like hepatitis A, amoebic dysentery, or paratyphoid can devastate a patient recovering from surgery. Mosquito-borne diseases, tuberculosis, and influenza strains pose additional risks. A compromised immune system from recent surgery makes these exposures more dangerous.
Interestingly, this cuts both ways. Doctors in tropical developing countries see a wider range of infectious diseases and may be quicker to consider diagnoses that Western physicians dismiss as "rare." There are documented cases of patients in wealthy countries being misdiagnosed for years because their doctors couldn't conceive that they might have tuberculosis or typhoid—diseases perceived as Third World problems.
Post-operative care quality varies enormously. What happens after surgery matters as much as the surgery itself, and standards differ by hospital and country. Patients may not receive the same follow-up care they'd get at home.
Long-distance travel soon after surgery increases complication risks. Long flights require prolonged immobility, especially in cramped window seats. This can cause deep vein thrombosis—blood clots in the legs—which can travel to the lungs as potentially fatal pulmonary embolisms. Even vacation activities can cause problems: fresh surgical scars can darken permanently if sunburned during healing.
Complaint resolution presents another challenge. If something goes wrong, what recourse do you have? Many medical tourism destinations have limited malpractice liability. Courts may award damages that hospitals or doctors can't pay, lacking adequate insurance coverage. The legal systems that American patients take for granted—however imperfect—often don't exist abroad.
When Doctors Say No
Some medical tourists aren't seeking cheaper versions of standard procedures. They're seeking procedures their doctors refuse to perform.
This happens when physicians believe the risks outweigh the benefits. A patient might want a surgery that their doctors consider too dangerous, too experimental, or simply inadvisable. When turned down at home, some patients travel to find more willing surgeons abroad.
This creates insurance complications. If a patient obtains a procedure against medical advice and complications arise, they may find their insurance—whether public or private—refuses to cover follow-up care. The feared complications that led doctors to refuse the procedure in the first place become the patient's sole financial responsibility.
It also raises questions about the ethics of surgeons willing to perform procedures that others won't. Are they more patient-centered, respecting individual autonomy? Or are they simply less scrupulous about risk?
The Dark Side
Medical tourism has an underbelly.
Organ trafficking is the starkest example. The illegal purchase of organs and tissues for transplantation has been methodically documented in China, Pakistan, Colombia, the Philippines, and elsewhere. Desperate patients seeking kidneys or livers may travel to countries where organs are available for purchase—organs that may come from executed prisoners, impoverished sellers, or victims of outright theft.
The Declaration of Istanbul, an international consensus statement, attempts to distinguish between "transplant tourism"—which is ethically problematic—and legitimate "travel for transplantation." The distinction matters because transplant tourism exploits vulnerable people and undermines legitimate organ donation systems in both source and destination countries.
Beyond organ trafficking, medical tourism can exacerbate healthcare inequalities. In India, critics argue that focusing on wealthy foreign patients while providing minimal care to the domestic poor creates a two-tiered system: "medical tourism for the classes and health missions for the masses." Resources flow toward profitable international patients rather than underserved local populations.
Thailand has experienced similar tensions. As of 2008, Thai doctors had become so busy treating foreign patients that Thai citizens were having difficulty accessing care. When the most skilled surgeons spend their time on medical tourists, who's left to treat the local population?
The Intermediaries
A new industry has emerged to facilitate medical tourism.
Medical tourism providers serve as intermediaries, connecting prospective patients with surgeons, hospitals, and support services abroad. They handle logistics that individual patients would struggle to manage: vetting hospitals, arranging consultations, booking travel and accommodations, and coordinating post-operative care.
Some American surgeons have partnered with these providers, traveling to Mexico to treat American patients. The logic is clever: if patients are worried about foreign doctors, give them American doctors in foreign (cheaper) settings. Self-insured American employers—companies that pay their workers' healthcare costs directly rather than through insurance—see potential savings in covering these arrangements.
Companies focused on what they call "medical value travel" often provide nurse case managers who assist patients before and after their trips. They help arrange follow-up care when patients return home, bridging the gap between foreign surgeons and domestic healthcare systems.
The Broader Picture
Medical tourism is a symptom of healthcare system failures.
When Americans fly to Thailand for surgery, that's a verdict on American healthcare costs. When Britons head to Hungary for dental work, that's a verdict on NHS waiting times. When Polish women travel to England for abortions, that's a verdict on Polish reproductive rights policy.
The phenomenon forces uncomfortable questions. Why does the same procedure cost three times more in one country than another? Why do some healthcare systems make patients wait months for necessary treatment? Why do regulations differ so dramatically that patients must travel abroad for procedures legal elsewhere?
For individual patients, medical tourism offers solutions to immediate problems. But those individual solutions don't fix the systemic failures that created the problems in the first place. A patient who flies to India for an affordable surgery hasn't changed American healthcare pricing—they've just found a way around it.
The growth of medical tourism may eventually force changes. When enough patients and dollars flow overseas, domestic healthcare systems may have to respond. Lost revenue focuses minds wonderfully. But until then, the flow of medical tourists will continue—millions of people voting with their feet and their wallets, seeking treatment wherever they can find it at a price they can afford.
The ancient Greeks who journeyed to Epidauria seeking healing from Asklepios would recognize the impulse, if not the logistics. When health is at stake, people travel.