By Dr. Gunjan Patel, co-founder of Your Care Promise
Bureau of Immigration figures published through India’s Ministry of Tourism recorded 644,387 foreign tourist arrivals for medical purposes in 2024. Almost none of those patients found their hospital alone. They found it through an intermediary, and in most cases that intermediary was paid by the hospital rather than by the patient.
This is not a scandal and nobody hides it. Facilitators are typically paid somewhere between 7.5 and 30 per cent commission by the provider they refer to, a range reported consistently across independent industry sources. A January 2026 analysis by Echelon Consulting put the working range at 20 to 35 per cent of the whole treatment value, which raises the floor rather than the ceiling. The arrangement funds the free consultations, the free second opinions and the free treatment plans that fill the first page of search results for anyone looking into treatment in India.
What it also does is put a price on one particular answer.
If a patient asks whether they should have the operation, and the person answering earns twenty per cent of the hospital bill when they say yes and nothing when they say no, the advice has a commercial weight attached to it before anyone opens the scans. That does not make the advice wrong. Plenty of good clinicians work inside arrangements like this, and plenty of patients are well served by them. But the patient is receiving a recommendation from a party with a financial stake in one particular answer, and is usually not told. That is the part worth knowing.
Why this is becoming a bigger question
Demand for treatment outside the home system is not a marginal behaviour any more. The NHS England elective waiting list stood at 7.27 million cases in June 2026, representing around 6.15 million individual patients. In Canada, CIHI reported in June 2026 that 65 per cent of patients received joint replacement within the national benchmark, which is another way of saying that more than a third did not. The Office for National Statistics recorded 523,000 people leaving the United Kingdom for treatment abroad in 2024, up from 348,000 two years earlier.
Those numbers describe a great many people arriving at the same decision at roughly the same time. Most have no medical training. Many are frightened. Nearly all of them are researching it on a phone, late, after the surgery they were told to wait for has been pushed back again.
The industry that has grown to meet them is organised around conversion. That is not a criticism of any individual company. It is a description of how the money moves. When revenue depends on a patient travelling, the pages that get written are the pages that make travelling feel reasonable, and the questions that do not get answered are the ones where the honest answer is stay where you are.
The questions nobody funds
Working on the patient side of this market, the same gaps come up repeatedly. Almost nothing published in this space answers them properly, and the reason is structural rather than editorial.
Whether the operation is necessary at all. Cleveland Clinic, which sells online second opinions at 565 dollars and 745 with pathology review, reports that around 67 per cent of them change the diagnosis or the treatment plan. That is one provider describing its own service rather than an industry finding, and it should be read that way. But it is a large enough number to be worth the question. An opinion commissioned by the party who would perform the surgery is not independent in any sense that helps the patient, however good the doctor writing it.
What the journey actually costs. A surgical quote is not a total. Flights for two, accommodation across a recovery, time off work, the diagnostics repeated on arrival because the originals were not accepted, and the extra week that a proportion of patients need. A quote that describes only the expected path is describing a fraction of the outcome.
Who provides care afterwards. This is the one that causes the most damage and gets the least attention. Stitches come out where you live. Scans get repeated where you live. Physiotherapy happens where you live. Patients often discover this after they have paid a deposit. By then they are asking a favour rather than setting a condition.
Whether to travel at all. There are patients for whom the answer is no, and the reasons are usually mundane rather than dramatic. The condition is time sensitive and the arranging itself becomes the delay. The procedure is routine and the local wait is short enough that the saving evaporates. A complication would break the budget. Nobody can travel with them.
A different commercial position
There is a version of this business where the patient is the customer. The fee comes from the patient, the hospital pays nothing, and the advice carries no financial preference between travelling and staying.
The disadvantage is obvious. It asks people to pay for something the rest of the market hands out free, and it gives up the commission that funds everyone else. That is a hard sell. What it buys in exchange is the ability to answer the four questions above without flinching, including the times when the answer costs the business the case.
At Your Care Promise we publish a page listing seven situations where we would tell somebody not to travel. It exists because a company earning commission cannot write it. Every item on that list is a booking a facilitator would lose. We are paid the same either way, so writing it costs us only the cases we should not have taken, and those are the cases that go wrong.
Whether patients will pay for that is a genuine question and the honest answer is that we do not know yet. The market has trained people to expect this advice for free, and free is a difficult price to compete with until somebody works out what free was funding.
What would actually improve this market
Three changes would make more difference than any amount of marketing.
Disclosure of the commercial relationship, stated plainly at the point of advice rather than buried in terms. A patient is entitled to know who pays the person recommending surgery.
Separation of the opinion from the referral. The specialist who reviews whether an operation is needed should not be paid more when the answer is yes, and the patient should be able to verify that.
Follow-up agreed before departure rather than after. A written commitment from a doctor at home, obtained before anything is booked, removes the single largest risk in the entire process. It is also the thing patients are least likely to think of unaided, which is precisely why somebody on their side should be raising it.
None of this needs regulation. None of it is technically difficult. What it needs is for companies to accept a commercial cost in exchange for being straight with patients, and that turns out to be a much harder ask than it sounds. It is why the gap has stayed open this long.
The 644,387 people who arrived in India for treatment in 2024 were making one of the larger decisions of their lives, mostly on information written by people who were paid when they said yes. Fixing that is not a marketing problem. It is a question of who the customer is.
Dr. Gunjan Patel is co-founder of Your Care Promise, an independent healthcare navigation service for international patients considering treatment in India. The company is paid by patients and takes no commission from hospitals.
Sources: Bureau of Immigration via India’s Ministry of Tourism, arrivals for medical purposes, 2024; NHS England elective waiting list statistics, June 2026; Canadian Institute for Health Information, June 2026; Office for National Statistics, outbound medical travel, 2024; Cleveland Clinic MyConsult published pricing and outcome figures; Echelon Consulting, January 2026. Commission ranges are reported by independent industry sources and are stated as typical rather than universal. No claim is made about any named company.
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